To the best of my knowledge everyone, including myself, making submissions to this site have no expert standing. The information has been made available by people "in the trenches" who are passing on ideas and suggestions which they have found worked for them.

Please do not take the information on this site as professional or medical advice. It isn't. For that, I suggest you contact your doctor or a licensed therapist.

The links to other sites and services are provided for your information only and come with no endorsement from us.

All pages on this site are copywrited and all rights are reserved. This includes, but is not limited to, the displaying of the material on this site within a frame from which revenue is derived.

We, of course, have no objection to you printing a single copy for your personal use. In fact, we encourage you to. It is here to help people.

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The Caregiver

The Caregiver section is not just for caregivers. Caregivers and those with anxiety disorders must work hand-in-hand. Therefore, this site is for everyone.

Hi. I 'm Ken. Welcome to our all-volunteer site, designed specifically to:

• provide caregivers with an understanding of the anxiety disorders;
• bring caregivers and those with anxiety disorders closer together through a mutual understanding of the needs of each;
• provide support for the caregivers;
• offer suggestions to caregivers, so they may be supportive without becoming overwhelmed;
• supply information, so the family may continue to function as a healthy unit;
• supply information to the extended support network, such as teachers and employers;
• post new information as it becomes available on the causes and treatment of anxiety disorders.

In Sept. of 1995, when we first opened, I wrote the following introduction:

I am pleased to see there is more-and-more information becoming available for people with panic attacks but there is virtually nothing for the caregivers - the people who supply the emotional support and are one of the few trusted people to accompany the person with panic attacks on outings, etc.

It was due to this lack of practical information that this site was established. We are all volunteers. I sincerely hope that everyone who has an interest will work with us to continue to build a site from which not only will you benefit, but so will others who follow.

The feedback was far more than I had hoped. Literally thousands of people contacted me with questions, comments and suggestions. Using their feedback and requests, this site has evolved into what it is today.

The book, Anxiety, Panic Attacks, and Agoraphobia: Information for Support People, Family and Friends is mentioned frequently because it is, to our knowledge, the only book available devoted entirely to the friends and supporters of those with anxiety diseases. Also, through the cooperation of Oakminster Publishing, it provides the funds necessary to keep this site running.

I hope you find the site useful and informative. Again welcome and thank you for joining us.

Contents:

• About Ken Strong
• About Me - The Caregiver
• Anxiety in the Workplace
• The Author of the Book
• Caregiver Letters and Stories
• General Information on Anxiety and Panic Attacks
• Legal Stuff
• Nine, Ten , Do it Again.'
• Panic Attacks: Why Do They Feel This Way?
• Supporting A Person With an Anxiety Disorder

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This information is taken from several sources, as well as, my own experiences. To the best of my knowledge it is correct. If some part is not clear, please let me know.

Question: Are panic attacks new?

Answer:No. They were described in medical literature over 100 years ago.

Question: Are they becoming more common?

Answer:It seems so but it could be due to better diagnoses, a greater public awareness, and more information being available. Some people think our more stressful lifestyle is a contributing factor.

Question: Do men and women both develop anxiety/panic attacks?

Answer:Yes, but more women than men seem to develop them. Some alcohol programs believe that some men tend to start drinking excessively in an effort to overcome anxiety.

Question: Can people of any age have anxiety/panic attacks?

Answer:Yes.

Question: Are people who suffer from anxiety/panic attacks sane?

Answer:Absolutely. However, until diagnosed and assured, it is not uncommon for the people to feel they are going insane.

Question: Can you tell if a person is having a panic attack?

Answer:In many cases no. They look and act as though nothing is wrong. However, in the midst of a panic attack, they may suddenly have to bolt for the nearest exit without regard to anything else.

Question: What causes anxiety/panic attacks?

Answer:There are various ideas. Some feel it is genetics, others believe past environment - particularly the environment in which they grew up. Still others say a combination of the above, and there are those who say none of the above. --- Regardless of the cause, it is a chemical imbalance in the brain. Diabetes is a chemical imbalance and so are panic attacks.

Question: How often do panic attacks occur?

Answer:From one every few years; to several a day.

Question: What is anticipatory anxiety?

