The process of recovery is learning to lose our many and varied fears. Once we lose our fears we lose our disorder ! Waiting for our fears to disappear before we start the recovery process is defeating ourselves from the outset.
Jasmine: How would you start with someone with panic disorder, when they first come to you to start working with their thinking?
Chris: By a very careful cognitive behavioural assessment of the person with the disorder. First of all you want to know what their beliefs are about how they developed the disorder. You want to know what their beliefs are about their symptoms. You want to know what kind of avoidance behaviours they might be engaging which continue to maintain the symptoms.
For example, people might be avoiding watching things on TV for fear that if they see something about somebody who has something, it might make them worse hearing about it. Once you think about that, you can see that there is a fair amount of room for cognitive distortions. You know, people are certainly unique, and I think there are many commonalities between people with panic disorder, but each case is unique and you really do need to assess the individual or idiosyncratic beliefs of the individual.
Once you have assessed them, the sorts of therapies that you generally do go over a whole range of issues. There are some cognitive strategies that you use, in addition to that there are a number of behavioural strategies.
Jasmine: So does that include graded exposure to some extent?
Chris: No. I think people are changing their beliefs about what graded exposure means. In terms of graded exposure for cognitive therapy, certainly you may use some kind of exposure, but what we do is use a number of behavioural experiments. That is, a person may go out and test a belief they have about a certain situation. Now, before the person goes out, they are certainly armed with a number of strategies that they can use to help them overcome their beliefs in that situation.
Jasmine: That is the clue, what is termed as graded exposure is not simply just forcing yourself into a situation without any strategies. You know the theory, exposure to a situation therefore you'll lose the fear. You must have strategies to work with in the situation.
Chris: Yes. You certainly do. I think that approach is fairly naive and doesn't work with many people.
Jasmine: And rather cruel I feel.
Chris: A definition of the cognitive theory of panic; people who experience recurrent panic attacks, they are said to do so because of a relatively enduring tendency to interpret body sensations as catastrophic. OK, so the sensations interpreted are normally those associated with ordinary anxiety responses such as being breathless, having palpitations, feeling dizzy, experiencing numbing of the extremities. So these are all ordinary sensations.
Now what seems to happen is that when a person develops panic disorder there is generally an increased sensitivity to all bodily sensations, so the person begins to interpret what are still normal body sensations as meaning that something quite bad could occur.
The difficulty with Panic Disorder is generally people fear that something is about to occur right then and there. For example, a person might have panic disorder for many years and fear having a heart attack. But all of the evidence is that they haven't had one over all of the years that they have feared it, is insufficient evidence to contradict the belief that they might have a heart attack in the next minute, next hour, or the next day. So consequently, cognitive therapy helps the person address those issues.
I don't think it is a matter of simply telling the person their thoughts are incorrect, or that they have nothing to worry about because family members have been doing that all along and it doesn't seem to help. It is a matter of helping to guide the person to discovering their own evidence which either supports or doesn't support their beliefs about their symptoms.
