Cbt for panic disorder

Exposure and Cognitive Restructuring for Panic Disorder

1. Cognitive Behavior Therapy for Panic Disorder Dr. Preeti Singh Consultant Clinical Psychologist Pt. Jawahar Lal Nehru Memorial Medical College Raipur (Chhattisgarh)

2. Topics will be covered Panic Disorder Case conceptualization of Panic Disorder Psycho-education Exposure Cognitive Restructuring Relapse prevention

3. Panic Attack – Panic Disorder - Agoraphobia

4. Case Conceptualization

5. Situational Cues

6. Catastrophic thoughts Fear of death or disability I am having a heart attack I am having a stroke I am going to suffocate Fear of humiliation and embarrassment People will think something is wrong with me They will think I am a lunatic I will faint and embarrassed Fear of losing control I am going to lose control and scream I am having a nervous breakdown If I don’t escape I will go crazy.

7. Psycho-education

8. Perceive real threat Activated SNS Body symptoms

9. Activities of ANS SNS - Active Heart beat increased Respiration rate increase Pupil and lung dilated Increased level glucose in body Digestion inhibited Blood circulation increased in legs, hand, brain PNS - Relax Heart beat decrease Respiration rate decrease Pupil and lung constrict Decrease level of glucose Digestion accelerated

10. Exposure

11. Steps of Exposure

12. Interoceptive Exposure (Internal cues) Spinning chair (Dizziness or light headache) Hyperventilation (Respiration) Running on stairs (Heartbeat) Tense all Muscles (Tremor or Shaking) Sit on a hot room or drink hot water (Sweating) Tie the tight scarf near neck (Tightness in throat) Place a tongue depressor on the back of the tongue (Choking) Stare at a light on the ceiling for 1 minute, then try to read for 1 minute (Derealisation)

13. Situational Exposure Mall Lift Train Room Market Crowded place Driving in car Dark place

14. Cognitive Restructuring

15. Goal of CR Increased awareness of thinking patterns Monitor relationship between thinking and panic episodes Challenge maladaptive thinking

16. CBT techniques Monitoring of Panic attack Evidence Analysis Behavioral Experiment Pie Chart Role Reversal Survey Method Cost analysis of Panic

17. Monitoring of Panic attack Day Trigger Situation Body symptoms Severity (0-100)/ Frequency Negative interpretation (0-100) Rational Response (0-100) Severity (0-100) Mon Lightening At home Heart beat, breathing, tremor, sweating 70/1 I am having a panic attack (80) It’s just a body symptoms, which appears many time before (90) 10

18. Evidence Analysis Symptoms of crazy person How many your symptoms Match How Many your symptoms didn't Match Liable mood Irritability Abusive behaviour Aggressive behaviour Irregular eating Irregular sleep Delusion Hallucination Socially inappropriate behaviour Socially inappropriate dressing Irritability Irregular sleep Liable mood Abusive behaviour Aggressive behaviour Irregular eating Delusion Hallucination Socially inappropriate behaviour Socially inappropriate dressing

19. Behavioral Experiment Prediction (0-100) Experiment Outcome (0-100) Learning If I will walk then I will have panic attack, will result in heart attack (90) Walk for 15 minutes No attack (0) Walking will not result in panic attack or heart attack

20. Pie Chart Heart attack – causes of heart attack (0-100)

21. Role Reversal What will you think about the person if you see them having a panic attack?

22. Survey Method How many people die with panic attack? How many people had heart attacks due to panic attack? How many people become crazy due to panic attack? How many people think that you are lunatic (Observed your panic attack)?

23. Cost analysis of Panic Motivation for treatment

24. Relapse Prevention Problem Solving Breathing Retraining Refocusing Mindfulness

25. ?

26. Thanks you so much