How to use cbt to treat panic disorder

How Can CBT Help With Panic Disorder?

Cognitive behavioral therapy is a common and effective treatment for panic disorder.3 The goal of CBT is to help the individual develop skills to recognize the connection between their thoughts, feelings, and behaviors; then apply those skills to manage how their thoughts and feelings interact and influence their behaviors.

CBT teaches coping skills specifically related to anxiety and panic attacks, including cognitive restructuring and refocusing, problem solving, relaxation techniques, and skills training.2 Through CBT, the individual can learn breathing and relaxation skills to aid in the event of a panic attack. CBT can also help people evaluate the triggers of their attacks, and learn ways to reframe these events to be less triggering.

One of the most important components of CBT in treating any disorder, including panic disorder, is that for the individual to make the most progress, he or she must practice the skills acquired in therapy outside of a therapeutic session. In other words, the skills must be applicable in the “real world” and the individual must be able to employ the skills learned when necessary outside of therapy.

There are many different techniques and tools common to Cognitive Behavioral Therapy that therapists use for treating panic disorder, including cognitive restructuring and breath control.

Some of the most common techniques utilized in CBT specifically for treating panic disorder are:

Cognitive Restructuring 

The aim of cognitive restructuring is to learn the difference between rational and irrational thoughts, or cognitive distortions. Once someone is able to accurately identify these distortions, then they can begin working toward restructuring their thoughts in more healthy, productive ways.

During a panic attack, it’s hard to organize thoughts in a way that makes sense to others. For example, someone who has a fear of crowds is out with a group but loses the group and finds themselves alone in a large crowd. Cognitive restructuring can help the person remember that their life isn’t in danger and come up with ways to cope and prevent separations from happening in the future.

Exposure Therapy 

Exposure therapy in CBT involves exposing someone to the trigger that’s causing them stress. With prolonged exposure, the anxiety related to the trigger begins to decrease. With continued training the someone can become desensitized to the stimulus, thus decreasing the anxiety related to it.

For panic disorders, this can be helpful if someone has recurring flashbacks to a particular traumatic event. Exposure therapy can be done through visualizations with a therapist—visualizing and confronting the trigger will make that individual less impacted by it over time.

Breath Control Procedures 

Breath control procedures are important skills to master for those suffering from any type of anxiety, especially panic disorder. Often during a panic attack, someone loses control of their breathing, causing the breath and heart rate to accelerate. Through breath control exercises, the individual can learn to control their breathing and reduce their heart rate. This practice of breath control is critical in battling a panic attack.

For panic attacks of any kind, breathing is a great way to stay grounded and help you focus on what is happening right now and not focus on “what-ifs.” This can be especially helpful for the individual mentioned above who has a fear of crowds and is separated from their group. A person’s physical state changes during a panic attack, and a breathing exercise can help to regulate what is happening in their body, helping slow their heart rate.

Muscle Relaxation 

Muscle relaxation is another way for a person experiencing a panic attack to regain control of their body. Muscle relaxation works by focusing on individual sections of the body and relaxing the muscles in that section, moving gradually through the body until all parts of the body are relaxed.

Similar to breathing exercises, muscle relaxation can be a good way to redirect the brain to focus on other things happening in the body, such as muscle tension disappearing. For panic attacks, finding ways to use your body as a way to self-regulate is effective because of the bodily changes that happen during a panic attack. Muscle relaxation can help to disarm and refocus the brain from the subject of the panic attack.

Grounding 

Grounding is a relaxation and mindfulness technique that gets someone to focus on their five senses as a way to ground themselves in the present.

Here’s an example of a grounding exercise that might be helpful if you feel a panic attack coming on:

• Find five things you can see
• Find four things you can touch
• Find three things you can hear
• Find two things you can smell
• Find one thing you can taste

Mindfulness Training 

Mindfulness training in CBT involves focusing attention onto the present. This can be done through deep breathing exercises, muscle relaxation, or grounding techniques. Whichever method someone uses, the point of the exercise is to keep thoughts centered in the here and now.

