Cognitive Behavioral Therapy (CBT) is a proven method of treating many anxiety related disorders, including Panic Disorder. Panic disorder is a relatively common anxiety disorder, and is often comorbidly diagnosed along with other anxiety disorders, such as agoraphobia or social anxiety disorder. The main component of panic disorder is the presence of recurrent, unexpected panic attacks.1
Treatment of panic disorder using CBT creates lasting therapeutic results using goal-oriented techniques designed to alleviate symptoms quickly and efficiently. Typical CBT therapy sessions last approximately 50 minutes and occur weekly for 3-6 months.
Central Concepts of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy focuses on an individual’s cognitions, or thoughts, and behaviors. The goal of CBT is to help the individual develop skills to recognize the connection between their thoughts, feelings, and behaviors; then apply those skills to manage how their thoughts and feelings interact and influence their behaviors.
A therapist practicing CBT aims to empower the individual through psychoeducation and skills development that allow the individual to practice self-analysis of their own cognitions and begin to positively reshape their beliefs about themselves and their world.2
Cognitive Behavioral Therapy uses several therapeutic techniques specific to CBT to aid in the growth of the individual. Common practices include cognitive restructuring and refocusing, problem solving, relaxation techniques, and skills training. The objective of CBT is to help the individual realize their own strengths and develop skills that they can then generalize and employ in various other facets of their life.2
How Can CBT Help with Panic Disorder?
Cognitive behavioral therapy is a common and effective treatment for panic disorder.3 CBT teaches coping skills specifically related to anxiety and panic attacks. Through CBT, the individual can learn breathing and relaxation skills to aid in the event of a panic attack, as well as learn to interpret and evaluate cognitive related components associated with panic-inducing stimuli.
One of the most important components of CBT in treating any disorder, including panic disorder, is that for the individual to make the most progress, he or she must practice the skills acquired in therapy outside of a therapeutic session. In other words, the skills must be applicable in the “real world” and the individual must be able to employ the skills learned when necessary outside of therapy.
Common CBT Techniques & Tools for Panic Disorder
There are many different techniques and tools common to Cognitive Behavioral Therapy that therapists use for treating panic disorder. Some of the most common techniques utilized in CBT specifically for treating panic disorder are:
Cognitive restructuring is a key component of CBT. The aim of cognitive restructuring is to learn the difference between rational and irrational thoughts, or cognitive distortions. Once the individual is able to accurately identify these distortions, they then begin working toward restructuring their thoughts in more healthy, productive ways.
Exposure therapy in CBT involves exposing the stress inducing stimulus to the individual. With prolonged exposure the anxiety related to the stimulus begins to decrease. With continued training the individual becomes desensitized to the stimulus, thus decreasing the anxiety related to it.
Breath Control Procedures
Breath control procedures are important skills to master for those suffering from anxiety related disorders, especially panic disorder. Often during a panic attack, the individual loses control of their breathing, causing breathing and heart rate to accelerate. Through breath control exercises, the individual can learn to control their breathing and reduce their heart rate. This practice of breath control is critical in battling a panic attack.
Muscle relaxation is another way for a person experiencing a panic attack to regain control of their body. Muscle relaxation works by focusing on individual sections of the body and relaxing the muscles in that section, moving gradually through the body until all parts of the body are relaxed.
Grounding is a relaxation and mindfulness technique that gets the individual to focus on their five senses as a way to ground themselves in the present.
A typical grounding exercise requires the individual to search out:
- five things they can see
- four things they can touch
- three things they can hear
- two things they can smell
- one thing they can taste
Mindfulness training in CBT involves focusing attention on the present. This can be done through deep breathing exercises, muscle relaxation, or grounding techniques. Whichever method the individual uses, the point of the exercise is to keep thoughts centered in the here and now.
Journaling is usually prescribed as homework by the CBT therapist. The act of journaling provides the individual with a way of tracking their thoughts and behaviors over time and discovering patterns in their cognitive distortions. It is a valuable tool for helping the individual gain insight into their irrational thoughts and beginning the process of cognitive restructuring.
Examples of CBT for Panic Disorder
Cognitive Behavioral Therapy utilizes many techniques when working with anxiety disorders, even when specifically working with panic disorder. The key with any treatment is to tailor therapy to the individual. Treatment for panic disorder may focus heavily on one specific aspect of CBT or a combination of different techniques may be applied. Some patients find different techniques more helpful for them than others, and therapy can be modified to fit the needs of the individual.
For someone suffering from panic disorder who makes the decision to see a CBT therapist, one common and highly effective treatment used for anxiety disorders is exposure therapy. During an exposure therapy session they would be exposed to whatever the stimulus is that triggers their anxiety.
Let’s say a patient has agoraphobia, an anxiety disorder that causes extreme discomfort in public settings in which you feel you cannot escape. When placed in these uncomfortable situations they often experience panic attacks. Now if we use exposure therapy to treat this condition, we would gradually introduce them to the anxiety-inducing environments.
At the start of the session, when introduced to the stressor, their anxiety would increase exponentially. But by staying in the situation and allowing themself to feel the anxiety and adjust to it, they then begin to become desensitized to the stressor. Over time, the anxiety decreases to a much lower, more manageable degree. With repeated exposure therapy sessions, the stressor becomes less and less anxiety provoking.
