Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.
Changes or goals might involve:
A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past.
They concentrate on a person’s views and beliefs about their life, not on personality traits.
Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families.
Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.
HOW TO GET HELP:
If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet.
You may, or may not, find a competent therapist in this manner.
It is wise to check on the credentials of a psychotherapist.
It is expected that competent therapists hold advanced academic degrees.
They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association.
Of course, they should be licensed to practice in your state.
You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations.
You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"
The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition.
These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.
A panic attack is an alarm reaction. When real danger is present (such as
when one’s life is being threatened), the alarm is a “true” alarm. In panic disorder,
the panic attacks are “false” alarms, because the feeling of the alarm
occurs even though there is no real danger.
A panic attack is defined as a sudden rush of intense fear or dread, which
usually goes along with several of the following physical symptoms and
thoughts: shortness of breath or smothering feelings, dizziness, feeling faint or
unsteady, racing or pounding heart, trembling or shaking, sweating, choking
sensations, nausea or abdominal distress, feelings of being detached or things
seeming unreal, numbness or tingling sensations, hot flashes or cold chills,
chest pain or discomfort, fears of going crazy, fears of losing control, and fears
of dying. In a panic attack these symptoms are not the result of a real medical
condition, such as illness, too much caffeine, or alcohol or drug intoxication.
Features of panic attacks are the suddenness with which fear is experienced—
panic attacks usually occur and peak in a very short time (1 to 10 minutes),
and the peak lasts on average only 5 to 10 minutes. Panic attacks are
very different from other types of anxiety: there is a strong urge to escape and
reach safety (also know as the fight-or-flight response); and the attacks come
out of the blue, with no obvious outside cause. However, over time, most attacks
become connected with specific situations (such as traveling long distances
Panic Attacks Are Common
Six to 12% of the general population reports an unexpected surge of fear or
panic at some time during a given year. According to the latest survey, from
2% to 6% of the general population suffers from panic disorder in any given 6-
month period. Thus, as many as 14 million Americans have panic disorder.
Panic disorder is distinguished from other anxiety disorders by the unexpected
nature of the alarm reactions as well as the continuing anxiety about
their return. Worry about the return of panic often leads to the avoidance of
situations in which help may not be available or from which escape is difficult,
should a panic attack occur. The types of situations avoided may include
crowded shopping malls, theaters, highway driving, elevators, walking alone,
or traveling far from home. This is known as “agoraphobic avoidance.” In contrast,
the occasional panic attack experienced by people with other types of
anxiety problems is rarely a major source of concern, and rarely leads to significant
An untreated panic disorder may result in depression, reliance on alcohol
and drugs to take some of the edge off the nervous tension, missed work, and
Characteristics of Panic Disorder
Panic attacks may occur as early as 10 years of age, but panic attacks typically
begin in the mid- to late-20s. The average age at which treatment is sought is 34.
Many panic sufferers seek medical treatment before seeking psychological
help. More women than men are diagnosed with this condition.
What Causes Panic Disorder?
Stressful life events often come just before an individual’s first panic attack.
Approximately 80% of people who panic can relate their first panic
attack to stressful life circumstances. This might be positive, such as having
a child, getting married, or moving to a new city, or negative, such as a
bad drug experience, or losing someone close. Conditions that may add to
the chances of having an attack under stressful conditions include certain
physical and psychological vulnerabilities.
Physical vulnerabilities refer to aspects of body functioning that may
make panic symptoms or paying attention to panic symptoms more likely.
The biological basis for this susceptibility can be shown by panic attacks
occurring in several members of the same family. However, the notion of
physical vulnerabilities should not be misunderstood to mean that certain
physical aspects “guarantee” the development of panic disorder. Panic disorder
seems to develop from a combination of psychological and physical
The psychological vulnerabilities include beliefs that the physical symptoms
of anxious arousal (e.g., shortness of breath or dizziness) are harmful
or threatening, and a sense that they are difficult to predict or control.
These beliefs seem to form the basis of continuing worry about the return
of panic attacks.
Chronic worry is characterized by focusing on and searching for any
bodily sensations that may mark another panic attack, and by high levels of
physical tension in general. Because such tension produces frequent physical
symptoms, worrying about panic can lead to the experience of more
The panic attack itself can be viewed as the combination of physical sensations
and the frightening thoughts about these sensations: “The chest
pain that I am feeling must mean that I am having a heart attack.” In other
words, panic attacks are in many ways like phobias, but instead of being
afraid of a specific object or situation, panic sufferers are afraid of their
own bodily sensations. Therefore, harmless changes in physical state
linked with routine activities (such as walking up stairs), drinking coffee,
or other mood states (such as anger), might lead the person to become
panicky. The sensations are likely to be mistaken as signs of immediate
physical or mental danger, such as losing control, dying, fainting, or going
Because these thoughts are frightening, the nervous system is turned on
(as would occur under conditions of real danger). As a result, more physical
symptoms are likely to be experienced, which in turn may be thought of
as further evidence of danger. That is, panic breeds an increasing cycle of
fear and physical symptoms. The urge to escape may increase the cycle
even further, particularly if escape is difficult or impossible. The attack
cycle is interrupted when the physical activation has run its course, or
when safety factors come into play (such as the arrival of a reassuring
friend or doctor).
Persistent overbreathing or hyperventilation (taking in more air than is
needed) may contribute to panic attacks. It is certainly natural to breathe
more quickly and more deeply when afraid. However, overbreathing does
not explain all panic attacks; it is important for some but not for others.
Cognitive Behavioral Treatment for Panic Disorder
Researchers from different centers around the world have developed treatment
methods, but all tend to include the same four components:
reeducation about the physical symptoms of anxiety and fear, to correct misinterpretations of them as being harmful or dangerous;
training in methods for reducing physical tension, usually by learning to breath differently and practicing relaxation techniques;
repeated exposure to feared and avoided physical situations; and
repeated exposure to feared and avoided sensations.
In exposure, specific exercises are used to produce the various symptoms
that characterize panic attacks. For example, aerobic exercise might
be used to produce shortness of breath and a pounding heart, and overbreathing
might be used to produce lightheadedness and dizziness. Systematic
exposure to these sensations reduces the person’s fear of them, and
teaches the person that the sensations are not dangerous. Activities that
were avoided are practiced to establish that they are not dangerous. These
activities might include climbing flights of stairs for aerobic effects, eating
certain foods, drinking coffee, and so on.
When fear of the body sensations is lessened, so is the fear of the return
of a panic attack. These new behavioral treatments eliminate panic attacks
in most clients. This favorably compares to the use of prescription medications
to reduce panic attacks. Research has shown that 2 years following
cognitive behavioral treatment, most patients remain panic-free. In contrast,
patients treated with prescription medications often experience a
return of panic when the medications are discontinued.
For more information or to find a therapist:
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