Treatment of Panic

Cognitive Monitoring and Cognitive Restructuring

Treatment begins with detailed recording of panic attacks. The patient should note the situation, the level of anxiety (0-10), the exact physical symptoms and, crucially, the interpretation of those symptoms ("I thought I would faint").

Cognitive restructuring is then applied to discuss these interpretations. Evidence is questioned: "How many times have you felt that dizziness? Have you ever actually fainted?".

Physiology is explained: in a panic attack blood pressure rises, whereas in a fainting spell it falls; therefore, it is physiologically unlikely to faint during a panic attack.

The goal is to change the label from "Life-threatening" to "Harmless anxiety symptom".

Interoceptive Exposure (Symptom Induction)

In order for the patient to lose the fear of his or her own bodily sensations, interoceptive exposure is used.

It consists of deliberately inducing, in the office, the symptoms that the patient fears, so that he/she can verify that they are safe and transitory. If the patient fears tachycardia, he is asked to run on the spot.

If he fears choking or dizziness, he is asked to breathe through a thin straw or to hyperventilate in a controlled manner or to spin in a chair.

By eliciting the sensation and seeing that no catastrophe occurs (no death, no freaking out), the association between physical sensation and imminent danger is broken.

Elimination of Safety and Acceptance Behaviors

Finally, work is done to eliminate the safety behaviors that maintain the disorder.

Many patients believe they survived the attack because they sat up, drank water, called someone, or leaned against the wall.

The therapist should encourage the patient to face the feeling without doing anything to "save" himself, thus demonstrating that the anxiety decreases on its own due to the body's natural habituation.

An attitude of acceptance of the symptom is promoted: instead of fighting the tachycardia (which increases it), the patient is taught to "let the sensation be", observing it as a wave that rises and inevitably falls, without trying to control it.

Summary

We begin by monitoring seizures and debating catastrophic interpretations. Evidence of medical dangers is questioned, changing the cognitive label of "imminent death" to "harmless anxiety symptom."

Interoceptive exposure seeks to lose fear of bodily sensations. Feared symptoms (dizziness, tachycardia) are deliberately induced to prove that they are safe, transient and do not cause the imagined disasters.

Finally, safety behaviors are eliminated. The patient faces anxiety without "crutches" to learn that discomfort decreases naturally by habituation and acceptance, without the need to fight against it.