CBT for Panic
Therapy for Agoraphobia and Panic in Canary Wharf
- Do you suffer from panic attacks?
- Do you worry about having another panic attack?
- Has your fear of having another panic attack lead you to avoid certain situations?
- Do you worry that you will lose control, pass out, or even die/have a heart attack during a panic attack?
Panic attacks are frightening. Anyone who has had one will tell you that they feared they were going to die/have a heart attack/stop breathing. Most people with panic disorder live in fear of having another panic attack. If you have had one or more panic attacks, you have probably made certain adjustments to your daily routine in order to avoid particular triggers, e.g., public transport, crowded shops, lifts, enclosed spaces, driving, or being too far away from home, among others.
What is Panic Disorder?
Panic disorder is an anxiety disorder characterized by recurrent, unexpected panic attacks. Panic sufferers typically are diagnosed with or without agoraphobia, depending on how much avoidance plays a part in their symptom presentation.
Some people with panic disorder prefer to be around others during a panic attack as they perceive other people as “safety” signals, whereas other panic sufferers prefer to be alone because they fear others will judge them and they would feel embarrassed or humiliated.
What is a Panic Attack?
A panic attack is a distinct period or episode of intense fear or discomfort that builds suddenly, peaks briefly, and is characterized by a number of physical sensations and frightening conditions.
Typically panic attacks last between 5 and 20 minutes.
Symptoms of a Panic Attack
According to the Diagnostic and Statistical Manual of Mental Disorder (DSM-V) of the American Psychiatric Association, a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time, four (or more) of the following symptoms occur:
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded or faint
- Derealisation (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going crazy
- Paresthesias (numbness or tingling sensations)
- Chills or hot flashes
- Fear of dying
If you have experienced at least four or more of the above symptoms at any one time, you may have panic disorder.
What is Agoraphobia?
Agoraphobia is the avoidance of specific situations because you fear that escape would be difficult if you should have a panic attack, and/or that help would be not be available if you were to develop panic symptoms.
Panic disorder is normally diagnosed with or without agoraphobia. If you have panic disorder with agoraphobia, this means that you tend to avoid the situations that you think will lead you to have a panic attack. You may have a fear of lifts or a fear of public places. Although avoidance of these triggers helps keep anxiety at bay in the short-term, it also means that your world may be gradually shrinking as your anxiety becomes generalized to more and more situations.
Many panic sufferers avoid certain situations completely (i.e., they may walk down eight flights of stairs instead of taking the lift, or or they take the bus instead of the Underground) whilst others might face their fears, i.e., take a lift or the Underground, but they endure it with intense fear and anxiety symptoms.
What is the difference between Panic Disorder and Panic Attacks?
Panic Disorder is the diagnosis you are given if you have recurrent, unexpected panic attacks (the trigger is not obvious and they can happen when you are relaxing or awaking from sleep).
Panic attacks are the key symptom of panic disorder, though you can also have panic attacks with other anxiety disorders, i.e., social anxiety. The difference between social anxiety and panic disorder is that the triggers to anxiety in social anxiety tend to be social-evaluative situations (“performance” situations), whereas the triggers in panic disorder tend to be the actual physical symptoms, or situation where you predict the symptoms will occur (supermarkets, lifts, etc). In social anxiety, the fear is of being judged negatively, whereas in panic disorder, the fear is that the symptoms are dangerous and that something bad will happen.
How Common Is Panic Disorder and What Causes It?
Panic disorder affects 2% of the population. At least one in 10 people experience occasional panic attacks, which are usually triggered by a stressful event.
There are many factors contributing to the development of panic disorder:
Family History: we are all born with certain genes. If you happen to have a family member with a history of panic attacks, you are more likely to develop them yourself.
Traumatic Brain Injury (TMI): it is common for individuals to experience panic attacks after a TMI. Traumatic Brain Injury increases the risk of anxiety symptoms. It is thought that the anxiety is most intense shortly following the TMI when the patient might be experiencing concussion like symptoms. Anxiety can also be triggered by the withdrawal of certain medications, i.e., opioids or tranquilizers.
Stressful events: it is thought that stressful life events like the death of a loved one, marriage, divorce, job change can trigger a panic attack, and if they persist, can develop into panic disorder.
