L20 Cognitive-Behavioral Therapy (CBT): Treatment for Panic Disorder?

參考文獻/圖片來源：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

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20.1 Cognitive-Behavioral Approaches

? Places emphasis on both?behavioral and cognitive?techniques

? Includes features of both:

- Time-limited

- Structured

- Focused on the present

- Focused on problems

? Treatments developed for?many mental health problems?with a strong evidence base

Cognitive-Behavioral Therapy (CBT)

? Evaluated in RCTs for many different disorders with?remarkable findings

? Review of 16 meta-analyses (Butler et al., 2006):

- Large effect sizes (d ≥ 0.8) for:

? Major Depressive Disorder

? Generalized Anxiety Disorder

? Panic Disorder with Agoraphobia

? Panic Disorder without Agoraphobia

? Posttraumatic Stress Disorder

? Social Anxiety Disorder

- Superior to antidepressants in the treatment of Major?Depressive Disorder in adults

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20.2 DSm-5 Criteria for Panic Disorder

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Panic Attacks

? An abrupt surge of intense fear or intense discomfort that reaches a peak?within minutes, and during which time four or more of the following?symptoms occur. The abrupt surge can occur from a calm state or an?anxious state:

- Palpitations, pounding heart, accelerated heart rate

- Sweating

- Trembling or shaking

- Shortness of breath

- Choking sensation

- Chest pain or discomfort

- Nausea or abdominal distress

- Feeling dizzy, unsteady, lightheaded, or faint

-?Chills or heat sensations

-?Numbness or tingling sensations

- Fear of losing control

- Fear of dying

- Derealization (feelings of unreality) or?depersonalization (detached from oneself)

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? Recurrent, unexpected panic attacks

? At least 1 attack has been followed by 1 month (or more) of one or?both of the following:

- Persistent concern or worry about additional panic attacks or their?consequences (e.g., losing control, having a heart attack)

- Significant maladaptive change in behavior related to the attacks?(e.g., avoidance unfamiliar situations)

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? The panic attacks are not the direct result of?substance use or a medical condition and are not?restricted to the symptoms of another mental?disorder (e.g., specific phobia, PTSD).

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20.3 Cycle of Panic

20.4 Key Components of CBT for Panic Disorder

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Components of CBT for Panic Disorder

? Education & Monitoring

- Introduction

- Negative Cycles of Panic

- Learning to Record Panic and Anxiet

-?Panic Attacks are Not Harmful

? Breathing Skills

? Thinking Skills

? Exposure?-?Facing Physical Symptoms & Feared Activities

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Rationale for Recording Panic & Anxiety

? Recording panic attacks and anxiety helps clients:

- Feel more in control by being able to identify when/where panic?attacks are likely to occur

- Identify specific ways in which they experience anxiety (i.e.,?physical feelings, thoughts about them, and behaviors)

- Judge your level of panic and anxiety more accurately

- Evaluate the success of your attempts to change

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The Anxiety-Breathing Link

? Over-breathing (i.e., chronic hyperventilation)

-?Indicators: Feeling short of breath, feeling like suffocating, chest?pain/pressure, frequent yawning, sighing

? Diaphragmatic Breathing

-?Breath via diaphragm not via chest

-?Smooth inhale and exhale

-?Normal amount of air

-?Meditative component:

? Count as breath in

? “Relax” as breath out

? Focus on breath

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“Thinking Skills”

? Challenging relationships between Thoughts ? Emotions

? Identifying negative?thoughts

? Evaluating odds of a?feared negative event

? Challenging negative?beliefs/perspective

Exposure Activities

? Create hierarchy of feared sensations and situations

? Situational Exposure

????????- Facing a feared situation (e.g., going to a store, driving on a?bridge) and learning something from it

????????- Steps in exposure typically include:

????? Identify specific worries/fears in the situation

????? Establish best conditions to disconfirm worries/fears

????? Envision ways to manage the fear in the moment

????????-?Using breathing skills and thinking skills

????????-???Recognizing probabilities

????? Evaluate what was learned

????? Interoceptive Exposure

????????- Facing feared sensations within the body (e.g., racing heart,?trouble breathing, chest pain)

????????- Specific activities done in session