Understanding and

Overcoming Panic

Michael Likier, PhD, ACT

NJ Licensed Psychologist

Diplomate, Academy of Cognitive Therapy

Senior Clinician, SMG

June 1, 2017

Goals

• Differentiate between anxiety, panic

attacks, and panic disorder

• Understand the cycle of panic and how

to interrupt it.

• Learn the fundamentals of panic

disorder treatment.

CBT

• Cognitive Behavioral Therapy

• Cognitive – Thoughts

• Behavioral – Actions

CBT Premises

• Thoughts -> Feelings

• Thoughts are not facts!

• Thoughts that produce negative feelings

are often unreasonable

• Change how we think -> Change how

we feel

Anxiety (mw.com)

• An overwhelming sense of

apprehension and fear often marked by

physical signs (such as tension,

sweating, and increased pulse rate), by

doubt concerning the reality and nature

of the threat, and by self-doubt about

one's capacity to cope with it.

Anxiety: Simplified

• Overestimation of probability of danger

• Underestimation of our ability to cope

• RISK/RESOURCE RATIO

Evaluating Anxiety

• What is the fear?

• How likely is this to occur?

• Where’s the evidence for and against?

• How would I handle it if it did?

• What’s a more reasonable way think?

• Test it out!

• Part of the treatment of Panic

Anxiety v. Panic

• Anxiety: fear that something bad will

happen

• Panic: thoughts and sensations that

occur when we strongly believe that the

bad thing is happening/imminent

Panic Attack• The abrupt onset of intense fear that reaches a peak within

minutes

Symptoms I

• Palpitations, pounding heart, or accelerated heart rate

• Trembling or shaking

• Sensations of shortness of breath, smothering

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, light-headed, or faint

• Chills or heat sensations/sweating

Symptoms II

• Paresthesia (numbness or tingling

sensations)

• Derealization (feelings of unreality)

• Depersonalization (being detached from

oneself)

• Fear of losing control, “going crazy,” or dying

• Feelings of choking

Panic Disorder

• Occurs when panic/fear of panic causes

significant impairment

Social

Occupational

Relationships

• Can be concurrent with agoraphobia

Facts I (Association for Behavioral and

Cognitive Therapies)

• 6% - 12% of the general population reports

experiencing a panic attack during a given year.

• 2% - 6% of the general population suffers from panic

disorder in any given 6 month period. 14 million

Americans

• Untreated may result in depression, substance

abuse, missed work, and social disability.

• May occur as early as age 10, typical onset mid-to-

late-20s.

Facts II (Association for Behavioral and

Cognitive Therapies)

• The average age at which treatment is sought

is 34.

• Medical treatment typically sought before

seeking psychological help.

• More women than men are diagnosed with

this condition.

• CBT is the recommended front-line treatment.

Across Cultures I

• Overall endorsement of panic symptoms

similar across racial/ethnic groups in the US.

• Differences may arise in endorsement of

specific symptoms.

• Asian-Americans may tend to endorse

symptoms such as dizziness, unsteadiness,

choking, and feeling terrified more frequently

Across Cultures II

• African Americans may report feeling

less nervous than those identifying as

white.

• Panic symptom severity was not found

to differ across racial/ethnic groups.

Panic Cycle

Goals for Treatment

• What has panic done to your life?

• What do you want instead?

How do we get from here to here?

Rules for Cultivating Panic

• Tell yourself panic is dangerous

• You can’t handle it

• Avoid by any means necessary

• Worry in between attacks

• Use Safety Behaviors (next slide)

• Demand certainty

• Use emotional reasoning

Safety Behaviors

• Things we do consciously or unconsciously to

avoid or escape panic

• Examples

Aisle seat of movie theater

Xanax

Physiological self-monitoring

Mantras

Breathing exercises, etc.

Rules to Beat Panic

• Panic is uncomfortable, not dangerous

• I can and will handle it

• I will create opportunities to practice

• Each attack gives me a chance to get better

• Approach threats

• Encourage panic and anxiety to stay

• Notice urge to use safety behaviors

• Bring it on!

A Metaphor

https://www.youtube.com/watch?v=ebtGR

vP3ILg

• On a scale of 0-100, where 0 is cool as

a cucumber and 100 is extreme panic,

how do you think the girl feels at the top

of the hill?

• How would you feel there?

• Notice her self-talk

Steps of Treatment

(Don’t Panic by Reid Wilson)

1) Evaluate Physical Symptoms

2) Understand Emergency Response

3) Change Your Attitude

4) Use Paradox

5) Practice!

Physical Symptoms

• Rule out any physical cause with

physician

Sinus tachycardia

Supraventricular tachycardia

Emergency Response System

• Blood sugar rises

• Eyes dilate

• Perspiration

• Tachycardia

• Tense muscles

• Hyperventilation

Allows us to respond most effectively.

Attitude Change

• Acceptance of condition

• Bring it on

• Learn skills

• It’s OK to be anxious

• I can let my guard down

• It’s all practice

• Accept uncertainty

• Setbacks are part of the process

Paradox Video

https://www.youtube.com/watch?v=cKUv

KE3bQlY

• Where is the truth in the humor?

• What do imagine George is feeling

when he approaches the woman?

Paradox

• What you resist persists!

• Efforts to avoid increase

• Therefore….

• Efforts to increase, decrease

• Commit to, in order of difficulty

a) Anticipating

b) Observing

c) Intensifying

Medication

• Most people seek medical treatment

first.

• SSRI are preferred to anxiolytics.

• CBT treatment is robust.

• Coming off meds (w/o CBT) usually

leads to relapse.

• CBT recommended as front-line tx.

Further Support

• Enlist significant others

• Be your own support

• Set SMART goals

• Educate yourself, e.g:

- Don’t Panic by Reid Wilson

- Anxieties.com

- Anxiety and Depression Association of America

• Cognitive Behavioral Therapy