Look out! IT’S PANIC!!! Many clients experience it at different times. So what do therapists do to help, especially when panic attacks arise frequently or enough to really affect people’s lives? Luckily, established treatments for panic attacks is one of mental health’s best treatments.
Panic attacks come on for clients anywhere from once a year or less to everyday. The DSM defines panic disorder as panic attacks that are accompanied by additional symptoms, such as persistent concern about future attacks lasting at least a month. But any frequency of panic attacks can be extremely distressing, whether they come on “cued” with clear noticeable negative or catastrophic thoughts, or “uncued” without any identifiable onset.
Panic disorder usually involves the elevation of a sympathetic nervous system response (e.g., racing heart, increased breathing). As that response elevates, the individual grows increasingly fearful that something terrible is happening to them physically.
For example, as a client’s breathing increases, they begin to believe they cannot breathe or that they are having a heart attack. Those thoughts of physical catastrophe lead them to grow increasingly fearful and to panic even more in the moment. That increasing fear leads to increasing panic, and the cycle “snowballs” into a full-blown panic attack.
Interoceptive exposure is a well-established approach available for therapists to help clients learn to break this cycle. This form of exposure is one of mental health’s most effective treatments for any mental health difficulty. You might not hear about it much, but it’s tried and true.
Interoceptive exposure with CBT shares some similarities with other types of exposure (e.g., prolonged exposure for PTSD, ERP for OCD, exposure for anxiety and phobias). It helps clients retrain their nervous system to stop fearing bodily responses as they unfold. This is done by exposing clients to these sensations and examining the accuracy of associated catastrophic thoughts.
This approach involves creating a safe space within the therapy room. In this space, the individual can fully attend to their physiological responses, their thoughts about those responses, and the accompanying emotions of fear or panic. The therapist helps the client recognize, in the moment, that although panic is frightening, it does not inevitably lead to physical harm. That people do not die of panic attacks.
Over relatively brief periods of time, clients begin to experience fewer and less intense physiological reactions. As a result, they are less likely to become caught in the cycle of escalating fear that can lead to a panic attack.
Research long finds CBT with interoceptive exposure to be highly effective for panic disorder. Contrary to some assertions, forms of exposure therapy do not physically or emotionally harm clients. In fact, exposure in the therapy room provides a safe, guided space for clients to approach feared stimuli. Otherwise, therapists miss opportunities help clients gain skills when they encounter panic outside of the therapy session. That is, anytime during their entire week, minus 50 minutes in therapy sessions.
So where can you find therapist resources on interoceptive exposure? There is a good training free from NOCD that help therapists learn how to conduct exposure therapy with clients. The University of Michigan also has a really great set of worksheets that help both client and therapist understand exposure, it’s exercises, panic, and provide sheets for tracking and exercises for exposure.
Therapists have plenty of resources to help client not look out too hard when it comes to panic. That’s comforting for client and therapist.
