LECTURE 13: Cognitive Behavioral Therapy for Panic Disorder

overview

  • cognitive behavioral therapy for panic disorder

    • education & monitoring

      • introduction

      • learning to record panic and anxiety

      • negative cycles of panic and agoraphobia

      • panic attacks are not harmful

    • breathing skills

    • thinking skills

    • exposure

      • facing physical symptoms

      • facing feared activities

      • facing agoraphobic situations

    • planning for the future

      • medications

      • accomplishments, maintenance, and relapse prevention

cognitive behavioral therapy

  • cognitive behavioral therapies (CBT) are an intervention based on a combination of both behavioral (BT) and cognitive theories (CT)

    • BT: problem behaviors are learned and can be modified through the application of learning principles

    • CT: cognitions mediate between environmental events and behavior/emotion

  • aims to modify maladaptive behavioral and cognitive patterns

  • focus on present functioning rather than childhood history

  • treatment components

    • education and monitoring

    • physiological component (depending on the disorder)

    • cognitive component

    • behavioral component

    • relapse prevention

  • significant roles for

    • self-monitoring

    • homework between sessions

panic disorder

  • the fear of repeated panic attacks

    • panic attack: sudden, intense fear response accompanied by physical symptoms

      • common across all anxiety disorders

      • can be cued or uncued

CBT FOR PANIC DISORDER

  • education & monitoring

    • introduction

    • learning to record panic and anxiety

    • negative cycles of panic and agoraphobia

    • panic attacks are not harmful

  • breathing skills

  • thinking skills

  • exposure

    • facing physical symptoms

    • facing feared activities

    • facing agoraphobia situations

  • planning for the future

    • medications

    • accomplishments, maintenance, and relapse prevention

CBT FOR ALL TYPES OF ANXIETY

  • typically contain

    • education & monitoring

    • relaxation skills (breathing, mindfulness, PMR, etc.)

    • cognitive restructuring

    • exposure

    • relapse prevention

education & monitoring

  • introduction and learning to record panic and anxiety

  • daily mood record & panic attack record

    • first thing we do in a CBT session is review monitoring

  • progress report

    • used to track treatment progression

    • useful for both clinician and client

  • negative cycles of panic and agoraphobia

    • interrupting this cycle can help with new learning that physical symptoms of panic are not harmful

    • changing thoughts can change the results (panic attack vs. return to baseline)

  • psychoeducation: PANIC ATTACKS ARE NOT HARMFUL

breathing skills

  • education about anxiety-breathing link

    • over breathing

      • chronic hyperventilation

    • indicators

      • feeling short of breath

      • feeling like suffocating ]

      • chest pain or pressure

      • frequent yawning, sighing, or air gulping

      • breathing quickly and shallowly when frightened

    • physiological effects

      • increased oxygen in blood (but not tissue)

        • less oxygen to the brain

      • decreased carbon dioxide

        • leads to panic

thinking skills

  • thoughts ← → emotions

    • thoughts mediate between events and emotions

  • identifying thoughts

    • what am I afraid of?

      • and if that were to happen, then what?

  • reevaluate odds of negative outcome

    • targets over estimation of likelihood of negative outcomes

  • challenges your perspective

    • targets catastrophic thinking about inability to manage negative outcomes

exposure

  • facing physical symptoms

    • observe reduction in anxiety (“habituation”) with continued exposure to feared symptoms, activities, and situations

      • rationale

        • face symptoms directly so learn not harmful and can tolerate

      • system assessment

        • identify which exercises produce symptoms similar to those in panic attacks

      • create hierarchy

        • rank similar exercises according to anxiety level

      • practice

        • work way up hierarchy

  • facing feared activities

  • facing agoraphobic situations

planning for the future

  • medications

  • accomplishments, maintenance, and relapse prevention