Substance Abuse: abusing alcohol or drugs can lead to panic symptoms, which again, over time, can persist and develop into panic disorder.
Although panic symptoms are scary, the panic response is actually a normal and natural response to fear, which is built into all humans as a way of protecting us from danger.
Fight or Flight
You’ve probably heard of the fight or flight response? The fight or flight response is what your body does to prepare itself for action when you are afraid. It is your body’s instinctual response to fear and is how your body’s automatic response to a threat stimulus prepares you to either fight or flee danger.
In primitive times, when we had to protect ourselves from sabre tooth tigers and other animals in the wild, this fight or flight response had great survival value. In those days, there was real physical threat to our survival.
In more modern times including the present, however, the problem we face is that our panic response sometimes gets triggered when there is no real physical danger. The threats that seem to trigger our body’s panic response nowadays are psychological threats, based on our own subjective perception of the situation. The fear is real, the symptoms are real, but the triggers are actually harmless. It’s as if we talk ourselves into being afraid! After all, there is nothing inherently dangerous about a busy supermarket, a lift, or being far from home. It’s what you tell yourself about the situation that creates the anxiety.
The fight or flight response includes physiological changes in the body including:
- Rapid breathing which allows more oxygen to your muscles to help you fight or flee
- Heart beats faster and harder allowing blood to be pumped around the body more readily
- Blood pressure rises
- Muscles tense up preparing you to jump into action
- Sweating more – fight or flight generates heat
In fact, even now, the fight or flight response would be perfectly appropriate if you stepped out onto the road and realized a car was speeding towards you; the increase in adrenaline would allow you to move out of the way quickly. You probably wouldn’t question the physical symptoms experienced at the time because they would help protect you from being run over.
However, the problem with panic is that the body’s “alarm system” can’t differentiate between a real physical threat (i.e., “I’m about to be run over by a car”) and a modern day psychological threat, i.e., “I’m about to get onto a crowded train” and so it sometimes signals danger when there is none. There is nothing inherently dangerous about getting onto a crowded train, other than the fear of feeling anxious.
Let’s take a look at what happens during a panic attack:
As you can see above, a trigger can be either internal to you (a physical sensation) or external to you, i.e., a supermarket, etc. The trigger is usually enough to get you thinking, “I don’t like this” – you perceive the trigger as a threat, and as something dangerous. This perception of the trigger leads to a state of fear and apprehension, which is usually accompanied by an intensification of bodily symptoms and sensations. These bodily sensations are usually interpreted in a catastrophic manner (“my heart racing means I am going to have a heart attack”), which leads to greater fear and, in turn, an even greater intensification of physical symptoms, and voila! You are caught in a vicious cycle of anxiety and panic!
It is at this point in the cycle that you might seek escape or help because things feel so awful. It’s not uncommon for panic sufferers to call the emergency services (999) because they actually believe they are having a heart attack or dying. Other help-seeking behaviours include sitting down, standing up/pacing, phoning a loved one, drinking some water, going home.
Fear of fear
Anyone who has experienced the physical symptoms of anxiety knows how unpleasant they are and so it is understandable that you would develop a fear of physical anxiety. However, these symptoms are not dangerous, despite them mimicking symptoms of physical health problems like heart problems, balance problems, respiratory problems. Anxiety is not the same as a real physical health problem. That’s great news! Because if you can learn how to respond differently to your anxiety, it will have less of a hold on you and your quality of life will improve.
Why Do I keep having panic attacks?
There are many factors that contribute to ongoing panic symptoms and strong levels of anxiety.
Once you have one panic attack, you become hyper-vigilant (on the lookout) for any sign or symptom that you might experience another. Panic sufferers usually spend more time than most examining their bodies and looking for evidence and signs of abnormality. If you notice your heart beating faster than usual, instead of thinking “oh, maybe it’s because I just ran up the stairs, or had a cup of coffee an hour ago” you might think, “this is not normal – something must be wrong”.
Catastrophizing – the key driver to panic symptoms
Not only do panic sufferers scan their bodies for signs of abnormalities, but as soon as they notice the slightest change in their body (heart racing or feeling a little light headed), they tend to catastrophize the symptom (blow it out of proportion) and tell themselves that “something is wrong”. This is because once you’ve had one panic attack, you develop a sensitivity to any slight change in your body such that you start to catastrophize even “normal” bodily experiences and sensations.
