CBT and Panic Disorder: Breaking the Cycle of Fear
Panic attacks are sudden incidents of extreme fear symptoms that cause a person to experience severe physiological symptoms that can sometimes present like a medical emergency - even when a person is not in a situation that typically causes such symptoms.
Often, people experiencing panic attacks can feel like they are experiencing a heart attack or that they are going to die. Many people rush to emergency rooms because of these worries, only to find out that their symptoms are more likely a result of a psychological condition than a physical one. This terrifying experience can happen to a person out of the blue once or twice in their life, likely due to life’s stresses or other circumstances that are situational; this is usually more typical for most people who experience panic attacks.
For some, however, they can experience recurring, unpredictable panic attacks that do not seem to go away and do not seem to have a consistent trigger that can be eliminated. When this happens, a person can become terrified of when the next attack is going to strike, which exacerbates their stress and suffering, ultimately leading to a diagnosis called panic disorder.
In order to receive a diagnosis of panic disorder, a person must experience recurrent, unexpected panic attacks, or sudden episodes of intense fear or discomfort that involves at least four symptoms of the following:
Heart palpitations/increased heart rate
Sweating
Trembling/Shaking
Shortness of breath
Feeling of choking
Chest pain or discomfort
Nausea or stomach pain
Feeling dizzy/lightheaded/faint
Derealization (feeling like the world is not real)
Depersonalization (feeling disassociated from self)
Fear of losing control or going crazy
While those are the symptoms of a panic attack itself, in order to meet criteria for panic disorder, a person must also experience one or more of these symptoms following a panic attack for at least one month:
Worry or concern about having another panic attack
Worrying about the consequences of a panic attack (losing control, going crazy, having a heart attack, dying, etc.)
Significant behavioral changes in response to the panic attack (avoiding social interactions or other triggers, isolating self, irritability, etc.).
These symptoms must also not be attributable to a legitimate health condition (hypothyroidism, for example) or the physical effects of a substance (drugs, caffeine, etc.).
When someone is experiencing the recurrent attacks associated with a panic disorder, they are often desperate to find solutions as this condition can be terrifying and debilitating. The first step is always rule out any medical conditions or other substance interactions, but when this has been cleared, the next steps usually involve seeking therapeutic treatment and possibly combining therapy with medication support to help manage the symptoms.
Research shows that the most effective treatment for panic disorder is cognitive behavioral therapy interventions, otherwise known as CBT. CBT is a highly effective psychological treatment that involves working with a therapist who helps a patient begin to understand their problematic patterns of thought and helps them challenge and reframe these thoughts to treat various types of mood disorders like depression, anxiety, PTSD, and more. CBT helps improve mental health by teaching individuals to identify, challenge, and change unhelpful thoughts; use relaxation and breathing techniques to reduce anxiety or depression; increase awareness and tolerance of emotions; and gradually face feared situations through exposure therapy.
Because there are many different types of interventions used through a course of CBT, researchers have been working to identify which kinds of treatments are most effective when treating someone with panic disorder. Recently, a meta-analysis1 (which is a large that takes the results from many smaller studies on the same topic and combines them to see the big picture) found that, for panic disorder the most helpful approach is working with a therapist in person, where a therapist will help a person bring on some of the body sensations that trigger panic (like a racing heart or shortness of breath) so they can get used to them, while teaching them how to spot and change unhelpful thoughts that fuel anxiety.
These components were associated with higher remission and response rates. Muscle relaxation and virtual-reality exposure were linked to lower success in treatment, while breathing exercises and in vivo exposure had only small effects on symptom improvement (though they modestly improved treatment acceptability).
Best interventions:
· Face-to-face CBT
· Interoceptive exposure (gradual exposure to feared bodily sensations)
· Cognitive restructuring (identifying and challenging maladaptive thoughts)
Less useful or potentially counterproductive components:
· Muscle relaxation
· Virtual-reality exposure
If you struggle with panic attacks, you don’t have to face them alone—and the right kind of therapy can make a real difference. Research shows that the most effective treatment for panic disorder involves working face-to-face with a trained therapist, practicing safe and gradual exposure to the sensations that trigger your panic (like a racing heart or dizziness), and learning proven strategies to challenge the thoughts that fuel your anxiety.
These techniques can help you reduce the intensity and frequency of your panic attacks, regain confidence, and feel more in control of your life. If panic has been holding you back, take the first step today by finding a therapist who specializes in CBT for your panic disorder. This is a crucial step toward recovery that can drastically improve your everyday life!