If you suffer from panic attacks or have been diagnosed with panic disorder, cognitive-behavioral therapy (CBT) may be beneficial for you. Learn about this treatment option and how it can help.
What Is Cognitive-Behavioral Therapy (CBT)?
Cognitive-behavioral therapy (CBT) is a form of psychotherapy that is especially effective for anxiety and insomnia but is also effective for other problems including substance abuse, difficulties managing intense emotions, depression, OCD, eating disorders, and addictions. It is more practical and more skills-based than traditional therapy. CBT therapists typically give patients homework exercises to do between sessions. This homework helps to build the skills needed to address the relevant problem.
CBT includes therapies such as acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), motivational interviewing, behavior therapy, exposure therapy, and others. There is a form of CBT that is specifically designed for panic disorder. This treatment is sometimes called “panic control treatment.” It involves specific exercises that make you less vulnerable to panic attacks and helps you understand why your body is reacting the way it does when you have panic symptoms.
Does CBT Work for Panic Disorder?
Cognitive-behavioral therapy is an effective treatment for panic disorder. In fact, it is a first-line treatment for the condition. This means that mental health providers should provide (or recommend) this treatment first before recommending other treatments. Medications are also considered a first-line treatment for panic disorder.
Generally, if you attend all the therapy sessions and do all the homework exercises recommended by your therapist, you should see significant improvement. Many people see a complete absence of panic attacks and associated avoidance and anxiety.
RELATED: How Avoidance is Making Your Anxiety Worse
What To Expect If You Do CBT for Panic Disorder (Panic Control Treatment)
Learning about panic
Once you’ve been diagnosed with panic disorder and agree to begin CBT therapy for it, the first step involves learning about how panic attacks work physiologically. When you have a panic attack, your brain, nervous system, and body are interacting in specific ways. The more you understand what’s happening, the better positioned you’ll be to do something about it.
Your therapist may also teach you how to breathe during a panic attack. If you’re able to follow these instructions, you’ll likely find that you can make the panic less intense by changing your breathing. (See one example of how this is done here.)
Then you’ll practice doing some exercises with the therapist that determine whether any physical sensations might be triggers for your panic attacks. If so, you’ll practice other exercises to reduce your sensitivity to these sensations. This will help reduce the number of panic attacks you have.
For example, many people with panic disorder can be triggered by the sensations that accompany an increase in their heart rate. In CBT for panic disorder, the therapist might “prescribe” exercises that will reduce sensitivity to these sensations over time. As a result, the patient will be less vulnerable to panic attacks.
You’ll also learn how to think differently in situations that can trigger panic for you. Many people with panic disorder find that their thinking can become distorted in certain situations, which can increase their vulnerability to panic attacks.
Reclaiming your life
Lastly, with your new skills, you’ll practice doing the things that used to give you panic attacks with your new skills. Once you do them without getting panic attacks, you’ll feel much more comfortable doing the things that used to be terrifying.
Which Is the Better Panic Disorder Treatment – CBT or Medication?
A noted 2005 summary of research found that CBT was “significantly more effective” than medication in some studies on panic disorder, and that CBT was overall “at least as effective” as medications for this condition. Some studies show that the combination of CBT and medication is more effective than either one alone.
Often, the decision about whether to do a course of CBT for panic disorder vs medication depends on one’s personal preference. Most people prefer one of these options to the other, and if both are available for you, it may make sense to just go with the one you’re more comfortable with.
RELATED: How to Stop a Panic Attack
One other fact to consider is how long your improvement will last. People who do a course of CBT for panic disorder typically maintain improvement for years. However, people who do a course of medication frequently see symptoms return once they discontinue their medication.
The most commonly used medications are selective serotonin reuptake inhibitors like Zoloft, Paxil, Lexapro, Prozac, and others. Also frequently prescribed are serotonin-norepinephrine reuptake inhibitors such as Cymbalta, Effexor, and Pristiq. Other medications, called benzodiazepines, are used less frequently because they can be habit-forming. These include drugs such as Xanax, Ativan, Klonopin, and Valium. A psychiatrist, psychiatric nurse practitioner, or primary care doctor can prescribe these medications.
Many people with panic disorder have been prescribed medication that they would like to discontinue. Cognitive-behavioral therapy can help people reduce or eliminate their need for medication.
What Else Can Help Panic Attacks and Panic Disorder?
There are several good self-help books that can be very useful for people suffering from panic disorder.
- One is the Panic Attacks Workbook by David Carbonell, Ph.D., currently in its second edition.
- Another is the “Panic Stations” workbook. You can download it free of charge from the Centre for Clinical Interventions in Australia at this page.
- Another recommended resource is a workbook called “Mastering Your Anxiety and Panic” by David Barlow and Michelle Craske, two world-renowned experts in the field of anxiety disorders.
Mindfulness-Based Stress Reduction (MBSR)
Mindfulness-based stress reduction is an 8-week group class that teaches meditation techniques. Research has shown it to be effective for panic disorder (though this research is not as strong as the research behind the first-line treatments described above). You can do it online, e.g., in the class offered by the University of Massachusetts Medical Center’s Center for Mindfulness. However, our recommendation is to do the class in-person locally if possible. To do so in the New York area, look for classes on this site.
Panic disorder is a condition that often improves the more you understand about it. In addition to the workbooks recommended above, you can educate yourself about some important panic disorder concepts such as avoidance or safety behaviors. By learning about these concepts, you’ll get better prepared to benefit from CBT for panic disorder, should you decide to do it.
Finding CBT for Panic Disorder Near You
If you’re looking to start a course of CBT for panic disorder and are in the New York area or Florida, please contact us and we’ll be happy to help you. If you’re outside of New York, New Jersey, or Florida, try the therapist directory at abct.org.