HOW COGNITIVE BEHAVIORAL TREATMENT WORKS
In order to understand how cognitive behavioral treatment works, you first need to consider why your panic attacks keep recurring.

What maintains them? Why is it so rare to have just one, and so common to have recurrent panic attacks?

In a typical case, a person will experience repeated panic attacks in which he/she fears one or more of the following: death (typically by heart attack or lack of air); insanity; fainting; "losing control" of themselves and acting in such a bizarre manner that they are scorned forever after. Now, the fact is that panic attacks don't cause these catastrophes. If you want to know why, see the article "What Can a Panic Attack Do to You?" But I don't tell you this in the hope that this information will cure you.

In fact, it's more likely to make you think "I bet I'll be the first!" than it is to cure you!

Being told that panic isn't dangerous won't stop anybody's panic attacks. Reading this here, or hearing about it on Oprah, or being told by your physician or therapist - none of that will do the job of ending your attacks.

You could look at your own experience. You could ask yourself "what's the worst thing that ever happened to me as a result of a panic attack?". And you could remind yourself that none of those catastrophes you fear has ever happened to you. That would be a useful thing to do, but it probably won't do the job either.

In fact, it often leads people to feel worse, because they think "I've been lucky so far but the odds in favor of dying (or whatever) keep going up!".

If you're like most people with panic attacks, you tend to explain your survival by crediting factors other than yourself - for instance, that you were lucky; or only survived because you were interrupted by a friend's arrival; or because you remembered you had medication with you; or were because you were distracted by something.

Now, the fact is that you survived intact simply because you're not such a frail creature as to be killed, or rendered insane, by fear, no matter how sudden and intense. But I know simply telling you that isn't going to do the job.

Or maybe you can agree, when you're not having an attack, that they aren't really dangerous. Maybe you're like the people I've worked with who say "I know it's not dangerous, but when I have one, I forget that. My emotions overrule my logic, and I get convinced I'm going to die then, even though I know right now it's not true", And so that person flees the situation, or avoids it entirely.

What keeps the panic attacks coming? Ultimately, it's the avoidance and resistance that people engage in. It's ironic - the very things they do in an effort to help themselves are what make it worse. Because people avoid panic, and struggle against it when it occurs, it becomes more entrenched and they become more fearful. They don't get the opportunity to learn that they can handle and survive a panic attack all on their own. They don't get the chance to practice coping methods by which they can calm themselves down, and become more confident in their use.

If you wanted to learn tennis, you would first learn a few basics and practice them on your own (hitting a ball against a playground wall, or returning balls fired by a throwing machine) until you had mastered them somewhat. If that's all you did, you'd never become a tennis player.

To become a tennis player, you'd have to find an opponent to play against, and hopefully someone just a little better than you so you could learn from playing that person.

That's how you learn a new skill and get better - you practice! And that's what you need to do with panic attacks.

So, in order to bring recurrent panic attacks to an end, you need to do something about what maintains them. What maintains them is resistance and avoidance. And you can bring them to an end with a program based on coping techniques and progressive exposure.

You learn coping techniques so that you become skillful at calming yourself, rather than getting yourself more afraid.

And you use progressive exposure to practice your coping techniques, first in easy situations and then in situations you find more challenging, in order to build your confidence that you know what to do during a panic attack, and you know how to calm down and handle it.

And as you get better and better with your practice, you develop an answer to all those "What if...?" questions that have been plaguing you. "I'll just do what I did the last time - that worked OK" becomes your answer.

Coping techniques and progressive exposure.

That's how cognitive behavioral treatment works.

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This page was last modified on 6-10-2004.