What to Expect CBT Treatment Series: Panic Disorder
This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.
My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.
Panic Disorder Treatment
What is it?
Most of us, in our lifetime, will experience a panic attack. However, when you develop panic disorder, you experience frequent, unexpected panic attacks (or surges of intense fear and discomfort) accompanied by either a fear of having another panic attack or change in behavior related to attacks (American Psychiatric Association, 2013). In other words, you live in fear of having another panic attack and have panic attacks that feel like they hit you out of the blue. This is often a very hard way to live.
What will we work on?
1. Exposure therapy: The goal of exposure therapy for panic disorder is to learn to sit with and tolerate physical sensations of panic (Craske & Barlow, 2007). For instance, if you experience heart racing and difficulty breathing during panic attacks, I will recommend that you engage in various exercises that induce those symptoms. We can learn to tolerate anxiety. We do not need to panic to panic. In exposure therapy for panic disorder, you will engage in what are called interoceptive exposure exercises that will desensitize you to panic sensations (that are not paired with an actual threat).
2. Psychoeducation: Panic is not harmful (Craske & Barlow, 2007). In fact, it is there to keep us safe during a threat! We will discuss this and ways to remind yourself of this when your body is telling you danger is present.
3. Coping skills: Coping skills for panic will include changing breathing that often leads to hyperventilation (Craske & Barlow, 2007). I will also help to challenge the way you are thinking about panic. I aim to help you see that you will be able to cope with the panic and situations in which you feel panic. You do not need to run from panic sensations. They will come and go if you face them.
Why Engage in this Treatment?
Panic attacks are painful and debilitating. Consider the ways your life has been negatively impacted by having panic attacks or by your fear of having additional panic attacks. Consider the time you have lost recovering from panic attacks or planning around them (Grayson, 2014). Does the panic impact your job, relationships, or ways you can spend your time? If so, you may want to give treatment a try.
Why this treatment works?
Panic attacks are essentially false alarms in the threat detector (the amygdala) in our brain. This treatment aims to reset your alarm system by artificially triggering it. Research has demonstrated the effectiveness of this approach (Craske & Barlow, 2007).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Craske, M. G., & Barlow, D. H. (2007). Mastery of Your Anxiety and Panic: Therapist Guide (4th ed.). Oxford University Press.
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.