Panic Disorder 317
Cognitive Restructuring of Catastrophic Misinterpretation
Cognitive restructuring fulfills two functions in cognitive therapy of panic: it introduces
conflicting evidence for the catastrophic misinterpretation and it offers an alternative
explanation for internal sensations. In panic disorder evidence gathering, identifying
cognitive errors (i.e., exaggerating the probability and severity of imminent danger), and
generating alternative explanations will be most helpful. See Chapter 6 for a detailed
discussion of these cognitive intervention strategies.
It is often useful to begin cognitive restructuring with a very clear description of
the most feared catastrophic outcome and then generate a list of possible alternative
explanations for the physical sensations. The Symptom Reappraisal Form (Appendix
table 8.8. symptom induction exercises Commonly used in the treatment of panic Disorder
Exercise Evoked physical sensation Example of misinterpretation of threat
- Hyperventilate for 1 minute Breathlessness,
smothering sensation
“I can’t stand this; I think I am going to
faint if I continue.”- Hold breath for 30 seconds Breathlessness,
smothering sensation
“What if I can’t breathe normally? I
could suffocate.”- Breathe through narrow
straw for 2 minutes
Breathlessness,
smothering sensation“I need to get more air or I’ll
suffocate.”- Spin around at medium pace
while standing for 1 minute
Dizzy or faint “If I let myself feel nauseous, I might
vom it.”- Place head between knees
for 30 seconds and then raise
head quickly
Dizzy or faint “When I feel lightheaded, could this be
a sign of a stroke?”- Shake head rapidly from side
to side for 30 seconds
Dizzy or faint “When feeling dizzy I am losing
contact with reality which could lead to
insan it y.”- Tense all body muscles for 1
minute
Trembling, shaking “People will notice that I am trembling
and think there is something wrong
with me.”- Run on spot for 1 minute Pounding, racing heart “I could have a heart attack.”
- Sit facing a heater for 2
minutes
Breathless, smothering
sensation, sweating“People will be disgusted by my
sweating.”- Place tongue depressor at
back of tongue for 30 seconds
Choking sensation “This choking feels so bad it could
cause me to vomit.”- Stare continuously at
fluorescent light for 1 minute
and then try to read
Dizzy or faint; feeling
of unreality“My environment is feeling weird. This
could mean that I am starting to go
insane.”- Stare continuously at self in
mirror for 2 minutes
Feeling unreal, dreamy;
dizzy or faint“If I feel spacey I could lose contact
w ith realit y.”- Stare continuously at spot on
wall for 3 minutes
Feeling unreal, dreamy;
dizzy or faint“Feelings of unreality means that I
could be having a stroke.”