Learn how to differentiate between anxiety, panic attacks, and panic disorder, understand the cycle of panic and how to interrupt it, and learn the fundamentals of panic disorder treatment.

1. Understanding and
Overcoming Panic
Michael Likier, PhD, ACT
NJ Licensed Psychologist
Diplomate, Academy of Cognitive Therapy
Senior Clinician, SMG
June 1, 2017

2. Goals
• Differentiate between anxiety, panic
attacks, and panic disorder
• Understand the cycle of panic and how
to interrupt it.
• Learn the fundamentals of panic
disorder treatment.

3. CBT
• Cognitive Behavioral Therapy
• Cognitive – Thoughts
• Behavioral – Actions

4. CBT Premises
• Thoughts -> Feelings
• Thoughts are not facts!
• Thoughts that produce negative feelings
are often unreasonable
• Change how we think -> Change how
we feel

5. Anxiety (mw.com)
• An overwhelming sense of
apprehension and fear often marked by
physical signs (such as tension,
sweating, and increased pulse rate), by
doubt concerning the reality and nature
of the threat, and by self-doubt about
one's capacity to cope with it.

6. Anxiety: Simplified
• Overestimation of probability of danger
• Underestimation of our ability to cope
• RISK/RESOURCE RATIO

7. Evaluating Anxiety
• What is the fear?
• How likely is this to occur?
• Where’s the evidence for and against?
• How would I handle it if it did?
• What’s a more reasonable way think?
• Test it out!
• Part of the treatment of Panic

8. Anxiety v. Panic
• Anxiety: fear that something bad will
happen
• Panic: thoughts and sensations that
occur when we strongly believe that the
bad thing is happening/imminent

10. Panic Attack
• The abrupt onset of intense fear that reaches a peak within
minutes

11. Symptoms I
• Palpitations, pounding heart, or accelerated
heart rate
• Trembling or shaking
• Sensations of shortness of breath, smothering
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations/sweating

12. Symptoms II
• Paresthesia (numbness or tingling
sensations)
• Derealization (feelings of unreality)
• Depersonalization (being detached from
oneself)
• Fear of losing control, “going crazy,” or dying
• Feelings of choking

13. Panic Disorder
• Occurs when panic/fear of panic causes
significant impairment
 Social
 Occupational
 Relationships
• Can be concurrent with agoraphobia

14. Facts I (Association for Behavioral and
Cognitive Therapies)
• 6% - 12% of the general population reports
experiencing a panic attack during a given year.
• 2% - 6% of the general population suffers from panic
disorder in any given 6 month period. 14 million
Americans
• Untreated may result in depression, substance
abuse, missed work, and social disability.
• May occur as early as age 10, typical onset mid-to-
late-20s.

15. Facts II (Association for Behavioral and
Cognitive Therapies)
• The average age at which treatment is sought
is 34.
• Medical treatment typically sought before
seeking psychological help.
• More women than men are diagnosed with
this condition.
• CBT is the recommended front-line treatment.

16. Across Cultures I
• Overall endorsement of panic symptoms
similar across racial/ethnic groups in the US.
• Differences may arise in endorsement of
specific symptoms.
• Asian-Americans may tend to endorse
symptoms such as dizziness, unsteadiness,
choking, and feeling terrified more frequently

17. Across Cultures II
• African Americans may report feeling
less nervous than those identifying as
white.
• Panic symptom severity was not found
to differ across racial/ethnic groups.

18. Panic Cycle

19. Goals for Treatment
• What has panic done to your life?
• What do you want instead?

20. How do we get from here to here?

22. Rules for Cultivating Panic
• Tell yourself panic is dangerous
• You can’t handle it
• Avoid by any means necessary
• Worry in between attacks
• Use Safety Behaviors (next slide)
• Demand certainty
• Use emotional reasoning

23. Safety Behaviors
• Things we do consciously or unconsciously to
avoid or escape panic
• Examples
 Aisle seat of movie theater
 Xanax
 Physiological self-monitoring
 Mantras
 Breathing exercises, etc.

25. Rules to Beat Panic
• Panic is uncomfortable, not dangerous
• I can and will handle it
• I will create opportunities to practice
• Each attack gives me a chance to get better
• Approach threats
• Encourage panic and anxiety to stay
• Notice urge to use safety behaviors
• Bring it on!

26. A Metaphor
https://www.youtube.com/watch?v=ebtGR
vP3ILg
• On a scale of 0-100, where 0 is cool as
a cucumber and 100 is extreme panic,
how do you think the girl feels at the top
of the hill?
• How would you feel there?
• Notice her self-talk

27. Steps of Treatment
(Don’t Panic by Reid Wilson)
1) Evaluate Physical Symptoms
2) Understand Emergency Response
3) Change Your Attitude
4) Use Paradox
5) Practice!

28. Physical Symptoms
• Rule out any physical cause with
physician
 Sinus tachycardia
 Supraventricular tachycardia

29. Emergency Response System
• Blood sugar rises
• Eyes dilate
• Perspiration
• Tachycardia
• Tense muscles
• Hyperventilation
Allows us to respond most effectively.

30. Attitude Change
• Acceptance of condition
• Bring it on
• Learn skills
• It’s OK to be anxious
• I can let my guard down
• It’s all practice
• Accept uncertainty
• Setbacks are part of the process

31. Paradox Video
https://www.youtube.com/watch?v=cKUv
KE3bQlY
• Where is the truth in the humor?
• What do imagine George is feeling
when he approaches the woman?

32. Paradox
• What you resist persists!
• Efforts to avoid increase
• Therefore….
• Efforts to increase, decrease
• Commit to, in order of difficulty
a) Anticipating
b) Observing
c) Intensifying

33. Medication
• Most people seek medical treatment
first.
• SSRI are preferred to anxiolytics.
• CBT treatment is robust.
• Coming off meds (w/o CBT) usually
leads to relapse.
• CBT recommended as front-line tx.

34. Further Support
• Enlist significant others
• Be your own support
• Set SMART goals
• Educate yourself, e.g:
- Don’t Panic by Reid Wilson
- Anxieties.com
- Anxiety and Depression Association of America
• Cognitive Behavioral Therapy