today i'm going to be talking about the treatment of panic disorder
and how we go about teaching someone how to control and manage panic attacks
hi everyone in today's video i'm going to be talking about panic disorder and
cognitive behavioral therapy for panic disorder the various different components of treatment
that we go about when we are teaching someone how to overcome panic attacks but before i get
into that just a couple of disclaimers to go over i'm a registered psychologist
in the province of british columbia canada and this video is for informational purposes
only it is not intended as a substitute or replacement for advice from your doctor
or mental health professional now with those things out of the way let's talk about cognitive
behavioral therapy for panic disorder now cbt works really well for a lot of conditions a lot of
anxiety disorders the treatment of depression but panic disorder is one of those conditions
that cognitive behavioral therapy is by far and away the most effective treatment
and so what i'm going to be talking about today is the main components of treatment for panic
and how we go about teaching someone to better understand and better manage their panic attacks
now the first thing to know about managing and treating panic disorder is you have to
understand what's happening in a panic attack and you have to understand the factors that maintain
panic attacks and panic disorder and i've done a couple of videos already describing those
describing the fear of fear model of panic and the two components that maintain panic attacks and
panic disorder and so if you haven't seen those videos what i'd suggest is you stop watching this
video and go and watch those videos i'll leave links to those videos in the description below and
i'll also leave a link up here somewhere so watch those videos because the treatment components
come directly from the model and understanding of what happens in a panic attack and if you
don't know that these treatment components aren't going to make a whole lot of sense
so the the key is to understand the fear of fear model of panic and that panic attacks aren't
caused by physical sensations of anxiety that a person experiences during a panic attack but
that panic attacks are caused by a catastrophic misinterpretation of those physical sensations
so we think about the panic sensations in catastrophic ways in ways that make me more
anxious about the physical sensations and the two factors that maintain panic attacks in panic
disorder is avoidance so avoiding or trying to avoid the physical sensations of uh anxiety
and the physical sensations that a person will experience in panic disorder but also avoidance of
situations or places or activities that may bring up those physical sensations so there's
this general avoidance of doing things that may for example get my heart rate increased or get
me breathing more quickly or get me feeling sort of hot and and uh and sort of stuffy
so i'll try to avoid anything that may bring on the physical sensations of panic and the two
factors and the other factor that maintains panic disorder is this anxious apprehension or this fear
of when the next panic attack might occur so i'm constantly living in this kind of fear this
nervousness or tension about when i might have another panic attack so that's the model and
those are the factors that maintain panic so the first treatment component that we talk about when
we work on panic disorder is relaxation training now there's lots of different forms of relaxation
training so there's things like diaphragmatic breathing there's things like box breathing
or progressive muscle relaxation autogenic training uh visualization there's lots of things
that you can do in terms of relaxation training and if you just google relaxation training or
do a youtube search on relaxation training you'll find lots of really good videos about relaxation
now the key is to understand when to use relaxation training to prevent a panic attack
and why you use relaxation to manage panic attacks in panic disorder
the key is do not and i will repeat this do not use relaxation techniques
to try and prevent a panic attack from occurring so this is one of the biggest mistakes that i see
people will engage in is they start to feel a panic attack coming on and they'll try and calm
themselves down they'll try and use deep breathing techniques or they'll try and relax themselves
this is a big mistake and i'll explain why probably in another video because
it's really important that you don't use these relaxation skills or relaxation tools
to ward off a panic attack if you feel a panic attack coming on you might be wondering okay well
if i'm not supposed to use these relaxation tools and relaxation techniques
to try and prevent a panic attack from coming on when am i supposed to use them or how am i
supposed to use them well the idea is to to sort of imagine that this is the threshold
that you need to hit to experience a panic attack and because of that anxious apprehension your
level of tension and stress is right here well it doesn't take a lot
of sort of stress or tension or pressure for you to bump up there and hit that threshold
and so if you're always here because you're kind of anxious or stressed about potentially having
another panic attack then you're really close to that threshold and it doesn't take much to
hit that threshold and to cause you to have to start or enter into a panic attack so the
idea of relaxation training isn't to change the threshold but the idea of relaxation training
is to bring down your overall level of stress and tension and so now because you've been regularly
practicing relaxation training it takes a lot more and a lot more stress to hit that threshold
so that's how you use relaxation skills it's not to prevent a panic attack from coming on
when you feel yourself starting to feel panicky or anxious but it's to bring down that overall level
of stress and tension so that it takes more to hit that panic threshold
so that's really important and again i'll emphasize do not use these relaxation skills
to try and ward off or prevent a panic attack use them at times when you're not experiencing
panic or anxiety just as a way of bringing down your overall level of stress and tension
the second component of treatment is exposure now exposure and panic disorder
can take a couple of different forms now one of them is really counterintuitive and for a
lot of my clients tends to be the scariest thing when we talk about how you manage panic attacks
and this is something called intraoceptive exposure and what interceptive exposure is it's
intentionally bringing on the physical sensations that you fear in a panic attack so
when i've got when i'm working with clients we'll do things like intentionally hyperventilate to
bring on those physical sensations that come when you hyperventilate so
lightheadedness hot and sweaty heart racing feelings of nausea will get people who
if uh they're one of the panic sensations they fear is dizziness i'll get them to sit in a
chair we'll spin the chair around and around and around to bring on that sensation of dizziness
if the feared sensations are my heart racing well what we'll do is we'll
run on the spot really quickly for 30 seconds or a minute or run up and down stairs for 30 seconds
