CBT for Panic Disorder: A Summary of an Effective Treatment Approach

Identifying an Effective Treatment for Panic Disorder Cardio

If you have been diagnosed with a panic disorder, or if you think you might be struggling with panic attacks, therapy can be a helpful way of getting relief and finding ways to cope with future anxiety. Deciding on the right treatment for you can feel overwhelming, particularly if you have never been in therapy before. Fortunately, standards for evidence-based practices have been established to help you determine exactly what treatment will be most helpful in treating your panic. According to the best practice guidelines, Cognitive Behavioral Therapy is the treatment with the most evidence for its efficacy of the treatment of panic disorder. Below we will take a look at the common components of CBT treatment for panic.

According to National Institute of Mental Health, individuals with panic disorder experience “sudden and repeated attacks of fear that last for several minutes or longer.” The disorder is associated with an intense fear of losing control and can be accompanied with painful physical symptoms including racing heart rate, difficulty breathing, sweating, dizziness, and chest pain.

Given the prevalence of panic disorders, a great amount of research and clinical trials have been conducted in order to determine the most effective treatment for this disorder. Cognitive Behavioral Therapy (CBT) has been found to be the psychosocial intervention with the most evidence. (Pharmacological interventions, while also supported by evidence, are beyond the scope of this blog post and will not be discussed further here.) Given the strong evidence for CBT for panic disorder, many protocols have been developed. While some variations between protocols may exist, these treatments typically involve similar core components of CBT.

Core Components of CBT


Evidence-based treatments such as CBT typically begin with a “psychoeducation” phase in which information is provided to you about your disorder and about the treatment you are consenting to engage in. For panic disorder, this educational phase will likely involve information about the nature of panic attacks including causes, common symptoms, information on the function of your body’s “fight or flight” system, potential situational triggers, and an identification of unhelpful means of coping that may be maintaining the panic (e.g., avoidance).  Also in this phase of treatment, your therapist will likely inform you about certain medical conditions that may contribute to panic symptoms and refer you to a physician if necessary. A psychiatry referral for a medication evaluation may also be discussed.

Cognitive Skills

As the name suggests, CBT treatment is broken down into cognitive and behavioral skills. The cognitive skills of CBT usually begin with an explanation of how our thoughts influence our emotions and our behaviors. This is particularly important in the treatment of panic disorder where anxious thoughts can often contribute to the onset of panic. For example, if you have the thought “I always have a panic attack at the grocery store,” what do you think will happen to your emotions next time you are preparing to go to the grocery store? You will become anxious, right? And will that anxiety make it more or less likely that you will panic? I’m guessing it will make it more likely.

Given the cyclical nature of thoughts and emotions (negative thoughts lead to anxiety which leads to more negative thoughts, etc), it is important to learn how to evaluate anxious thoughts for their accuracy. In CBT treatment, you learn how to evaluate your thoughts and to develop more accurate appraisals of a given situation. Skills you may learn include identifying thinking traps (also called cognitive distortions), learning to estimate the odds of a feared situation occuring, learning to gather evidence for and against your thoughts, and learning how to stop yourself from jumping to conclusions. In the example above, the therapist may help you to identify that you are using “black and white thinking” by using the word “always.” Using learned skills the therapist will then help you to remove this “thinking trap” in order to develop a more balanced thought such as “Even though I had a panic attack at the store last week, on most occasions I have been able to complete my shopping without panicking.”

Behavioral Skills

Behavioral components of CBT typically involve methods of managing physical symptoms (e.g., diaphragmatic breathing), identifying/reducing avoidance behaviors and developing plans for facing situations that cause you fear. The purpose of these “exposures” are so that you can learn that your fears are often not as bad as you expect them to be and that you can handle them better than you think you can. For the treatment of panic disorder, exposures to feared experiences often fall into two general categories: confronting the physical symptoms of panic and confronting the situations where you fear panic may occur.

Returning to the example above, if your fear is that you will panic at a grocery store, you and your therapist will come up with a series of exposures that will help you to face this fear. Perhaps you will plan several trips to the grocery store during which you will observe whether or not your feared outcome occurs. You may also plan an exposure to face one or several of your feared panic symptoms (hyperventilation, for example) while at the store. The exposures will help you to learn new information about the likelihood of your fear (in this case, panic) occurring as well as your ability handle the feared situation.

Taking Charge of your Panic

When done with a qualified professional, CBT treatment for panic disorder can be quite effective. If you have been experiencing the symptoms of panic and/or think that CBT treatment may be right for you, please contact us to find out more or to schedule an appointment. You may also find useful resources such as Mastery of Your Anxiety and Panic on our CBT Resources page.

Anna L. Lock, Psy.D, Director of Training | Behavioral Associates Los Angeles

Behavioral Associates Los Angeles is a group of cognitive-behavioral therapists specializing in the treatment of anxiety and mood disorders. To find out more, contact us by phone at 310-205-0523 or by email at treatment@behavioralassociatesla.com.

You can also request an appointment with a Behavioral Associates LA psychologist by submitting a brief patient assessment form on our Website. Our clinical staff will follow up with you within 24 hours of submission.