Answer:It's rather like stage fright which some actors experience before going on stage. The actor overcomes it and goes out onto the stage. In the case of people with panic attacks, the stage is the area outside of their safe zones. They have an anxiety that they may have a panic attack. If they do not leave their safe zone because of the anticipatory anxiety, they have developed agoraphobia.

Question: What is agoraphobia?

Answer:If a person becomes uncomfortable or develops panic attacks when they leave the house or a certain part of the house, then agoraphobia is present. It is very difficult, if not impossible for them to venture very far from their comfortable area or safe spot.

Question: Are safe spots always in the house?

Answer:Not always. There may be additional safe areas, such as, in the office, etc.

Question: Why do elevators, bank line-ups, etc. cause anxiety to build up?

Answer:The person is trapped. An escape route is not readily available.

Question: Do all people with anxiety/panic attacks show the same symptoms?

Answer: No. Some may be perfectly all right driving while others have a terrible time. The same is true of various situations.

Question: How is the illness treated?

Answer:Usually with a combination of medication and counseling.

Question: Where can I find a doctor/psychiatrist/psychologist who is able to treat the illness?

Answer:Ask your doctor, a local hospital, or university.

Question: Will the person ever get over the illness?

Answer: Yes. For some it takes more time than others, but they will.

Question: What are panic attacks like?

Answer:Try to explain to a man what being pregnant is like. Unless you have been there, it is difficult to understand. Have you ever been so frightened that you panicked and just wanted to get out of the situation? If you have been in this situation, you know the adrenaline starts flowing as it prepares you to fight or run. Your heart speeds up, your breathing rate increases, and you are just plain scared and want out. Once you have left the danger zone and found a safe place, your body starts returning to normal. With panic attacks, this same response is triggered off; frequently with no apparent cause.

Question: Do panic attacks ever reoccur after one is free of them for several months or years?

Answer:Some people have a relapse. Most get over it much faster than they got over the first bout. Sometimes this relapse lasts for a few days.

Question: Where can I find out more information?

Answer:Other parts of this site contain a great deal of information. 

Question: What is a caregiver or support person?

Answer:A very important person(s) in the life of ill people. The support person is their emotional supporter, as well as; being the person who will help them get well by being with them as they go into scary situations. The ill person trusts the support person to see that no harm comes to them. They rely on this person to be their hand-holder. Their supporter. The person who will lead them to safety if overwhelming problems arise. In short, you are their life line.

Question: Isn't that a very responsible function?

Answer:Yes, but also a very rewarding function. Spouses frequently find that when the panic attacks have gone, they have grown closer together and understand each other more.

Question: Can more than one person be a support person?

Answer: Certainly. If several people in a family/friends work together, all the better.

Question: Where can I find out more information on being a support person?

Answer: There is not that much information on the net. Also, you will find some people do not agree on the best approach. I have written up a few suggestions which I have found help.

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Anxiety, Panic Attacks and Agoraphobia and Anxiety Disorders: The Caregivers

Information For Support People, Family and Friends

Ken Strong is a graduate of the University of British Columbia. During his 35-year teaching career, he has published widely in the fields of Science Education, Forensics and Herpetology.

His books are based upon his personal experiences as both a past sufferer of panic attacks and a long-time role as a support person to those with panic attacks. As the maintainer of this multi-award winning Caregiver's site, Ken has been in close contact with hundreds of people who had the disease and an equally large number of families who were both looking for and willing to share information. These books, ANXIETY, PANIC ATTACKS AND AGORAPHOBIA - Information For Support People, Family and Friends and Anxiety Disorders: The Caregivers reflects their needs and advice.

From the Preface to the Second Edition:

"The tremendous response to the 1st edition indicated there was a definite need for this information. Your comments and letters of encouragement have made the whole project more than worthwhile. Many have gone so far as to say the material in the text was a God-send and had made a large difference in their lives. What more could those involved in writing this book ask for?" Ken

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Hello, I'm Ken and I live in Victoria, B.C. Canada. I have been maintaining this caregivers' site since 1995.

About halfway through my high school teaching career, I developed cancer which led to almost continuous rounds of radiation and chemotherapy. I beat the cancer, but the stress triggered panic attacks, agoraphobia, depression and more than a touch of OCD. I overcame those too, but what I went through was almost worse than the cancer. I will not forget the way I felt and the 'demons' which tried to control me.

