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Panic disorder: What are some of the cognitive factors?
 Many
people with panic disorder have stated that they experienced their
first panic attack in conjunction with stressful life experiences such
as childbirth, separation or loss, moving, physical illness or
relationship conflicts. However, that does not apply to everyone with
panic disorder. Some individuals have stated that the precipitating
factors cannot be identified or that preceding factors in their life
did not seem to be intensely anxiety provoking. In most cases
however, the first panic attack is usually misinterpreted by the
individual as intense or catastrophic. The panic attacks that
subsequently follow become associated in an individual's mind with a
variety of experiences or stimuli such as open spaces, crowded public
places, situations in which they cannot escape from such as elevators,
trains, planes and automobiles. They can also be linked to very
specific stimuli such as exercise or an activity that raises the
pulse, dehydration, heights, sudden movements of the head and
dizziness. Individuals with panic disorder and agoraphobia sometimes
report that it seems to help to have a companion or "safety person" to
accompany them in these situations and that it may also help to sit on
the outside of an aisle near an exit, use distraction and wear
sunglasses.
One of the biggest
concerns may be that panic is frequently exacerbated by a person's
cognitive distortions. These distortions usually have a tendency to
focus on the anxiety in an "anticipatory" way (i.e. “I can't go
because I might have a panic attack."), physical sensations (i.e. "I'm
so dizzy I might pass out."), and self-directed criticism (i.e.” I
must be a weak minded person"). Many therapists rely upon cognitive
behavioral techniques that explore and help people to change their
cognitive distortions in working with patients with panic disorder and
agoraphobia. Therapists who use a strictly behavioral approach will
probably ignore the cognitive distortions and focus strictly on
providing exposure to feared situations to reduce the panic or
anticipatory panic. Some of the more common cognitive distortions
include distorted automatic thoughts in the form of personalizing,
labeling, catastrophizing, looking at underlying maladaptive
assumptions, the use of "should" statements”, "if-then", statements
and dysfunctional schemas, which look at basic beliefs in the form of
a individual’s sense of helplessness. A patient's response to their
panic may provide an excellent opportunity to modify and examine their
general cognitive distortions.
Panic Disorders:
Outcome studies for cognitive behavioral treatments:
Outcome studies on
cognitive behavioral treatment for panic disorders have been extremely
favorable with some studies indicating a 75%-90% level of efficacy.
Follow-up studies have found a high level of maintenance of the
original improvement, even two years after termination of treatment.
Many patients who have had cognitive behavioral treatment are much
less likely to rely on psychotropic medications to maintain their
improvement. Interestingly enough, although approximately 80% of
patients on medication show improvement, discontinuation of medication
usually results in a substantial level of rebound panic disorder
symptoms.
Information adapted from Treatment Plans and Interventions for
Depression and Anxiety Disorders by Robert L. Leahy and Stephen J.
Holland
Webpage and additional
information By Paul Susic MA Licensed Psychologist Ph.D Candidate
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