Panic Disorder 313
does this sense of safety last before the patient is again concerned about the recurrence
of panic? What is the individual’s degree of self- efficacy in her ability to cope with panic?
Information on panic outcome can be obtained from the weekly panic log, the Symptom
Reappraisal Form (Appendix 8.2), and the Anxious Reappraisal Form (Appendix 5.10).
Helen was able to achieve a reasonably high level of safety after her episodes of
acute anxiety and panic but these tended to be relatively short-lived (e.g., 12–24 hours).
She engaged in extensive reassurance seeking from family members and searching for
her symptoms on the Internet, as well as avoiding perceived triggers. She believed that
avoidance was quite effective in curbing the anxiety and ensuring that it did not escalate
into panic. The reassurance seeking was considered moderately effective in reducing
current states of anxiety over unexplained physical sensations. Helen also relied heavily
on self- reassurance in which she repeated to herself “Everything will be okay, nothing
is wrong with me.” Again she thought this helped “calm her down” to a certain extent.
Treatment, then, had to target Helen’s beliefs about the effectiveness of her avoidance
and safety- seeking strategies to ensure the elimination of maladaptive coping that con-
tributed to the persistence of panic.
Clinician Guideline 8.9
A cognitive case formulation of panic should include a contextual analysis of the panic attacks
as well as an assessment of (1) physiological hypervigilance, (2) catastrophic misinterpreta-
tion of bodily sensations, (3) presence of maladaptive beliefs about anxiety tolerance, (4) role
of avoidance and safety- seeking strategies, (5) accessibility of reappraisal schemas, and (6)
perceived outcome of anxiety and panic episodes. The case formulation will be the basis of
treatment planning and implementation of an individualized cognitive intervention.DesCription of Cognitive therapy for paniC DisorDerThere are five main treatment goals in cognitive therapy for panic disorder. The first
two goals pertain to the automatic schematic threat processing that occurs during the
immediate fear response (Phase I), whereas the remaining goals refer to responses that
occur during elaborative processing (Phase II) (see Figure 2.1). The primary treatment
goals are:
- Reduce sensitivity or responsiveness to panic- relevant physical or mental sensa-
tions - Weaken the catastrophic misinterpretation and underlying hypervalent threat
schemas of bodily or mental states - Enhance cognitive reappraisal capabilities that result in adoption of a more
benign and realistic alternative explanation for distressing symptoms - Eliminate avoidance and other maladaptive safety- seeking behaviors
- Increase tolerance for anxiety or discomfort and reestablish a sense of safety
Table 8.7 presents the main treatment components of cognitive therapy employed to
achieve these goals.