Cognitive Therapy for Panic

Common to all anxiety disorders are irrational thoughts (cognitions) which are generally characterised by being automatic, involuntary, distorted, unhelpful yet superficially plausible. The content differs for each condition, although overlap does exist, but commonly includes catastrophisation, fear of internal or external disaster, fear of ill health or personal vulnerability, automatic assumption of danger. These thoughts are common in anxiety and phobic disorders and treatment needs to address the negative thoughts present during the panic attack (usually catastrophic thoughts of impending death or ill health), the thoughts associated with anticipatory anxiety when people are about to go into a situation where they fear a panic attack and finally thoughts linked to incomplete resolution of panic disorder and residual symptoms. It needs to be stressed that Panic Disorder is not so much a disorder of physical symptoms, but a disorder marked by misinterpretation of the importance of these symptoms.

Thinking errors can be effectively identified, evaluated, controlled and modified by cognitive therapy techniques in many cases. Most cognitions associated with panic and phobic disorders can be challenged effectively in contrast to the obsessions of OCD and thoughts in patients with severe comorbid depression which are very resistant. The process involves:

  • Becoming aware of negative thoughts - diary.

  • Answering/challenging negative thoughts.

  • Action to test negative thoughts and build up a body of contrasting evidence.

The use of pen and paper techniques is probably best either with the RET model of Ellis (ABC) or the dysfunctional thought record of Beck. David Burns' book "Feeling Good" gives simple instructions on the use of such techniques to identify and challenge negative and dysfunctional thoughts. The final step involves behavioural experiments to build up a body of evidence to convince the patient that these thoughts are incorrect.