There are many different relaxation techniques utilized in CBT. Breathing techniques, muscle relaxation, and grounding exercises are among the most common. A CBT therapist would spend time during a therapy session explaining the different procedures they would like the patient to use and then guide them through the exercise until the patient feels comfortable using the technique.
Homework is also usually assigned to practice the techniques outside of the therapy session. With most relaxation skills, the more the individual practices, the better they become using the techniques when they are needed.
These are Specific, Measurable, Attainable, Realistic, and Time-specific goals that are set by the patient with the help of their therapist. What does this mean?
- Specific means that the patient knows exactly what it is they want to accomplish. The goal is clearly defined.
- Next, the goal must be measurable, so the patient will know if progress is being made and when they have achieved their goal.
- When setting a goal it is important to make sure the goal is attainable, that the patient has the skills and resources necessary to reach the goal.
- The goal must also be realistic, meaning that it is something the patient will devote their time and energy into accomplishing.
- Finally, the goal should be time specific. The therapist and patient decide on an appropriate time frame for completing the goal.
It is the therapist’s responsibility to make sure that the patient sets a goal that meets the S.M.A.R.T. goal standard. Failure is more likely to occur when the patient does not set reasonable and realistic goals that are unattainable given their skill level or time frame.4
When setting therapy goals it is important to keep in mind the amount of time you will spend in therapy. For a therapist using CBT, the average amount of time and number of therapy sessions is about one hour every week for approximately five months. This average is dependent on many factors, including specific diagnosis, comorbidity of diagnoses, and severity of symptoms.
Is CBT Effective for Panic Disorder?
Cognitive Behavioral Therapy is a proven method for treating anxiety-related disorders, including panic disorder. In fact, many studies suggest that CBT is as effective, if not more so, than other therapy methodologies. Cognitive Behavioral Therapy is, in fact, one of the few psychotherapy methods that has ample research and scientific evidence to support the claim that CBT is effective in producing change.3
The effectiveness of CBT has been reported by national organizations such as the Mayo Clinic, the National Institutes of Health, and the American Medical Association. A review published by the NIH suggests very strong empirical evidence supporting the use of CBT in treating anxiety related disorders.5
How to Find a CBT Therapist
Because of the proven effectiveness of CBT for treating many mental health conditions, it is one of the most utilized therapeutic approaches used by psychologists, counselors, and other mental health professionals. There are websites available to help in your search for finding a provider in your area with online directories.
Most of these sites also offer you the option to select CBT as part of your search criteria. When contacting a provider, always ask if they are familiar with Cognitive Behavioral Therapy and how much clinical experience they have using CBT.
At-Home CBT Exercises for Panic Disorder
While Cognitive Behavioral Therapy should only be practiced by a qualified and experienced professional, there are certain CBT related relaxation exercises that you can try at home:
Deep Breathing Exercise
A simple deep breathing exercise that can be performed at home is a 4-4-6. To do this exercise:
- Breath in through your nose for 4 seconds.
- Hold the breath in your lungs for 4 seconds.
- Breath out through your mouth for 6 seconds.
Practice this for about 5-10 minutes at a time. This technique can be used to calm your breathing and slow your heart rate when you are feeling anxious.
Progressive Muscle Relaxation Exercise
An easy muscle relaxation exercise to try at home is the progressive muscle relaxation exercise:
- Feet: Curl your toes tightly into your feet, hold for 5 seconds, then release.
- Calves: Point your feet, hold for 5 seconds, then release.
- Thighs: Squeeze your thighs tightly together, hold for 5 seconds, then release.
- Torso: Tighten the muscles of your abdomen, hold for 5 seconds, then release.
- Back: Squeeze your shoulder blades together, hold for 5 seconds, then release.
- Shoulders: Lift your shoulders up toward your ears and squeeze them together, hold for 5 seconds, then release.
- Arms: Make fists and bend your arms in bringing your forearm toward your biceps squeezing the muscles in the arms, hold for 5 seconds, then release.
- Hands: might tight fists by curling your fingers into your palms, hold for 5 seconds, then release.
- Face: Scrunch your facial features and pull them toward the center of your face, hold for 5 seconds, then release.
- Full body: tighten and squeeze all the muscles in your body together at the same time, hold for 5 seconds, then release.
Practice this muscle relaxation exercise daily to release anxiety-induced tension from your body.
While a grounding exercise can be done to keep focus on the here and now by seeking out sensory stimuli in your current environment, this imagery-guided grounding exercise can also be used as a way to calm anxiety:
To begin, think of a place you find comforting. Somewhere in your house, a favorite spot, a beach, or a memory from your childhood. Now spend 5-10 minutes visualizing this place that you have conjured in your mind.
Use your senses to help you:
- What do you see? Look around and take in your surroundings in this space. What can you see in the distance? What do you see close to you? Try to notice small details you might normally miss?
- What do you hear? Listen closely to the noises around you. Are the noises you hear soft or loud? Do they sound close by or far away?
- What do you taste? Are you eating or drinking something? If so, what does it taste like? Is it sweet or savory?
- What can you feel? Is it warm or cool? Is there a breeze? Is the sun shining on you warming your skin? Or are you bundled up in a soft blanket? Concentrate on how everything feels.
- What can you smell? What does the air smell like here? Is the scent strong or faint? Focus on the scents you smell and appreciate them.
Use this exercise to relax your mind when you are feeling anxious or stressed. Spend as long as you need visualizing your comfortable space. Allow yourself to feel calm and safe.