CBT for Panic Disorder in Liverpool

Panic Attacks can become Panic Disorder when they increase in frequency, the individual spends a lot of time worrying when the next panic attack will occur and they change their behaviour to reduce the chances of having another one.

For instance, someone who has the catastrophic misinterpretation of their racing heart rate as being an indication of them having a heart attack, might engage in a safety behaviour which tries to reduce their heartrate – things like try to stay calm, get reassurance from someone, or take an anti-anxiety medication.

Now, if getting reassurance from someone genuinely stopped people from having heart attacks, then we would have no need for defibrillators and crash units! But, when having a panic attack, because the Catastrophic misinterpretation doesn’t come true when the person uses their safety behaviour they make a link between the two.

In their mind, it goes something like: “I believed that I was going to have a heart attack then.  I managed to feel better after I got reassurance from my friend and a family member.  That means that if I get reassurance next time the problem occurs, then I’ll be safe.”

Safety behaviours such as this then keep the problem going because the individual never gets to find out what would happen if they just let the sudden panic attack happen.

So how do we treat this?  Let’s have a look.

Step 1

Considering a Psychological Explanation

Therapy for Panic Liverpool: As we have seen, Panic Attacks occur when a person misinterprets normal anxiety symptoms as being something that is physically catastrophic.  At the time of the panic attack, they believe that something truly catastrophic is happening to them.  Therefore, treatment for Panic Disorder would want to enable the person to consider an alternative belief for their panic attacks.

This is what the first phase of CBT treatment for Panic Disorder is about.  I’m going to detail two commonly used techniques in CBT which begin the process of getting your panic attack sufferer to contemplate a psychological explanation for their symptoms.  The first technique is what we call the “Paired Words Task” and the second is what we call “symptom induction” or “interoceptive exposure.”

• The paired words task – In this intervention, we present you with 2 lists of words.  One list names a list of physical experiences, such as “breathlessness” and “Light-headedness.”  This list is paired with what we would think of as catastrophic associations to each item.  As the panic attack sufferer reads through the list, we get them to focus upon what is happening in their body.  We typically find that as they read each word pair, they start to notice aspects of the physical symptoms themselves, as their anxiety also kicks in.  From this, we then discuss why just reading a set of words on a page can actually lead a person to experience anxiety, catastrophic thoughts and physical sensations.  You can download a copy of paired words test for panic here.
• Symptom Induction / Interoceptive exposure – In this intervention, we aim to use different techniques to bring on some of the physical sensations that people experience when they have a panic attack.  This serves two functions.  One function is that the panic attack sufferer experiences another cause for their feared sensation, that is, they get to find out that the feared sensation just might be caused by something else other than their catastrophic fear.  The second function of interoceptive exposure is to get the sufferer to get used to and expose themselves to the anxiety symptoms.  The more often that they do this, the less likely they are to fear them when they arise on a day to day basis.Learning how to challenge unhelpful thinking
• Step 2
• The initial cognitive approach to emotional problems has a central tenet which underpins it – How we think about things generates what we feel.
  What this means in practice is that we are always in our day to day lives making sense of how to respond to the world based upon how we think about it.  We’ve already seen how catastrophic thoughts about our anxiety symptoms, leads to more and more anxiety symptoms until we end up having a sudden attacks.
  CBT teaches us how to “catch” feeling anxious and negative thoughts like this and then use different techniques to see how reliable and accurate the thoughts are.  If we arrive at the conclusion that our negative thoughts are not realistic, then we generate new ones which are more balanced, realistic and helpful for us.
  Here are some of the typical techniques we use in learning how to change our thoughts in panic disorder.
  • Thought diaries – Thought diaries are the first step in learning how to catch our unhelpful thoughts in Panic Disorder.  One of the features of our day to day thinking is that our thoughts about our experiences are very automatic.  This means that we don’t always notice that the thoughts has actually been there and told us what to think about our experience before it has disappeared.  This is why people think that someone might think that being in a supermarket gives me a panic attack.  In reality it is the person’s thoughts about being in a supermarket that gives them a panic attack.  Catching thoughts using a thought diary is a simple way to begin noticing what the thoughts are, where we have them, and how they relate to our difficult emotions.
  • Thought challenging – Once we have learned to catch our negative thoughts and began to understand how they can lead to difficult feelings for us, we can then begin testing out whether they are a realistic thought in relation to our experiences.  So, if I think my increased breathing rate means I’m going to faint, and as yet, I’ve never actually fainted, then there is a high probability that my automatic thoughts are unrealistic.  We can begin to challenge our thoughts by checking out the actual evidence for and against them.  Or, we could look at the costs and benefits of believing the thoughts – do we need to think of an alternative, more helpful belief to explain our symptoms.  Take a look at my articles of challenging negative thoughts for more information on this phase of treatment.
  • Thought labelling – Another feature of our thinking is the tendency for us to sometimes adopt unhelpful thinking styles, in the form of biases, distortions and other logical errors.  We all are prone to this at times.  Thinking errors include things like catastrophisation, mind reading and fortune telling (you can read more about unhelpful thinking styles here) all contribute to emotional distress which may not be relevant to the stressful situation we are in.  Thought labelling is the act of understanding the thoughts and relating them to the unhelpful thinking styles.  When we understand that we are using thought distortions and that they rarely give us an accurate view of the situation then we can make a decision to not respond to them.Behavioural experiments
    Step 3
  • Considering a Psychological Explanation (Physical Sensations)
    Therapy for Panic Liverpool: As we have seen, Panic Attacks occur when a person misinterprets normal anxiety symptoms as being something that is physically catastrophic.  At the time of the panic attack, they believe that something truly catastrophic is happening to them.  Therefore, treatment for Panic Disorder would want to enable the person to consider an alternative belief for their panic attacks.
    This is what the first phase of CBT treatment for Panic Disorder is about.  I’m going to detail two commonly used techniques in CBT which begin the process of getting you panic attack sufferer to contemplate a psychological explanation for their symptoms.  The first technique is what we call the “Paired Words Task” and the second is what we call “symptom induction” or “interoceptive exposure.”
    • The paired words task – In this intervention, we present you with 2 lists of words.  One list names a list of physical experiences, such as “breathlessness” and “Light-headedness.”  This list is paired with what we would think of as catastrophic associations to each item.  As the panic attack sufferer reads through the list, we get them to focus upon what is happening in their body.  We typically find that as they read each word pair, they start to notice aspects of the physical symptoms themselves, as their anxiety also kicks in.  From this, we then discuss why just reading a set of words on a page can actually lead a person to experience anxiety, catastrophic thoughts and physical sensations.  You can download a copy of paired words test for panic here.
    • Symptom Induction / Interoceptive exposure – In this intervention, we aim to use different techniques to bring on some of the physical sensations that people experience when they have a panic attack.  This serves two functions.  One function is that the panic attack sufferer experiences another cause for their feared sensation, that is, they get to find out that the feared sensation just might be caused by something else other than their catastrophic fear.  The second function of interoceptive exposure is to get the sufferer to get used to and expose themselves to the anxiety symptoms.  The more often that they do this, the less likely they are to fear them when they arise on a day to day basis.