Panic Disorder and CBT
Panic Disorder is a serious and debilitating disorder affecting 2-3% of adults in the U.S, with women being twice as likely to be affected compared to men. From my experience, before seeking out the proper psychological care, patients who have panic disorder have usually made multiple trips to the emergency room already, fearing that they were having a heart attack or experiencing some other cardiac problem. After all, the symptoms of panic disorder can mimic those of a heart attack – dizziness spells, racing heart, unexplainable chest pains and tingling sensations. It is certainly advised that people be aware of any cardiac issues and receive medical treatment when warranted. However, if the real problem is panic disorder, getting treated by a trained CBT psychologist when symptoms begin to develop will provide the best prognosis. Understanding panic and how CBT can help may expedite the process of overcoming panic disorder in order to reclaim areas of your life affected by panic.
What are Panic Attacks?
According the DSM-5, panic attacks are characterized by “an abrupt surge of intense fear or discomfort that reaches a peak within minutes”, with multiple symptoms being experienced in that time frame. The surge can occur even when a person is feeling calm, which oftentimes leads to more panic when there doesn’t seem to be an obvious trigger. Some of these symptoms include: accelerated heart rate, sweating, shaking, shortness of breath, sensations of choking, chest pain, nausea, dizziness, chills, tingling or numbness, feelings of unreality or detachment, and fears of losing control or dying. When panic attacks begin to interfere with a person's daily functioning in a significant manner, a diagnosis of Panic Disorder will apply.
Panic attacks are often maintained through ‘conditioning’, where your body and mind develops and maintains a learned “fear of fear” after a panic attack, and begins to misinterpret signals in the body as a sign of impending danger. When I talk about panic disorder with my patients, one of the first things we do together is to identify the relationship between thoughts, physiological sensations, and behaviors that trigger and maintain the panic attacks. To use a hypothetical situation, let’s say that someone had a panic attack unexpectedly after riding in an elevator, although they have usually been fine riding in elevators in the past. Because of this negative experience, they may start to fear the next time they need to ride an elevator. When that situation occurs again, they may have the thought, “I hope I don’t have another panic attack.” The physiological sensations that accompany this thought might include sweating, racing heart, and shortness of breath. This person may begin avoiding elevators, opting to take the stairs instead (i.e. altering behavior due to fear of panic). The avoidance helps decrease the symptoms related to a panic attack, but does not allow this person to learn that they can indeed overcome this fear. Understanding the connection between these components is critical in treating panic disorder.
What is Agoraphobia?
Agoraphobia is sometimes diagnosed along with Panic Disorder, for individuals who have an intense fear of being in situations in which escape might be difficult, or fear of having a panic attack in such situations. This can prove to be quite debilitating, as people begin to fear leaving their homes, being in enclosed spaces, or riding on public transportation. If the fear of having a panic attack begins to affect your normal routine, it may be time to seek professional help.
What can I do about panic attacks?
Cognitive-behavioral treatment has been shown to be the gold standard treatment for panic disorder. Being on medication might be helpful in the short-run, but can eventually become a “safety behavior” and a means of avoiding difficult situations, and is unlikely to help you overcome panic disorder in the long run. CBT for panic disorder is not for the faint hearted – it requires persistent work, energy, and motivation to be able to challenge some of the anxious thoughts perpetuating the disorder, practice ‘de-conditioning’ to physiological sensations, and actively choose alternative adaptive behaviors that will significantly decrease panic attacks and help you to get back to your normal routine. If you are suffering from panic attacks/panic disorder, it may be beneficial to reach out to a cognitive-behavioral therapist who can help you develop skills and strategies to overcome panic.