Cognitive Behavioral Therapy for Panic Disorder

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If you've decided to go to psychotherapy for panic disorder, you may be wondering what your therapeutic treatment options are. Numerous types of therapy are available, depending on your therapist’s approach and training background.

Panic-focused psychodynamic psychotherapy (PFPP) is one such option that's been shown to be effective in treating panic disorder; another effective psychotherapy—often considered to be the most popular type of therapy for anxiety disorders—is cognitive-behavioral therapy (CBT).

Eye movement desensitization and reprocessing (EMDR) therapy is another option that can be effective in the treatment of panic disorder. EMDR is often used in the treatment of post-traumatic stress disorder (PTSD). Researchers suggest that EMDR can be helpful for panic disorder for the same reasons it is useful for PTSD since panic disorder often involves difficult memories and distressing panic attacks.

Due to its proven effectiveness, goal-oriented focus, and quick results, professionals who treat panic disorder often prefer CBT to other forms of therapy. Research also suggests that CBT is consistently more effective than panic-focused psychodynamic psychotherapy (PFPP) as well as applied relaxation training (ART) in the treatment of panic disorder.

The following describes the CBT approach and explains how it's used to treat panic disorder, panic attacks, and agoraphobia.

What Is CBT?

Cognitive-behavioral therapy, or simply CBT, is a form of psychotherapy used in the treatment of mental health conditions. The underlying concepts of CBT are based on the notion that a person’s thoughts, feelings, and perceptions influence their actions and behaviors.

According to the tenets of CBT, a person may not always be able to change their life circumstances, but they can choose how they perceive and act upon life’s ups and downs.

CBT works to help change a person’s faulty or negative thinking, and assists in shifting unhealthy behaviors. CBT is currently used for the treatment of numerous mental health disorders, including major depressive disorder, phobias, post-traumatic stress disorder (PTSD), and addiction.

CBT has also been found to be an effective treatment option for some medical conditions, such as irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue.

Research has also found that internet-based CBT is just as effective as in-person CBT. This could be particularly beneficial in the treatment of panic disorder since it may help people feel that therapy is more accessible and comfortable.

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CBT as a Treatment

One of the main goals of CBT is to help a client overcome negative thinking patterns so that they may be able to make better choices in their actions and behaviors. In general, people with panic disorder are often more susceptible to negative thoughts and self-defeating beliefs, which can result in lowered self-esteem and increased anxiety.

Fearful and negative thinking is often associated with panic attacks, the main symptom of panic disorder.

Panic attacks are frequently experienced through a mix of physical and cognitive symptoms. Typical somatic symptoms include shortness of breath, heart palpitations, chest pain, and excessive sweating. These symptoms are often perceived as frightening and can lead to distressing thoughts, such as a fear of losing control, going crazy, or dying.

Fears associated with panic attacks can become so intense that they begin to negatively impact a person’s behaviors. For example, a person may begin to fear having an attack while driving or in front of other people (thoughts). The person will then avoid driving or being in crowded areas (behaviors).

Such behaviors lead to a separate condition known as agoraphobia. With agoraphobia, fearful thoughts become instilled over time, and avoidance behaviors only serve to reinforce these fears.

CBT can assist people with panic disorder and/or agoraphobia in developing ways to manage their symptoms. A person may not be able to control when they have a panic attack, but they can learn how to effectively cope with their symptoms. CBT assists the client in achieving lasting change through a two-part process.

The CBT Process

  1. Recognize and Replace Negative Thoughts. The CBT therapist will first assist the client in identifying his negative cognitions or thinking patterns. For instance, a person may be directed to contemplate how they perceive themselves, views the world, or feels during a panic attack. By focusing on the thought process, a person can begin to recognize their typical thought patterns and how it influences their behaviors.
  2. The therapist may use a wide range of activities and exercises to help the client become aware of their negative thoughts, and learn to replace them with healthier ways of thinking. Additionally, homework activities are often assigned between sessions to help the client in continually identifying and eliminating faulty thinking.
  3. Writing exercises can be a powerful way to conquer faulty thinking patterns. These exercises may be used to increase awareness of and replace negative thoughts. Some common CBT writing exercises include journal writing, keeping a gratitude journal, using affirmations, and maintaining a panic diary.
  4. Skill Building and Behavioral Changes. The next step of CBT involves building on healthy coping strategies to change maladaptive behaviors. During this phase, the client will learn to develop skills to help in reducing stress, managing anxiety, and getting through panic attacks. These skills may be rehearsed in session, but it's also important that the client practices new behaviors outside of therapy, too.
  5. Desensitization is a common CBT technique that is used to help the client get past avoidance behaviors. Through systematic desensitization, the CBT therapist gradually introduces the client to anxiety-producing stimuli while teaching him how to manage his feelings of anxiety. The person is slowly introduced to more fear-inducing situations, developing ways to cope with panic symptoms through each feared circumstance.
  6. To help remain calm through anxiety-provoking circumstances, relaxation techniques are also learned. These skills assist in managing fears, lowering heart rate, reducing tension, and improving problem-solving skills. Some common relaxation techniques include deep breathing exercises, progressive muscle relaxation (PMR), yoga, and meditation.

A Word From Verywell

As one of the most widely used forms of therapy, CBT may be part of your recovery process. CBT can help in reducing symptoms on its own, but many will find a combination of treatment options to be the most beneficial. Your doctor or therapist can help you determine if CBT is right for you and assist you in developing a treatment plan that will best suit your needs.

8 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Milrod B, Chambless DL, Gallop R, et al. Psychotherapies for panic disorder: a tale of two sitesJ Clin Psychiatry. 2016;77(7):927-935. doi:10.4088/JCP.14m09507

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  6. Stech EP, Lim J, Upton EL, Newby JM. Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis. Cogn Behav Ther. 2020 Jul;49(4):270-293. doi:10.1080/16506073.2019.1628808

  7. MedlinePlus. Panic disorder.

  8. MedlinePlus. Agoraphobia.

Additional Reading

By Katharina Star, PhD
Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness.