Cognitive restructuring of catastrophic interpretations

Cognitive restructuring is a core technique in Cognitive Behavioral Therapy (CBT) for Panic Disorder.

Its goal is to help the person identify, challenge, and modify the catastrophic interpretations they make of their physical sensations and the likelihood of feared consequences occurring during a panic attack.

Identifying Catastrophic Thoughts

The first step is for the person to become aware of the negative automatic thoughts that arise when they experience feelings of anxiety or during a panic attack.

These thoughts are usually of the type: "I'm having a heart attack", "I'm going to lose control", "I'm going to go crazy", "I'm going to faint", "I'm going to make a fool of myself".

Tools such as self-records are used to identify these thoughts and the situations or sensations that trigger them.

Questioning the Evidence (Socratic Debate)

Once the catastrophic thoughts have been identified, they are then critically examined using Socratic debate.

The person is encouraged to act as a "scientist" and look for evidence for and against the thoughts:

• "What evidence do I have that I am really having a heart attack when I feel palpitations? Has this ever happened before?"

• "What evidence do I have that I am going to lose control or go crazy? How many times has this happened in previous attacks?"

• "What is the actual probability that the catastrophe I fear will occur?"

• "Are there other, less catastrophic explanations for these sensations (for example, that they are normal symptoms of anxiety)?"

Developing Interpretations Realistic Alternatives

The goal of questioning is not simply to deny the fears, but to develop alternative interpretations that are more realistic and adaptive.

For example, instead of "The palpitations mean I'm going to have a heart attack," an alternative interpretation might be: "The palpitations are my body's normal response to anxiety; they are unpleasant but not dangerous, and they will pass."