It is normal to want to avoid situations where you previously felt anxious or panicky, but in the long-term this is not a helpful strategy for overcoming panic, not only because it restricts your life, but also because it stops you from learning that nothing awful happens when you experience panic.
Along with avoidance behaviours, many panic sufferers engage in safety behaviours; these are the actions you take in order to protect yourself from panicking.
Example of safety behaviours include:
- Taking a bottle of water with you wherever you go
- Swallowing or coughing frequently to check that you are breathing
- Carrying anti-anxiety tablets with you in case you need to calm yourself down
- Only going out if accompanied by someone
- Sitting on an aisle seat or near a door just in case you need to make a quick escape
Whilst these safety behaviours may make it possible for you to carry on as normally as possible, in the long-term they only reinforce your fear of panic symptoms because they stop you from discovering what would have happened had you not utilized a safety behavior.
- Sitting down when feeling hot for fear you might faint prevents you from discovering that you might not have fainted if you had remained standing.
- Avoiding caffeine because you fear the onset of heart palpitations means you never get to learn that you can have heart palpitations without it leading to a heart attack
- Always carrying a bottle of water with you (just in case) prevents you from learning that you can leave your home without water and that nothing bad happens
We also know that if you remain in an anxiety-provoking situation without using your safety behaviours, your anxiety will diminish on its own.
What is CBT for Panic Disorder?
Cognitive-behavioural therapy for panic disorder (CBT for Panic Disorder) is an evidence-based, highly effective therapy, which has been proven effective in helping individuals like you overcome panic symptoms.
CBT is recommended by the National Institute for Health and Care Excellence (NICE) in the treatment of panic disorder. CBT involves a variety of tools and treatment techniques, and our work will primarily include:
Cognitive Restructuring: I will help you to de-catastrophize the symptoms you experience so that you can remain rational while experiencing them.
Reducing safety behaviours: learning to reduce your safety behaviours will help you discover that you can venture away from home without a major catastrophe occurring.
Exposure: Facing your fears (whether this is an external trigger like a supermarket or an internal one like your own bodily sensations) is a key component of CBT for Panic. Putting yourself in your feared situation, whilst at the same time dropping any safety behaviours, will result in a reduction of anxiety because you will see that nothing bad happens. This will help you gain the confidence to go about your daily life without worrying about having a panic attack.
CBT for panic will help you to think differently about your symptoms and face your fears, so that you can start to live life to the fullest instead of being restricted by your fears.
Do you still have questions or concerns about panic attack treatment?
Won’t facing my fears make me feel worse?
Sometimes exposure sessions can feel challenging because you are being asked to face the very thing you are afraid of.
In CBT for Panic, you will not be thrown in at the deep end – I promise! The first few sessions involve developing a shared understanding of your difficulties. You will then learn CBT skills to help you manage your fears. You will be equipped to succeed! And, we will always work together at a pace that you feel comfortable with.
I don’t want anyone to know I’m seeing a CBT therapist for panic attacks.
I understand your privacy concerns. One way that I protect your anonymity is by booking meetings so they are spaced out. That way, your session will finish before my next client arrives, and you won’t have to worry about running into someone on your way in or out.
The only time I would need to disclose that you are seeing me is if you were an imminent risk to yourself or to others (see FAQS #8 & #9 for more information).
If I attend during the day, won’t I feel worse when I go back to work? I’ll need to be able to concentrate back at the office.
This is an understandable concern, but most of my clients actually feel that they are able to return to work feeling more positive. They feel pleased that they are taking charge and tackling their problems.
Sometimes, however, sessions can feel emotionally draining, and it can be a good idea to leave yourself some time to process the session and prepare yourself mentally before you return to work. I recommend stopping off at a coffee shop en route back to work to give you time to reflect and regroup before returning to work.
Do you have more general questions about CBT?
What does CBT for panic cost?
Are you ready to take the first step?
If you are ready to address your fear of having a panic attack, and learn how to manage your anxiety better, or if you still have questions about cognitive behavioural therapy for panic disorder at CBT Canary Wharf, please get in touch with me on (020) 7531-1220 to schedule a preliminary phone consultation. I look forward to hearing from you!