Those who suffer from panic attacks talk about their bodies taking over, rather aggressively, increasing heart rate, chest pain, hot flashes, shallow breathing, weakening knees - even feeling a sense of stepping outside of one’s skin and watching oneself from a surreal or unearthly perspective.
Individuals often feel as if they’ve lost control, and that brings on a sense of impending danger and the need to escape.
Mental health professionals help individuals who suffer with repeated panic attacks overcome these frightening, unpredictable episodes. Therapists and counselors trained in a particular type of psychotherapy called cognitive behavioral therapy (CBT) use its effective methods to help others manage, overcome, cope with and subdue this disorder’s distressing symptoms.
Step 1: Stop catastrophizing
Cognitive behavioral therapy addresses both the thoughts (cognition) and the behaviors that contribute to panic attacks.
Catastrophizing is one of the major cognitive errors made by individuals suffering from panic disorder. Individuals who catastrophize automatically link an internal sensation associated with a panic attack, such as a rapidly beating heart, with an oncoming panic attack. For example, panic attacks cause the heart to beat rapidly, so in any situation, such as running for the bus or exercising, individuals think an increase in heartbeat signals a panic attack. They take drastic measures, such as stopping an exercise program because of the fear of bringing on a panic attack.
Researchers Sara Freedman Ph.D., and Rhonda Adessky, Ph.D, wrote in an article titled “Cognitive Behavior Therapy for Panic Disorder” that individuals learn to fear natural physiological reactions, developing a “fear of fear.”
The article appearing in The Israel Journal of Psychiatry and Related Science, explains that the “fear of fear” can even lead to panic attacks that occur during sleep and relaxation. Many times a panic attack slows breathing, and for those individuals, the breathing changes that occur during sleep are the same as those experienced during an attack. This causes individuals to wake while having a panic attack.
“Studies have shown that people with panic attacks are more likely than controls to notice and misinterpret internal bodily changes,” the authors, both associated with Hadassah Hebrew University in Jerusalem, wrote.
For professionals treating panic disorder, the first step involves educating the patient that normal physiological processes are not dangerous (see Anxiety Counseling). Freedman and Adessky call it “psycho-education.” This education teaches individuals that what they interpret as panic attack symptoms are actually normal autonomic nervous system reactions.
The other type of catastrophizing occurs in thoughts surrounding the issue of living through and surviving panic attacks. For instance, an individual will think that if a panic attack occurs, they’ll embarrass themselves in front of others, cause an accident, or suffer in some horrific way – such as have a heart attack or die.
The counselor’s job is to get the patient to see how illogical these thoughts are by having patients analyze what actually happens during a panic attack, detailing the evidence negating their thoughts, and getting the patients to conclude that exaggerated thoughts are just that – exaggerations. Death or a heart attack haven’t occurred before, so they won’t occur again. And how embarrassing were the patient’s behaviors during the attack? In many cases, an individual’s perception of what actually occurred is heavily skewed toward unrealistic negativity.
Step 2: Cognitive Restructuring
Having patients analyze their thoughts surrounding panic attacks is called cognitive restructuring. Mental health professionals motivate patients to analyze their thoughts so that they understand how certain errors in thinking or dysfunctional patterns of thought contribute to repeat panic attacks. These thoughts lead to avoidance behaviors.
Freedman and Adessky state that some individuals must “work on their core beliefs (e.g., I must be in control all the time) in addition to their automatic negative thoughts about having a panic attack (e.g., if I have a panic attack I will lose control of my bodily functions.)”
The two authors identify a restructuring technique used to help patients examine and challenge their thoughts as the following:
- Imagine the worst case scenario.
- Critically analyze it.
- Assess the hassle or horror of it.
- Determine if it will really change their life.
- Decide what is their ability to cope with such a scenario.
The patient vocalizes answers in addition to writing down alternative ways of thinking about what happens and doesn’t happen during a panic attack. More positive ways of thinking about the attack are also stated, and ways to identify “triggers” that contribute to errors in thoughts and behaviors.
Step 3: Exposure
Addressing “behavior” in the cognitive behavioral approach to managing panic disorder requires patients to experience, with the guidance of the therapist or counselor, the sensations or environments causing their panic attacks.
Freedman and Adessky describe two types of exposure interventions: interoceptive exposure and in-vivo exposure. The purpose of both exposure types is to have the patient remain in distressful states long enough until anxiety levels decrease. By experiencing and coping with these distressful states, the patient builds a tolerance for anxiety rather than avoiding it.
- Interoceptive exposure. During this type of exposure, patients encounter the fearful sensations usually brought on by a panic attack. This means that if dizziness is a distressful symptom, the counselor might spin the patient in a chair to induce dizziness, or if heart racing causes distress, the patient will run to replicate this physiological response. If many sensations are experienced, the therapist replicates as many as possible at one time.
- In-vivo exposure. During this type of exposure, patients actually visit the places or situations that bring on the panic attacks. Usually the patient rates the list of places and situations from the least stressful to the most, and the therapist takes the patient gradually through the list. For those patients able to handle in-vivo exposure on their own, they are given exposure homework and they record their anxiety levels both at the start and at the end of their exposures.
Step 4: Relapse prevention.
Treatment for panic disorder is usually short-term, ranging from 12 to 15 sessions, and highly successful. Individuals report greater control over their lives, including the ability to manage and cope with panic attacks when they occur. Many report a significant reduction in attacks, and some even report a complete remission of panic disorder.
During treatment, the counselor’s goal is to provide cognitive skills that guide individuals through a panic attack, teaching them how to prevent attacks from “getting started” or recurring. Relapse prevention happens throughout the course of treatment, but is often summarized toward the end of therapy to guide patients on the right course if and when another panic attack strikes.
CBT and Medicine
Certain medications are prescribed for panic disorder. Studies have shown that medications and cognitive behavioral therapy are equally effective in treating the disorder. In some studies, cognitive behavioral therapy has proven more effective. And in still other cases, a combination of medication and CBT has proven effective for some individuals.
In all cases, CBT has proven the most cost-efficient approach to solving the puzzle and distress of recurring panic attacks.
Careers Associated with Treating Panic Disorder
If you desire to help individuals overcome panic attacks associated with panic disorder, consider a career in the mental health field as a counselor. Most states require a master’s degree in mental health counseling to treat individuals with therapies such as cognitive behavioral therapy.
Most states also require a license to practice, requiring the taking of a state exam.
Panic Attack Facts:
- Approximately 80% of individuals with panic disorder report having experienced a major life stressor during the previous 12 months.
- Panic disorder is correlated with other mental health conditions. About 90% of individuals with panic disorder will have at least one other psychiatric condition during their lifetimes.
- Education has proven critical in helping individuals overcome panic attacks. Materials for patients are available at the Anxiety Disorders Association of America (ADAA) and the National Institute of Mental Health (NIMH).
- Five classes of medication have proven effective in treating panic disorder. These medications include selective serotonin-reuptake inhibitors (SSRIs), serotoninnorepinephrine reuptake inhibitors (SNRIs), high potency benzodiazepines, tricyclic antidepressants, and monoamine oxidase inhibitors.