One-Day Therapy for the Fear of Panic (Panic Disorder)
The Illawarra Anxiety Clinic offers a highly effective therapy that aims to help clients overcome their fear of panic in just one day.
About the fear of panic (panic Disorder)
Panic disorder is characterized by recurrent panic attacks, worry about future attacks, worry about the consequences of the attacks, and avoidance of situations and activities that might provoke attacks. The essence of panic disorder is the fear of panic itself. Individuals who fear panic worry that panic-related body sensations and reactions are dangerous and intolerable. For example, some worry that heart palpitations may cause a heart attack, that difficulty breathing may lead to suffocation, or that racing thoughts mean one is going crazy. Such beliefs understandably lead individuals to avoid situations that might provoke a panic attack and to seek safety once panic-related feelings arise. Unfortunately, these safety behaviours can fuel maladaptive beliefs about panic, maintain and worsen the fear of panic over time, and diminish quality of life as important activities are given up. In severe cases, sufferers may be unwilling to leave the comfort of their own home.
Science-based cognitive-behavioural therapy (CBT) for Panic Disorder
A science-based cognitive-behavioural therapy (CBT) approach, specifically developed to target the fear of panic, is the most effective means of overcoming panic disorder. This approach emphasises exposure-based strategies for modifying maladaptive beliefs, facing feared situations and body sensations, and eliminating unnecessary safety-seeking behaviours. This CBT approach has strong scientific support and is the #1 recommended treatment in clinical guidelines around the world. About 80% of clients who receive this therapy fully overcome the problem. Notably, CBT that emphasises coping skills such as controlled breathing and relaxation, and does not include exposure, is not an evidence-based approach to panic disorder. This approach is used in clinical trials as a placebo therapy and is less effective than science-based CBT. In addition, the use of coping skills such as cognitive therapy techniques, relaxation, and controlled breathing does not augment the benefits of exposure therapy for panic and may worsen longer-term outcomes Accordingly, a strong case can be made that brief, intensive exposure therapy alone is the best available approach for overcoming panic disorder.
CBT vs. medications for Panic Disorder
Drugs marketed as "antidepressants" can be effective for panic disorder. Their benefits tend to last as long as they are taken, and the fear of panic tends to return when they are discontinued. Compared to "antidepressants," CBT is at least as effective in the short-term, more effective in the longer-term after treatment has finished, better tolerated, less expensive, has no adverse biological effects (e.g., sexual dysfunction, emotional blunting, suicidality, withdrawal symptoms upon discontinuation), and is more preferred by clients (see here for a review). Benzodiazepines such as alprazolam (Xanax) and diazepam (Valium) are also often prescribed for panic disorder. These drugs are not recommended in clinical guidelines yet they are often prescribed by doctors. Their effectiveness quickly wears off with regular use, they can produce significant adverse effects (e.g., drowsiness, nausea, cognitive impairment), are physically and psychologically addictive, and can cause severe and long-lasting withdrawal symptoms (including anxiety and panic attacks) when discontinued. The combination of CBT and these drugs is not more effective than CBT alone, risks worse long-term outcomes after drugs are discontinued, and exposes clients to the harms associated with these drugs. Research also shows both antidepressants and benzodiazepines can worsen the effectiveness of CBT. These considerations have led experts including the Royal Australian and New Zealand College of Psychiatrists to recommend CBT alone over these drugs as the first-line treatment for panic disorder.
BRIEF CBT FOR PANIC DISORDER
Science-based CBT for panic disorder typically involves 12 to 16 weekly sessions over 3 or 4 months. Although this approach works well in a reasonably short time span, it is not ideal for some clients. Because most experts trained in this approach are located in major cities, it can be difficult to access for clients who live in rural settings. This approach can also be inconvenient for clients whose occupational, academic, medical, family, and other circumstances make it difficult to attend weekly sessions. Lastly, some clients desire immediate relief from panic and prefer not to wait 3 to 4 months to get it.