Mindfulness-based CBT is a great intervention specifically for panic disorder. In a study lasting 8 weeks, it was found that individuals with panic disorder showed significant improvement on their intolerance of uncertainty as well as improvements in self reports on their overall symptoms of both depression and panic disorder. Mindfulness-based CBT can have a great impact on improving quality of life for those suffering from chronic panic attacks.11

Journaling 

Journaling is usually given as homework by the CBT therapist. The act of journaling can provide a way of tracking thoughts and behaviors over time and discovering patterns in cognitive distortions. It is a valuable tool for helping someone gain insight into their irrational thoughts and beginning the process of cognitive restructuring.

S.M.A.R.T. Goals

S.M.A.R.T. goals are set by the patient with the help of their therapist, and stand for:

• Specific: The client knows exactly what it is they want to accomplish. The goal is clearly defined.
• Measurable: The client will know if progress is being made and when they have achieved their goal.
• Attainable: The client has the skills and resources necessary to reach the goal.
• Realistic: The client will devote their time and energy into accomplishing it.
• Time-specific: The therapist and patient decide on an appropriate time frame for completing the goal.

It is the therapist’s responsibility to make sure that the client sets a goal that meets the S.M.A.R.T. goal standard. Failure is more likely to occur when the client does not set reasonable and realistic goals that are unattainable given their skill level or time frame.4

Is CBT Effective for Panic Disorder?

Cognitive Behavioral Therapy is a proven method for treating anxiety-related disorders, including panic disorder. In fact, many studies suggest that CBT is as effective, if not more so, than other therapy methods. Cognitive Behavioral Therapy is, in fact, one of the few psychotherapy methods that has ample research and scientific evidence to support the claim that CBT is effective in producing change.3

• In a meta-analysis of 21 studies, it was found that CBT was the most effective intervention type for treating panic disorder, including over breathing retraining.

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• In another study looking at the brain activity, it was found that CBT was effective in reversing the effects of a panic episode in those with panic disorder as evidence by the increase of brain activity in the middle frontal and parietal lobes.

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• In a study lasting 10 weeks, it was found that internet-based CBT was effective for those with social anxiety, depression and panic disorder, and specifically those with panic disorder who have greater deficits at baseline can benefit the most from internet CBT.

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Are There Any Risks?

There are no known risks of CBT at this time. However, it may not work for everyone or may not be as effective for everyone who receives CBT only as a treatment option (some people might do better with another treatment option or with the addition of medication). When compared with no treatment, CBT does effectively help in decreasing symptoms of panic. CBT with medications also improved overall severity of panic, mania and anxiety.

If you’ve decided to go to psychotherapy for panic disorder, you may be wondering what your therapeutic treatment options are. Numerous types of therapy are available, depending on your therapist’s approach and training background.

Panic-focused psychodynamic psychotherapy (PFPP) is one such option that’s been shown to be effective in treating panic disorder; another effective psychotherapy—often considered to be the most popular type of therapy for anxiety disorders—is cognitive-behavioral therapy (CBT).

Eye movement desensitization and reprocessing (EMDR) therapy is another option that can be effective in the treatment of panic disorder. EMDR is often used in the treatment of post-traumatic stress disorder (PTSD). Researchers suggest that EMDR can be helpful for panic disorder for the same reasons it is useful for PTSD since panic disorder often involves difficult memories and distressing panic attacks.

Due to its proven effectiveness, goal-oriented focus, and quick results, professionals who treat panic disorder often prefer CBT to other forms of therapy. Research also suggests that CBT is consistently more effective than panic-focused psychodynamic psychotherapy (PFPP) as well as applied relaxation training (ART) in the treatment of panic disorder.

The following describes the CBT approach and explains how it’s used to treat panic disorder, panic attacks, and agoraphobia.

What Is CBT?

Cognitive-behavioral therapy, or simply CBT, is a form of psychotherapy used in the treatment of mental health conditions. The underlying concepts of CBT are based on the notion that a person’s thoughts, feelings, and perceptions influence their actions and behaviors.

