How To Overcome Panic Attacks
from Roger Tilton, Ph.D. Cognitive-behavior therapy has been shown in numerous studies to be the treatment of choice for overcoming panic disorder. The reason it is so effective is because it is based on an accurate understanding of what causes and maintains panic attacks. This makes it a much more specific and powerful approach than more general approaches such as relaxation or other types of psychotherapies, and in terms of lasting results it is far more effective than psychotropic medication.What Really Are Panic Attacks?
Although panic attacks may seem as if they come out of the blue, they are actually a product of your own thinking. A panic attack is really nothing more than bodily sensations of anxiety and a misinterpretation of those sensations as leading to a catastrophic or dangerous outcome. Your belief that you are in danger results in increased anxiety, which then leads to more sensations and more catastrophic thoughts, creating a vicious cycle between bodily sensations, distorted thoughts, and anxiety, which can rather quickly culminate in a panic attack.
The real problem is actually your mistaken belief that something catastrophic will happen – not the panic itself – since panic is in fact an appropriate emotional reaction when you believe that you are in danger. For example if you interpret rapid heart rate as a possible heart attack it makes sense to panic, since panic is a normal and useful reaction when you believe that your life may be in danger. The panic actually makes complete sense given what you are believing. However the beliefs that cause panic attacks are not true and when people identify their beliefs and no longer accept them as valid they stop having panic attacks.
What Are The Most Common Beliefs That Cause Panic Attacks?
People who have panic attacks are remarkably similar in the specific catastrophic beliefs they have about specific sensations. The most common of these are:
You misinterpret rapid heartbeat as meaning that you might have a heart attack or heart failure.
You misinterpret tightness in your chest or throat or rapid breathing as meaning that you might choke and be unable to breathe.
You misinterpret lightheadedness as meaning that you may be about to faint.
You misinterpret harmless feelings of depersonalization or unreality as meaning that you are about to go crazy and might wind up in a mental hospital.
You mistakenly believe that when you panic you might lose control and do something rash or impulsive such as losing control of your car, running from your car in traffic, or flagrantly embarrassing yourself.
Even though what you fear never happens during a panic attack, you mistakenly tell yourself, "This time might be different".
Good News: None Of These Things Are Going To Happen
· Rapid heartbeat and “respiratory” sensations are merely normal sensations of sympathetic nervous system arousal which is a physiological response that mobilizes you for fight or flight. Ironically there would be something wrong with your heart if it didn't beat faster when you have very high anxiety. Tightness in the throat is caused by muscles and has nothing to do with your breathing while rapid shallow breathing is actually mobilizing you for fight or flight.
· Fainting is caused by a sudden drop in blood pressure, but when you become anxious, your blood pressure actually goes up making fainting almost an impossibility. The only kind of anxiety disorder that can lead to fainting is a blood injury phobia which involves a sudden drop in blood pressure. The lightheadedness that people commonly experience with high anxiety is typically caused by anxiety and hyperventilation.
· People with panic disorder don't go crazy. Psychotic problems such as schizophrenia and panic disorder are completely different. Depersonalization and derealization (feelings of unreality) are very common symptoms of high anxiety which are harmless and go away when your anxiety comes down.
· People experiencing a panic attack never lose control and are in fact more in control than they even need to be.
· "I know my panic attacks have never lead to anything catastrophic before but maybe this time is different" This time is not different nor will the next time be different.
People with panic disorder say that what they fear is their panic attacks. However what people actually fear is what they imagine the panic attack will lead to. However the only thing a panic attack ever leads to is the panic attack ending. When people fully realize the truth of this they stop having panic attacks, because the reason for their panic, their mistaken perception of catastrophe/danger, is no longer there to create it.
Identifying Sensations And Thoughts
The first step we take in overcoming panic attacks is to identify the bodily sensations you fear and the catastrophic thoughts you are having about these sensations. It is important to separate thoughts and sensations. For example, “I feel like I’m going to faint” is actually a sensation of lightheadedness and a thought or belief that you are about to faint. “I feel like I’m choking” is a sensation of tightness in your throat and a thought or belief that you will choke and not get enough air.
Once we identify the sensations that you fear and the specific thoughts/assumptions you have about those sensations then we can work on eliminating your fear by getting you to reexamine your assumptions. It is actually not unusual for people with panic disorder to fear only one sensation. That means that some people are only one mistaken belief away from no longer having panic attacks.
Also while panic attacks may seem like they come out of the blue as an outside force, this is actually not the case. Panic attacks are the result of your own catastrophic beliefs about anxiety and anxiety sensations. Since with corrective information you have the power to change your beliefs this means that you ultimately have the power over whether or not you continue to have panic attacks.
Interoceptive Exposure
Another very helpful component of cognitive-behavior therapy for panic disorder is interoceptive exposure in which exercises are done that simulate the sensations that are feared. For example if a person fears their heart beating fast we might have them run up stairs so as to actually make their heart beat fast or we might have a them hyperventilate to simulate feelings of lightheadedness. This is the behavior therapy component of cognitive-behavior therapy which involves desensitizing maladaptive anxiety by exposing you to what you fear. I don't use interoceptive exposure with everyone I see with panic disorder, but it can be very helpful and has been validated in a large number of treatment outcome studies as a highly effective technique.
It is not unusual to hear mental health professionals recommend that people with panic disorder not take anything with caffeine. This actually reflects a misunderstanding that caffeine itself can cause panic attacks. Caffeine in itself does not cause panic but rather causes sensations of physiological arousal, and it is the fear of these sensations that causes the panic not the caffeine itself. In fact taking caffeine is not infrequently used as an interoceptive exposure exercise. By exposing the person to their feared sensations they become desensitized to the sensations and learn that they do not lead to anything and are harmless. Actually avoidance of what we fear is a key factor in what keeps an anxiety disorder going, so avoiding caffeine is actually counterproductive. I myself don't typically use taking caffeine as a formal interoceptive exposure exercise, but I advise people whom I am seeing to not avoid caffeine that they would otherwise want to take such as in coffee or chocolate.
Panic Disorder with and without Agoraphobia
There are actually two panic disorder diagnoses: panic disorder without agoraphobia and panic disorder with agoraphobia.
Agoraphobia involves high anxiety or panic in situations where escape is difficult or help is not available. People with agoraphobia have a significant amount of avoidance which significantly reduces their life space. They may go only a limited distance from home and may avoid driving on freeways, public transportation, shopping malls, or crowded places especially if they are alone. While the principles for overcoming panic attacks are also useful the key element in overcoming agoraphobia is exposure therapy in which feared situations are confronted. There are two ways this can be done. One is gradual exposure and the other is nongraduated intensive exposure. Nongraduated intensive exposure is actually significantly more effective with agoraphobia. At Boston University after a four day program of intensive exposure 80% of people have no more agoraphobic avoidance. I do both gradual and intensive exposure for agoraphobia depending on what the person I am seeing is comfortable with and chooses to do.
Panic Disorder without agoraphobia involves panic attacks and a fear of having panic attacks but without significant agoraphobic avoidance. This is one of the easiest problems to treat and involves identifying and overcoming the fear of specific sensations. A good deal of the therapy is educational in which you are given an understanding of panic attacks and corrective information about them. The majority of people can become panic free after short-term cognitive-behavior therapy and the results are lasting.
Copyright: Roger Tilton, Ph.D.
You may visit my website for more information at http://cognitivetherapycenterofriverside.com.
Or you may contact me at cognitiveriv@charter.net or at cognitiveriv@aol.com or by phone at (951) 682-6007. Also please feel free to contact me if you have any questions about anxiety disorders.