or a minute and then stop suddenly and then get a person to notice how hard their heart is beating
for people who fear that sensation of choking will will get ties and will actually
tie a tie around your neck and tighten it up so that it it is does feel a little bit harder to
to breathe will do things like straw breathing so there's lots of different things that we can do
that mimic or bring on the physical sensations that a person will experience
in a panic attack and so the question you might be asking is why in the world would we do this
why in the world if i'm afraid of my heart beating quickly if i'm afraid of feeling dizzy or nauseous
if i'm afraid of that sensation of my throat being tight or not being able to get enough air
why in the world would i do anything that would bring on these physical sensations
well that's the answer it's because you're afraid of these physical sensations we want to do
exposure to those physical sensations essentially breaking the link between the physical sensations
and those uh-oh thoughts that i talk about in the fear of fear model so by bringing on
these physical sensations over and over and over again what happens is you become more familiar
or more used to those physical sensations outside of the context of a panic attack
so the idea is you know where these physical sensations are coming from you know you've
brought them on yourself so you don't experience those uh-oh thoughts when you have these physical
sensations and the more you can have these physical sensations without the uh-oh thoughts
the less scary they become and so what you do is you break this link between the physical
sensations you experience in a panic attack and the uh-oh thoughts that actually cause
a person to experience a panic attack and so the physical sensations become very familiar
and so you practice regularly hyperventilating or breathing through a straw and then what happens in
your day-to-day life when you start to feel some of those physical sensations come on
the first thought isn't oh the first thought is oh this is familiar this feels a lot like
what it was like when i did my hyperventilation practice at home so the physical sensations
lose some of their scariness and you don't immediately jump to those uh-oh thoughts now
another form that exposure can take is exposure to those situations or places or activities that
a person will avoid because they fear bringing on the physical sensations of anxiety so
i'll get people to do homework such as going to the gym and working out i'll get people to
intentionally drink a cup of coffee if they've avoided drinking coffee because they're afraid
that the coffee makes them feel panicky or anxious what we'll do is we'll get a person
to drink coffee to bring on those physical sensations one of the things people will do
is they'll they'll avoid things that might get their heart rate going or get themselves
kind of really excited and so sometimes what can happen is people will avoid sex
and so one of the more fun homework exercises i get to assign people is you know go home and
have sex and bring on those physical sensations and tolerate them without jumping to those uh-oh
thoughts so what this exposure does is it really begins to sort of open up a person's world and
allows them to get back to doing activities and going places that they've been avoiding
because they were fearful of bringing on the physical sensations but because you've
already done the interceptive exposure where you've gotten used to the physical sensations
those physical sensations coming on when you go to the gym aren't as scary anymore because you've
broken that link and that connection between the physical sensations and the other thoughts
and the third component of treatment cognitive behavioral therapy for panic disorder
is cognitive therapy techniques to actually challenge those uh-oh thoughts
to actually look at the uh-oh thoughts that you might be experiencing that's causing these
panic attacks and to evaluate whether or not these uh-oh thoughts are real or accurate are realistic
so challenging the thoughts and and learning ways to talk back to the thoughts when you
start to feel them coming on or when you start to have some of these thoughts at the beginning of
a panic attack so challenging thoughts like if my heart's racing i'm having a heart attack or
i'm gonna die or if i start to feel light-headed or dizzy i'm gonna pass out in this situation or
other people are gonna notice if i'm having a panic attack and it's gonna be really embarrassing
so this third component of treatment is really targeting the uh-oh thoughts and really sort
of getting at those uh scary thoughts that people will have during a panic attack that really drives
the panic attack and so if you can learn ways of challenging those scary thoughts and changing the
way you think about the physical sensations and the meaning of the physical sensations
you're not going to experience the anxiety you're not going to hurry up and tense up the
physical sensations aren't going to increase and you don't enter that fear of fear cycle
so if you think about our fear of fear model of panic these various treatment components these
three treatment components are attacking different parts of this model so the relaxation training is
really getting at that anxious apprehension and reducing the overall levels of anxiety and stress
that you might be experienced that you might be experiencing
which means you're not as close to that threshold for the sensations to increase
to trigger a panic attack the exposure exercises both the interceptive exposure and the natural
real world exposure what that does is it breaks that link between the
physical sensations that you experience during a panic attack and the uh-oh thoughts and the
cognitive therapy or cognitive restructuring really targets those uh-oh thoughts and
helps you think about these physical sensations in a different way in a less scary way so that you
don't fuel this fear of fear cycle with the way that you're thinking and so thoughts become less
catastrophic and you don't enter that fear of fear model so all three of these treatment components
work together to help cut off the fuel supply of this fear of fear model and panic attacks and help
a person overcome and manage their panic disorder but the key first component is understanding that
model and so that's why i really spend a lot of time emphasizing and explaining the model of panic
and the factors that maintain panic disorder so uh i hope that's been helpful to give you a sense of
how we go about treating panic disorder i'll be doing some other videos specifically about talking
about ways of challenging catastrophic thoughts and overestimating thoughts in in panic disorder
so i'll be doing a video about that in the future so keep an eye out for that i'd love
to hear your comments or thoughts about anything i've talked about in this video so please leave
me some comments in the comment section down below i hope you're enjoying my videos if so and
and if you want to see more please hit that subscribe button and notification bell
and you'll be alerted every week when i post a new video so that's it for today's video thank
you for making it all the way to the end of this video and i will see you in the next one