Larry felt his heart beginning to pound. Within 10 minutes he was sweating, trembling and could barely breathe. He began to experience chest pains, nausea and lightheadedness. He was sure he was having a heart attack and was going to die because he was.
Wisely he called the paramedics who rushed him to the emergency room. After a thorough examination the physicians determined he was having a panic attack. Larry was relieved, but wondered if he was going crazy. Could his mind really have caused this?
The ER doctor gave Larry medications to calm him down, and he took them for several months after this episode. But they made him feel sedated, and he learned that people can become dependent on these kinds of drugs. In fact, when he decided to stop taking his prescription he experienced some uncomfortable withdrawal symptoms.
Within a few weeks of stopping his medications Larry had another panic attack. But this time he researched his treatment options. He discovered that something called Cognitive-Behavioral Therapy had been proven to be as effective as drugs in providing people with relief for their symptoms. And CBT was even more effective than medications in preventing a relapse.
The Cochrane Collaborative, an international nonprofit medical review organization, reports that as many as 70 percent of patients are helped by either drugs or CBT in the first few months of treatment. A somewhat higher percentage was helped by a combination of the two approaches.
In the long term, the Cochrane reviewers revealed, patients who received CBT treatment alone did as well as the combination approach in follow-up studies lasting up to 24 months. The Cochrane physicians had bad news for patients who relied on drugs alone – up to 50 percent of patients relapsed within six months of discontinuing their anti-anxiety medications.
The June 2008 Harvard Mental Health Letter reported on another review which concluded there is not enough evidence to recommend combining drug treatment with CBT when treating panic disorder because the benefit of adding medications does not hold up over time. They concluded that since CBT alone provides comparable outcomes in the long run, including drugs in the treatment process only adds to the risk of developing side-effects and dependency.
CBT works by providing people with practical tools they can learn to use to prevent panic. The first principle patient’s learn is that panic is triggered by what they’re thinking. Psychologists refer to people’s thought process as cognition. That’s your automatic self-talk, which involves how you’ve learned to explain events, as well as your assumptions, attitudes and beliefs. Your thoughts determine how you feel, which, in turn, causes you to act the way that you do.
Sometimes you’re reacting to situations that are occurring in the present moment. But many times your behavior is controlled by your ruminating about what’s happened in the past or speculating about what might happen in the future. If your thinking about the past or future is negative, you’ll feel fear. Your body will react as if the images you’re conjuring up in your mind were actually happening right now.
Negative thoughts that cause severe emotional reactions such as panic usually contain serious ‘cognitive distortions.’
When we distort our thinking with faulty assumptions, we create anxiety, depression and problems in our relationships. Most people assume that their thoughts are perfectly rational, so they’re usually unaware of when they have errors in their thought process.
Examples of distorted thinking include all-or-nothing thinking, which prohibits us from seeing a mutually satisfying middle ground.
Sometimes we’ll distort our cognitions by catastrophizing – believing that things will turn out badly when there’s no evidence to support that conclusion. Or we’ll twist our thinking by over-generalizing a single negative outcome into a continuous pattern of defeat.
The goal of CBT is to strengthen the part of our brain that can recognize distortions, solve problems, nurture and affirm us. This happens when we develop a healthy voice that provides a counterbalance to our fear-based voice. CBT therapists teach clients to untwist their thinking in order to have more accurate and adaptive self-talk.
Clients learn to recognize the automatic thoughts programmed into their brains that prompt panic. CBT helps them to change their thinking in order to see positive possibilities instead of overwhelming problems. Envisioning positive outcomes stops panic and enables people to proactively engage their strengths.
CBT also replaces the mental filters that cause poor listening, inept inquiring and negative responding with constructive communication skills focused on clarifying, empathizing, brainstorming and planning.