202 ASSESSMENT AND INTERVENTION STRATEGIES
Th e r a p i sT: Renée, I notice from your panic log that last Wednesday you were driving
alone to a retail customer along a route that you don’t normally take when you sud-
denly felt like you couldn’t breathe. You indicated that you pulled the car to the side
of the road and got out to get some fresh air. You wrote down a number of bodily
sensations like a lump in your throat, feeling like you couldn’t get enough air, grasp-
ing for breath, chest tightness, heart palpitations, dizziness, and general tension.
cL i e nT: Yes, it was one of the worst panic attacks I’ve had in a long time. I just couldn’t
seem to breathe properly. The harder I tried the worse it got. I took sips of water to
clear my throat but that didn’t help.
Th e r a p i sT: What were your afraid might be happening?
cL i e nT: I was really afraid that I would suffocate. That’s what it felt like. Here I was
alone, in the middle of nowhere, and I couldn’t breathe. It got so bad I wondered if
I could actually suffocate to death.
Th e r a p i sT: Okay, Renée, let’s write that anxious thought—“Thought that I would suf-
focate alone and die”—here on this line using a form called “Testing Anxious
Appraisals: Looking for Evidence” (Appendix 6.2). Now I would like you to think
back to when you had the panic attack. When you were off to the side of the road,
alone, and struggling to catch your breath, how likely was it that you were suffocat-
ing to death? In other words, based on how you were feeling, what did the prob-
ability that you were suffocating feel like to you from 0% (no chance it will happen)
to 100% (certain it is happening).
cL i e nT: Well, at the time it felt like a 90% probability that I was suffocating.
Th e r a p i sT: And what about the severity of the outcome? How serious did it feel to
you? Were you focused on the worst possible outcome like death by suffocation or
something less serious like feeling the discomfort of panic? What rating would you
use from 0 to 100 to indicate how serious the consequence seemed to you when you
were panicky.
cL i e nT: Oh, it was serious. All I could think about was suffocating to death by myself.
I would give this a 100 rating.
Th e r a p i sT: Okay, now let’s look at the evidence, such as anything that was happening
at the time, or past experiences, or information of any kind that would indicate that
you were at high risk of experiencing a serious outcome like death by suffocation.
cL i e nT: Well, one thing that makes me wonder if this suffocation feeling is serious
is that it comes on me so suddenly, out of the blue. One minute I’m fine and then
before I know it I can’t breathe.
Th e r a p i sT: Okay, let’s put that down on the first line under evidence for the anxious
thought: “onset of suffocation feeling is rapid and unexpected.” Any other evi-
dence that makes you think you’re likely to suffocate to death?
cL i e nT: The anxiety associated with this feeling is very intense, even panic. It’s so bad
I’m convinced something serious must be happening.
Th e r a p i sT: Let’s put that down under the second entry: “feel intensely anxious, even
panicky.” Anything else?
cL i e nT: Well, the fact that I try to calm myself down by taking long, slow breaths and