CBT for Panic Disorder

If you suffer recurring panic attacks, you may be experiencing panic disorder. This debilitating condition can rob sufferers of their confidence and leave them bewildered as to how to return to their previous sense of freedom from fear. Fortunately, expertly-applied CBT is highly effective, and most of my clients with panic disorder are panic-free by the end of treatment.

Many of us will experience a panic attack during our lifetime. It’s an overwhelming feeling of sudden and intense anxiety that quickly rises to a crescendo, and which perhaps seems to come out of the blue, but is often triggered by stressful life events, hormonal changes, illness, caffeine, drugs, memories of unpleasant events or as a feature of another anxiety disorder. This can be scary if you don’t know what’s going on, so much so that some who have a panic attack for the first time call an ambulance, fearful for their lives.

During a panic attack, physical symptoms build very quickly, including:

  • a pounding or racing heartbeat
  • feeling faint, dizzy or light-headed
  • feeling very hot or very cold
  • sweating, trembling or shaking
  • feeling sick
  • pain in your chest or abdomen
  • struggling to breathe or feeling like you’re choking
  • feeling like your legs are shaky or are turning to jelly
  • feeling disconnected from your mind, body or surroundings, which are types of dissociation

However, while panic attacks are unpleasant and can be frightening, they are not dangerous and will not harm you.

Panic disorder, not panic attacks

Many people who have a panic attack will only ever have a single episode and never experience another. However, for a minority, once the panic attack is over, the fear doesn’t subside, and they begin fearing fear itself, worrying and wondering when and where the next one will happen. Fear of panic attacks becomes a central focus of their life, and they start looking for ways to avoid another episode, even if this means changing their routines and avoiding activities that may trigger another attack, perhaps everyday activities such as shopping, driving or even leaving the house. They eventually begin to avoid any situation they fear may make them feel helpless if a panic attack occurs. These attacks are often linked to a catastrophic belief, perhaps of an imminent danger of going crazy, losing touch with reality, fainting, losing control of their bowels, having a heart attack, stroke or dying.

If this is familiar, and you can’t stop worrying about having another panic attack, you might be living with panic disorder. To earn a diagnosis of panic disorder, you would have to have spent at least one month worrying about having more panic attacks, worrying about the possible consequences of panic attacks and also avoiding activities that you value or once enjoyed.

For a minority, once the panic attack is over, the fear doesn’t subside, and they begin fearing fear itself, worrying and wondering when and where the next one will happen.

How CBT Can Help

We will focus on these three areas to start out on the road towards being panic-free:

  • Identify the catastrophic misinterpretations related to your bodily sensations. In panic disorder sufferers, these ‘distorted’ beliefs about bodily sensations persist despite numerous experiences to the contrary, for example, someone who believes they are having a heart attack during a panic episode may continue to believe this despite having had thousands of attacks during which they did not die. They may even have had repeated visits to A&E during which they were told that their heart was normal. From an outsider’s perspective, such persistence seems puzzling, so why are panic disorder sufferers unconvinced by the repeated non-occurrence of their worst fears? Well it’s explainable using CBT, and the good news is, it’s also changeable. 
  • We’ll generate alternative, non-catastrophic interpretations of those bodily sensations.
  • And we’ll test out the validity of those catastrophic and non-catastrophic interpretations through discussion and behavioural experiments. In working with panic disorder, you’ll realise that these behavioural experiments are particularly important.

Using CBT we can build a programme where you gradually face anxiety-provoking situations in an informed and structured way, because not facing them is a big part of what feeds your fear. What’s different is you’ll be armed with a greater understanding of what’s happening for you, so when you have uncomfortable sensations that normally trigger anxiety, you’ll have skills to help you think about them differently and lean into them. The vast majority of clients are panic-free by the end of treatment. 

Get in touch to see if CBT for panic disorder could help you regain your confidence.