Cognitive Restructuring for Panic Disorder

A CBT Technique to Change Negative Thinking

Cognitive Restructuring.

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Several theories of psychotherapy are founded on the notion that mood and anxiety disorders are largely caused by faulty thinking patterns. Negative thinking can be a major issue faced by people with panic disorder. Also known as cognitive distortions, these negative thinking processes may contribute to panic and anxiety symptoms.

Cognitive behavioral therapy (CBT) is one form of psychotherapy that is based on the idea that our thoughts influence our feelings and behaviors. Thus, those with a pessimistic view of themselves and the world around them will be susceptible to issues with depression and anxiety. CBT focuses on reinforcing healthier ways of thinking and behaving.

Cognitive restructuring is one type of CBT technique that is designed to help change cognitive distortions.

By restructuring one’s negative thought process, a person with panic disorder may be able to let go of some stress and feel less anxious.

The following describes cognitive distortions and how cognitive restructuring can help you overcome this faulty way of thinking.

Understanding Cognitive Distortions

There are many types of cognitive distortions that may influence feelings of fear, stress, and anxiety. The most common faulty thinking patterns include all-or-nothing thinking, should statements, blame, and labeling. Listed below is a brief summary of these typical cognitive distortions:

All-or-Nothing Thinking – This distortion involves only seeing the extremes, without noticing any gray areas in between. Life is either good or bad. A person is either a total success or a complete failure. People with panic disorder often see themselves as overly nervous or frazzled, without accounting for all the times they remain cool, calm, and collected.

Should Statements – When going along with this cognitive distortion, the person will use self-statements that involve the terms “should,” “ought,” or “must.” A panic disorder sufferer may think to himself, “I must control my panic attacks or others will think less of me,” I ought to be able to get over my anxiety already,” or “I should be able to overcome my fears without any help.” Such negative self-statements can lead to a lowered sense of self-esteem and unhappiness.

Blame – Far too many people with panic disorder blame themselves for their condition. For example, a person may think to themselves, “My panic symptoms are all my fault.” Blaming others can also be a negative thinking pattern in which the person begins to believe that others are the source of their problems or responsible for their anxiety.

Labeling – This common cognitive distortion often entails negative statements about oneself. A person with panic disorder may label himself as “crazy” or “neurotic,” which can make him feel pretty hopeless about his condition.

How To Use Cognitive Restructuring

Cognitive restructuring can be an effective way to get past these and other cognitive distortions. This technique involves identifying, challenging, and changing your negative thoughts. Follow these steps to start overcoming your habitual and pessimistic ways of thinking:

Notice Your Thoughts

Changing the way you think begins by paying attention to your thought process. Spend some time throughout your day self-reflecting on the way in which you think. This may seem really strange at first but will become more natural with practice. To help you remember this initial step, it may be beneficial to keep a journal or other record of your thoughts. Jot down a few notes throughout your day, tracking your typical thought process.

Once you’re in the habit of bringing more awareness to your thoughts, start to recognize when you are using cognitive distortions. Are you frequently labeling yourself as an “anxious person?” Have you been blaming family members for your panic attacks? Do you put yourself down about your struggle with anxiety? Again, take some notes throughout the day and notice how often you a falling victim to cognitive distortions.

Dispute Your Negative Thoughts

Now that you recognize your cognitive distortions, it is time for you to challenge them. You start by using a negative thought that seems to come up often throughout your day. For example, perhaps you notice that you experience a lot of should statements. Take a piece of paper and fold it in half. Label the top of the left column “Should Statements” and the right side “Realistic Thoughts.”

Under the “Should Statements” column, write a should statement that you recently experienced, such as “I should always be able to control my nervousness.” Think about this statement for a moment. Is it necessarily true that you should always control your feelings of nervousness? Think about some ways you can dispute this idea, making it a more realistic statement. For instance, you may think, “Everyone feels nervous from time-to-time. I am working on ways to control my nerves better and until I can, I still accept myself.” Try performing this activity with all the negative thoughts you experience over a period of three days. Simply write down a negative thought followed by a more realistic way of looking at your situation. If at the end of three days you find that you are more aware of your cognitive distortions, you are ready to proceed to the final step.

Change Your Thoughts

With practice, you will no longer need to write down each negative thought that arises. Instead, you can start to shift your cognitive distortions right away. After you have become more comfortable writing out and disputing your negative beliefs, start to practice changing your thoughts on the spot. For example, imagine that a negative thought like “I am such a failure for feeling so anxious” comes to mind. Rather than writing it down, take a deep breath and think about a way to challenge this thought. You may think, “Well, that’s not really true. I’ve achieved a lot of success in my life despite experiencing frequent panic and anxiety.” Notice if you feel differently after stopping to dispute your thought. You may feel as though some of your negativity has lifted.

Cognitive restructuring can be an effective self-help technique to reduce some of your feelings of stress and anxiety. Keep going through these three steps of cognitive restructuring and you may notice a shift in your way you see the world. Through regular practice, you may take on a healthier and more positive way of thinking.

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Additional Reading
  • Burns, D. D. (1999). Feeling Good: The New Mood Therapy. Avon Books: New York.
  • Burns, D.D. (2006). When Panic Attacks: The New Drug-Free Anxiety Therapy That Can Change Your Life. Broadway Books: New York.