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CBT for panic disorder

Some really positive things can be said about therapy, although those positive things don’t include cost or universal competence of therapists.  If you are going through a difficult period in life, such as a divorce or death in the family, a therapist may be of great help.  It is your first divorce, it is the therapist’s 450th.  Your therapist has seen all the petty, self-defeating things people do during the quasi-psychotic period of relationships endings plus the feelings that accompany the changes.  Think of her as your guide through a maze, serving to at least to advise you from doing gold-plated, guaranteed stupid, self-serving things and wasting your limited emotional resources on various forms of Revenge and dwelling on topics that can be summarized as “my life is ruined and I will never be even passingly happy as long as I live”.

For panic disorder, the party line (carefully copied onto many Web sites) is that cognitive behavior therapy (CBT) will fix your panic disorder right up.  CBT contains elements of relaxation therapy, exposure therapy, and how-your-thoughts-are-screwing you- up analysis.  The basic premise of the last element is that we have negative thoughts and those thoughts cause us to be stressed or depressed, so can panic be far behind?.  There are lots of these Nasty Thoughts that have their very own names: Generalization, Fortune-telling, Magnification, Mind Reading, etc.  For example, if you get a haircut and a friend says, “hummm…I liked your hair better before you got it cut”, you might Generalize that to, “everyone in the world hates my new haircut’, which is just down the street in the psyche to “everyone in the world thinks I’m unattractive”, which could lead to “I can’t go out of the house until my hair grows back”.  The CBT approach would be to point out that your friend didn’t say the new haircut was uncomely, simply that they liked the old haircut better-and besides, that was just one opinion, perhaps the next thousand people will congratulate you on your choice of follicular arrangement.  So, like, chill.  Another aspect of CBT is sometimes Interoceptive Desensitization/Symptom Induction; for example, intentionally making a patient dizzy to demonstrate to them that dizziness is not always followed by panic; a technique somewhat akin to having a person play a game of Russian Rolette to convince them that the consequence of pulling the trigger isn't always  bad.

 CBT has become ubiquitous worldwide as a prison activity, so taking CBT on the “outside” has the additional advantage that if you get busted, you’ve got a shot at being a star pupil in your  “CBT for Felons” class in the slammer.

Wait, you say, it seems to me I have negative thoughts because I’m depressed or stressed, not the other way around; might CBT not have the proverbial cart before the horse?  Maybe, but luckily for all concerned, it will be pretty hard to prove one way or the other (although one insightful researcher measured periods of panic during dream-free states of sleep; hard to postulate thought/panic causation in the absence of thoughts).

The obvious question, for which many studies have been designed and executed to try and answer, is “does CBT really help with mitigating panic disorder?”  A realistic answer might be "sometimes".  But don't count on it.








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