Fortunately, science-based CBT for panic disorder can be delivered in a brief format with sacrificing its effectiveness. This approach includes the core components of standard-length CBT and compresses them into in a matter of days rather than months. Research shows that brief CBT is as effective as standard-length CBT. A bonus is that because it is over so quickly, clients are less likely to drop out of therapy due to issues with childcare, transportation, work conflicts, and so on. Our brief CBT approach, described in detail below, is conducted during one full day. This approach is quick, effective, and minimally disruptive to clients’ lives, making it an ideal choice for clients seeking immediate relief for their fear of panic.
Fortunately, science-based CBT for panic disorder can be delivered in a brief format with sacrificing its effectiveness. This approach includes the core components of standard-length CBT and compresses them into in a matter of days rather than months. Research shows that brief CBT is as effective as standard-length CBT. A bonus is that because it is over so quickly, clients are less likely to drop out of therapy due to issues with childcare, transportation, work conflicts, and so on. Our brief CBT approach, described in detail below, is conducted during one full day. This approach is quick, effective, and minimally disruptive to clients’ lives, making it an ideal choice for clients seeking immediate relief for their fear of panic.
OUR ONE-DAY CBT APPROACH
Clients interested in this approach should first contact me for an initial phone consultation at no cost. Those who are a good fit for the approach then meet with me, either in person or via video or phone, for a 90-minute assessment and planning session. This session emphasises generating an individualised understanding of the client's fear of panic and an explanation of how and why exposure therapy can help them overcome their fears. Clients then complete a number of assigned readings and preliminary therapy tasks. The therapy begins in earnest when clients come to the Illawarra Anxiety Clinic. The day involves 8 hours of individual therapy with me followed by a number of assigned tasks to be conducted following this session. The specific components of the approach are as follows:
- Becoming an expert on anxiety and panic - Individuals diagnosed with panic disorder tend to misinterpret their own anxiety-related body sensations, emotions, and cognitions as dangerous and intolerable. To help combat this tendency, clients learn about the nature and physiology of the anxiety response. This information helps demystify the uncomfortable body sensations experienced during panic attacks and helps clients understand the protective, harmless nature of these feelings. I also work with clients to more accurately understand the consequences of anxiety and panic attacks. We examine the evidence regarding the client’s specific feared catastrophes (e.g., passing out, heart attack, loss of control) to promote accurate understanding of risk. This education prepares clients to understand, at the intellectual level, that panic is safe and tolerable. The strategies that follow involve facing feared sensations and situations directly to reinforce this new understanding at the gut level.
- Exposure to feared body sensations – Individuals diagnosed with panic disorder tend to fear their own body sensations and go out of their way to avoid activities that elicit them. Accordingly, the goal of this component of therapy is for clients to counteract these tendencies by participating in exercises that recreate feared anxiety-related body sensations, emotions, and cognitions. In doing so, clients learn firsthand that their uncomfortable anxiety reactions are safe and tolerable, even when safety behaviours are not used to control them. Clients participate in a number of exercises that induce intense body sensations, such as hyperventilation, running in place, and spinning in a chair. Once the most feared exercises are identified, clients repeatedly practice them, one by one, until they are no longer anxiety-provoking. This process is performed together with me, who coaches clients through the procedure using techniques with documented scientific effectiveness.
- Exposure to feared places and situations – Most individuals with panic disorder also avoid certain public places in order to prevent panic attacks, a phenomenon known as agoraphobia. Agoraphobia can produce severe functional impairment and is an important target in the comprehensive treatment of the fear of panic. In this component of brief CBT, clients face their fears of public places by directly confronting them with my assistance. Exposure tasks might include riding elevators, standing in queues, or riding buses. As with exposure to feared body sensations, the goal of exposure to feared places and situations is to help clients learn through their own experience that feared stimuli and their associated emotional responses are safe and tolerable.
- Relapse prevention – The final component of therapy prepares clients to build upon the gains they made in brief CBT. They are provided with a specific, individually-tailored plan that details exposure exercises that clients need to continue on their own as well as avoidance behaviours that need to be eliminated. Clients are also educated about how to respond to a possible return of panic attacks using the skills they learned in therapy. Brief CBT helps clients learn the skills and experiences they need to overcome their fear of panic in the long-term.
COST
The cost of this service, which includes an initial phone consultation, a 90-minute face-to-face or phone/video assessment and planning session, and 8 hours of individual therapy with during the full-day session, is $1800. This rate reflects a 15% discount compared to my usual hourly fee.