Cognitive behavioral therapy for Panic Disorder focuses on fears of bodily symptoms, catastrophic thinking, and avoidance behavior. This is done by identifying specific ways in which the patient can reduce anxiety.
Cognitive restructuring – Identifying and countering fear of bodily sensations and focusing thoughts away from the negative consequences of such sensations.
Individuals with PD often have distortions in thinking that cause a cycle of fear. When the person experiences physical symptoms, such as racing heart, they react with catastrophic thinking, e.g., “I’m having a heart attack”. Cognitive restructuring helps the person to recognize thoughts and feelings and to modify their fear response to them. By changing catastrophic thought patterns the person gains more control over the symptoms, e.g., “it’s only uneasiness and it will pass”.
Breathing retraining – Learning how to use anxiety management techniques and lifestyle changes (see page 2) to control physiologic reactions.
Exposure therapy – Helps the person accept and face some fear and anxiety in order to cope with phobic situations. This is done by facing the feared situation and actually doing it. The person must enter real world situations that cause anxiety, e.g., driving a car on the expressway. Exposure therapy requires considerable time and discipline from the patient. Exposure exercises must be practiced routinely and monitoring must be continuous. The patient has to be willing to confront the feared situations. It is easier to establish a hierarchy from the least to the most difficult task. It’s ok to pause, breathe, and/or take medication, but then proceed.
Avoidance behavior makes panic disorder worse. Resist the urge to stop or avoid those things that trigger fear and/or physical symptoms
Desensitization – Occurs with persistence and practice. This involves exposing the patient to fear cues, specific things or situations that trigger panic attacks.
