This in the seventh in a series of blog posts about Cognitive Behavioural Therapy formulations. This blog will focus on Cognitive Behavioural Therapy formulation for panic disorder.
1. What is Panic Disorder?
Panic disorder is characterized by a reoccurrence of unexpected panic attacks, including persistent worrying that panic attacks will occur and the initiation of unhelpful behaviours as a result (e.g. avoidance of activities, certain places, or use of substances as a coping strategy). A panic attack is defined as the experience of intense fear with physical sensations such as hyperventilation, tingling and numbness, sweating, nausea, fainting, palpitations, shaking and the overwhelming thought that one will die. In order to meet formal diagnostic criteria for a panic disorder diagnosis the individual must have experienced a minimum of 1 month of persistent worry as a result of panic attacks.
Some people may be more vulnerable than others to developing these difficulties.
2. Predisposing factors
Predisposing factors may include: early exposure to stressful situations, experience abuse or trauma, physical illness, certain medications, alcohol use, excessive stimulant consumption, illicit drug use or witnessing a parent with similar difficulties. Smoking has also been queried as a factor increasing the vulnerability to developing this difficulty.
3. Precipitating factors
Precipitating factors include stressful events such as life transitions, trauma or interpersonal difficulties. Subsequent panic attacks may be triggered by settings or reminders of previous panic attacks.
4. Perpetuating factors
Perpetuating factors include unhelpful cognitions, for example misinterpreting bodily sensations as a signal of something catastrophic, difficulty discussing the experience due to shame, avoidance of situations or things that are associated with panic attacks, hyper vigilance to physical sensations and anticipatory anxiety.
5. Protective factors
Protective factors include examples such as: a positive support system, social self-efficacy, coping strategies and seeking support from professionals.
6. Case example
Roger is walking home from football practice one evening. He takes a shortcut through the park, which he would not normally take because of the rain. Roger is apprehensive but tells himself it’s better than getting soaked. Roger starts to hear noises up ahead of him so he starts to walk quicker. Suddenly a dog jumps out of the bush and runs down the path from where Roger had come. Roger gets a terrible fright and his heart starts pounding. The fright has left Roger breathless and slightly light headed. Roger has never felt faint like this before and the experience frightens him more. He worries he will collapse, and he is still far from home. Roger starts to worry no one will find him. Roger eventually takes out his phone and calls his mother to collect him.
A week later Roger is taking the bins out at home. He walks down the path and starts to hear rustling in the buses. Roger thinks back to his experience last week and starts to worry again. Again he loses his breath and his heart starts to pound. After this Roger refuses to take out the bins again.
This can be understood within a CBT formulation as follows:
Predisposing factor: Unclear. Perhaps Roger has a family member with similar difficulties or has utilized substances or stimulants.
Precipitating factor: Roger’s initial experience of a panic attack in the park and his catastrophic interpretations.
Perpetuating factors: Reminders of the initial panic attack (i.e. being outside in the dark, hearing rustling in bush), avoidance of triggers (i.e. taking out the bins). It is also unclear if Roger has discussed this experience with anyone. If he hasn’t this may indicate shame associated with the experience. This may make it more difficult for Roger to seek support.
Protective factors: Unknown. Speaking to his loved ones and seeking support would help him. Roger enjoys sport and attends football practice.
7. How does CBT work for other mental health conditions?
To find out more about how Cognitive Behavioural Therapy work for other specific mental health conditions such as low mood & depression or anxiety disorders please read our series of blog posts on this topic:
- A Guide to Cognitive Behavioural Therapy
- Cognitive Behavioural Therapy for Anxiety Disorders
- Cognitive Behavioural Therapy for Depression
- Cognitive Behavioural Therapy for Health Anxiety
- Cognitive Behavioural Therapy for Social Anxiety
- Cognitive Behavioural Therapy for Obsessive Compulsive Disorder
- Cognitive Behavioural Therapy for Specific Phobia