Cognitive-behavioural Therapy (CBT)

CBT was previously called Behavioural Therapy, and the cognitive part has been added after many psychologists have started to work with the thoughts. Anxiety is often fed by negative automatic thoughts. These thoughts threaten you and the body, thereby triggering anxiety and fight & flight reactions. The thoughts can also add on to a depression in progress. One of the main goals of cognitive therapy is to re-evaluate these thoughts, and to finally replace them with more realistic and logic thoughts. It is useful to consider what errors of mind you perform when you are in a situation where you feel anxiety. You often overestimate the probability for something terrible to happen, or you exaggerate the negative consequences.

The behavioural part of CBT is built on exposure. This means that you expose yourself to the anxiety-provoking situations. This is not easy, and CBT is a tough therapy where you have to work hard yourself. Exposure is also used for all kinds of phobias. The idea is to learn - hands on- that your catastrophic thoughts are unreal. You can also realize that it is possible to keep on going in spite of a lot of anxiety in a certain situation: "I can stay in the store, and pay the goods even though I have anxiety". Most people will not notice your anxiety. The most common mistake in therapy involving exposure is that the time is too short. You must stay in the situation until the anxiety declines. If you leave the situation too early, i.e. when the anxiety is still at its peak, you might easily get more frightened and you confirm to yourself that it was exactly as bad as you expected. Again, this is not easy, but the more anxiety raised by the exercise, the better results.

It is not necessary to start with the worst situations, however, you can take them in order from the least scary and then increase. The idea is to stay in the anxiety-provoking situations, but most therapists agree that it is OK with "security exits", at least in the beginning. This will not necessarily destroy the result of the exposure. It is more important to get started to move the limits. You decide beforehand that you are allowed to leave the bus before the stop of the goal, or to sit by the exit door. You may also bring a friend as supporting person during the exposure.

It is also ok to perform breathing or relaxation exercise in case a panic attack starts. Distraction is another trick: to concentrate on something outside your body, for example the clothes of the other bus passengers or counting the coins in your purse if you are queuing in the post office. But you should try to get rid of the "security exits" and tricks as soon as possible. There are investigations showing that it is negative to showe off the negative thoughts, since you then never get to test their truth. And as long as there is something that can save you from the panic attack, then you are still afraid of the panic and amenable to it. If you suddenly are without your "security exit" or "safe person", you might believe that you will have a panic attack- and thereby get it.

Exposure can also focus on bodily sensations which you experience as threatening. The goal is to disconnect the sensation from the panic. Many persons only get the exposure (antiphobics therapy) without the cognitive part, and this is considered too little by most books. The question asked by many is exposure to what? It is not always a certain place that triggers the anxiety, and you already know that the place (such as a queue in a store) is not dangerous. Even if you stay in the situation until the anxiety diminishes, what help do you get if you are anxious day and night. Then it is more useful to look for the inner sensations that trigger the attacks. Because you are often more afraid of the anxiety than of the queue in the store. A lot of work must be done to change the thought process. It may sound as if I contradict myself, considering everything else that is written above. But the truth is that psycologists and psychiatrists do not agree. Some consider exposure and exercise the most important, other mean that you must focus on the anxious fright for anxiety and how it starts an evil spiral.

Cognitive-behavioural therapy is generally a short-term treatment, and there are often residual problems afterwards. It is important that you continue to work with the anxiety problems afterwards, alone or together with a friend. You can do that by repeating the exercises. You might also need to work out other personal problems by psychotherapy. There is always a risk of transient relapses of panic attacks and anxiety, especially in case of stress and big changes in your life. Life is never simple, and you cannot expect to go through it untouched. But if anxiety returns you know what it is and what to do about it. It is only transient, and what worked before will most probably work this time too (and faster). Other useful methods include build-up of self-esteem and practice on how to handle stress.

Cognitive Psychotherapy

It is assumed that the automatic thoughts are results of dysfunctional basic assumptions. These basic assumptions work as maps with which we orient in the world, and if they are dysfunctional you can visualize that the map does not show the true surroundings. We read the reality in a way that creates problems for us. By exposure and by questioning the automatic thoughts you can rewrite the map. This is not far from the CBT, but Cognitive Psychotherapy also wants to understand HOW and WHY the map was wrong. Sensations and relations also become important, however, without the same focus on early sensations as in Psychotherapy (see below). The focus is still on the present. Another difference is that the Psychotherapeut construes a lot, while the Cognitive Psychotherapeut asks so called "Socratic questions" helping the patient to investigate and understand his or her own thoughts and feelings.

Psychotherapy

Psychotherapy can help anxiety-struck persons in many ways. You might need to go deep into yourself to understand how things have started. But this is not necessary for everyone with panic disorders. Although not everyone can find a cause of anxiety in the past, others can find that they meet the same type of problems again and again, and that they are carrying a difficult experience that governs their life. The psychotherapy helps you working with these conflicts, which you are often unconscious about and which may originate in your childhood. The conflicts can add on to the anxiety problems. The psychotherapy does not help directly to cure the symptoms, but it can help you to handle stressing events in life, events that could otherwise trigger panic attacks. You can learn to handle feelings in a better way, and it can also be very useful to discuss if you feel shame or anger or other feelings you are trying to repress. It can ease your burden and improve your self-esteem.

            

I am in no way a doctor, and this is not a treatment program. just things I have found helpful and other things I have found on the net.