Panic Disorder 309
Weekly Panic Log
One of the most important instruments in any assessment of panic is a daily self- reported
measure of panic attacks called the panic log (Shear & Maser, 1994). The panic log
should be introduced at first contact with the client and utilized as a weekly homework
assignment throughout the course of therapy. Appendix 8.1 provides a weekly panic log
that is tailored to the cognitive therapy discussed in this chapter. If completed correctly
it will give the clinician most of the basic information that is needed to develop a cogni-
tive case formulation of panic. The panic log provides crucial contextual information
about panic attacks, their symptom expression, anxious interpretation, extent of reap-
praisal capacity, and coping resources. To maximize the clinical utility of the panic log,
the therapist should provide instructions on how to use the panic log. The following
points should be covered in the explanation.
- Complete the log as soon as possible after experiencing a panic or anxiety attack
to ensure greater accuracy of self- observations. - Record a broad range of panic experiences including full-blown panic attacks,
partial attacks, and acute anxiety attacks. In the Severity/Intensity column, label
each anxiety episode as a full-blown panic attack (i.e., abrupt onset involving
four or more physical symptoms), a limited panic attack (i.e., abrupt onset involv-
ing one-to-three physical symptoms), or an acute anxiety episode (i.e., sudden
onset of apprehension or nervousness). - Duration of panic (column 1) is defined as the length of time the panic lasts at its
peak intensity (i.e., Brown et al., 1994). - In the second column briefly note the circumstances or context in which the anx-
iety or panic occurred. Make particular note of any specific external or internal
stimulus that may have triggered the panic (e.g., “you are driving alone in the
car and notice that you are breathing more deeply than usual”). Also indicate
whether the attack is expected or unexpected. - Briefly describe the physical and mental symptoms that characterized the panic
attack. Make special note of the symptoms that were particularly intense or
most distressing. - In the column labeled “Anxious Interpretation,” answer “What concerned you
most while having the panic attack?”, “What were you afraid might happen?”,
“When you were most anxious, what was the worst consequence or outcome
that crossed you mind? (e.g., heart attack, loss of control, embarrassment or
humiliation).” - The sixth column, labeled “Evidence for the Alternative,” inquires whether the
client was able to find any evidence or explanation that the panic attack was less
serious than first thought. “Was there anything about the anxiety or panic that
made you think it was not a serious threat?” “Or did you recall anything that
made you question the seriousness of the anxiety or panic experience?” - In the last column indicate how the panic or anxiety episode terminated. “Did
you do anything that ended the panic attack?” “How effective were you at bring-
ing an end to the anxiety or panic episode?” “To what extent was a sense or feel-
ing of safety restored at the termination of the episode?”