According to the tenets of CBT, a person may not always be able to change their life circumstances, but they can choose how they perceive and act upon life’s ups and downs.

CBT works to help change a person’s faulty or negative thinking, and assists in shifting unhealthy behaviors. CBT is currently used for the treatment of numerous mental health disorders, including major depressive disorder, phobias, post-traumatic stress disorder (PTSD), and addiction.

CBT has also been found to be an effective treatment option for some medical conditions, such as irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue.

Research has also found that internet-based CBT is just as effective as in-person CBT. This could be particularly beneficial in the treatment of panic disorder since it may help people feel that therapy is more accessible and comfortable.

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CBT as a Treatment

One of the main goals of CBT is to help a client overcome negative thinking patterns so that they may be able to make better choices in their actions and behaviors. In general, people with panic disorder are often more susceptible to negative thoughts and self-defeating beliefs, which can result in lowered self-esteem and increased anxiety.

Fearful and negative thinking is often associated with panic attacks, the main symptom of panic disorder.

Panic attacks are frequently experienced through a mix of physical and cognitive symptoms. Typical somatic symptoms include shortness of breath, heart palpitations, chest pain, and excessive sweating. These symptoms are often perceived as frightening and can lead to distressing thoughts, such as a fear of losing control, going crazy, or dying.

Fears associated with panic attacks can become so intense that they begin to negatively impact a person’s behaviors. For example, a person may begin to fear having an attack while driving or in front of other people (thoughts). The person will then avoid driving or being in crowded areas (behaviors).

Such behaviors lead to a separate condition known as agoraphobia. With agoraphobia, fearful thoughts become instilled over time, and avoidance behaviors only serve to reinforce these fears.

CBT can assist people with panic disorder and/or agoraphobia in developing ways to manage their symptoms. A person may not be able to control when they have a panic attack, but they can learn how to effectively cope with their symptoms. CBT assists the client in achieving lasting change through a two-part process.

The CBT Process

1. Recognize and Replace Negative Thoughts. The CBT therapist will first assist the client in identifying his negative cognitions or thinking patterns. For instance, a person may be directed to contemplate how they perceive themselves, views the world, or feels during a panic attack. By focusing on the thought process, a person can begin to recognize their typical thought patterns and how it influences their behaviors.
2. The therapist may use a wide range of activities and exercises to help the client become aware of their negative thoughts, and learn to replace them with healthier ways of thinking. Additionally, homework activities are often assigned between sessions to help the client in continually identifying and eliminating faulty thinking.
3. Writing exercises can be a powerful way to conquer faulty thinking patterns. These exercises may be used to increase awareness of and replace negative thoughts. Some common CBT writing exercises include journal writing, keeping a gratitude journal, using affirmations, and maintaining a panic diary.
4. Skill Building and Behavioral Changes. The next step of CBT involves building on healthy coping strategies to change maladaptive behaviors. During this phase, the client will learn to develop skills to help in reducing stress, managing anxiety, and getting through panic attacks. These skills may be rehearsed in session, but it’s also important that the client practices new behaviors outside of therapy, too.
5. Desensitization is a common CBT technique that is used to help the client get past avoidance behaviors. Through systematic desensitization, the CBT therapist gradually introduces the client to anxiety-producing stimuli while teaching him how to manage his feelings of anxiety. The person is slowly introduced to more fear-inducing situations, developing ways to cope with panic symptoms through each feared circumstance.
6. To help remain calm through anxiety-provoking circumstances, relaxation techniques are also learned. These skills assist in managing fears, lowering heart rate, reducing tension, and improving problem-solving skills. Some common relaxation techniques include deep breathing exercises, progressive muscle relaxation (PMR), yoga, and meditation.

A Word From Verywell

As one of the most widely used forms of therapy, CBT may be part of your recovery process. CBT can help in reducing symptoms on its own, but many will find a combination of treatment options to be the most beneficial. Your doctor or therapist can help you determine if CBT is right for you and assist you in developing a treatment plan that will best suit your needs.