A few years after I recovered, I found myself the primary caregiver to a dear friend who had recently developed severe agoraphobia and panic attacks. Based on my own experience, I could offer some help but I didn't feel I had a sufficient number of tools with which to be an effective support person and not allow the vortex of fears in which she lived to control my life. 

Not finding anything in print which offered suggestions to families of those with these anxiety disorders, I turned to the Net. The Net had no information, but there were many people (both caregivers and those with the disorders) looking for similar information. We hoped we would be able to support each other until the professionals who had the information were able to disseminate it.

Pioneer Efforts to Help the Caregiver

Basically, I found that we were the pioneers in gathering this information and professionals and lay people alike come to take advantage of it.

I actually started the site with the hope I could get large publishers interested in having something written by experts. It didn't take too long before we all realized there were few if any experts and much of what has subsequently appeared on many "expert" pages seems startlingly similar to what is on this site. Also, material on some other sites reflects only the programs offered by the site maintainers and does not give alternate methods of help. Not everyone responds to the same procedures.

In short, it appeared hardly anyone had thought of the anxiety sufferer's caregivers. I was constantly faced with people who didn't have a clue about what was wrong with the people who experienced severe anxiety and had less of an idea about what to do to help out.

The contents and format of the material on this site and in our publication are the result of the combined input from caregivers, those with the disorders, teachers, employers, health professionals and other interested people.

Today, we are still gathering information and probably have the largest collection of anxiety caregiver/support information available anywhere. In addition to making some of it available on this site, Oakminster Publishing is assembling the information and will make it available as part of their Anxiety Caregiver Series.

Thanks for dropping by.

Editor's Note: Ken Strong passed away in 2007. His contributions are important and we keep his site alive.

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We all experience some level of anxiety before a test. A little nervousness can actually help motivate us to perform our best. Too much anxiety can become a problem if it interferes with your performance on tests. Some strategies for dealing with test anxiety:

• Be prepared. Study the material in advance; do not leave cramming for the day before your test. Do not do a last minute review.
• Get plenty of sleep, it is hard to function at your best when overtired.
• Avoid any use of drugs and alcohol, they can interfere with your mental ability.
• Exercise may increase your alertness and sharpen your mind.
• Have a moderate breakfast, fresh fruits and vegetables help reduce stress; avoid caffeine, sugar and junk foods.
• Allow yourself plenty of time; arrive at the test location early.
• Choose a seat where you will not be easily distracted.
• Use abdominal breathing to help reduce anxiety. Place one hand on your abdomen, right beneath your rib cage. Inhale through your nose and feel your abdomen fill like a balloon. Count to three on your inhalation and then slowly exhale counting to four, feeling your abdomen contracting with the exhalation.
• Do a reality check, how important is this exam in the grand scheme of things. Put it in perspective.
• Use positive affirmations, say a phrase to help keep things in perspective. "I've done this before, I can do it again" or "I have all the knowledge I need to get this done."

During the test take a few minutes to:

• Review the entire test. Read the directions carefully.
• Work on the easiest portions of the test first.
• Pace yourself. Do not rush through the test.
• If you go blank, skip the question and go on.
• Multiple choice questions, read all the options first, eliminate the most obvious.
• Essay questions, make a short outline. Begin and end with a summary sentence.
• Take short breaks, tense and relax your muscles throughout your body.
• Pause, do a few abdominal breaths, say your affirmation.
• Stay in the present moment.
• There is no reward for being the first done.

After the test, reward yourself:

• Try not to dwell on your mistakes.
• Indulge in something relaxing for awhile.

If these test taking anxiety strategies do not work for you, visit your school counselor or other health care professional.

Source:

• Freedom From Fear website

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Learn how to relax using these relaxation techniques.

To overcome anxiety, phobias, or panic attacks it is of paramount importance to learn how to relax. It is impossible to feel relaxed and tense at the same time. People who live with high levels of anxiety often do not know how to relax or to release the tension stored in their muscles that is contributing to the experience of anxiety.

Regular, daily practice of relaxation techniques will assist you in relieving muscle tension, greatly improve your overall feeling of wellbeing and reduce your anxiety. Deep relaxation involves a number of physiological changes including:

• Decreases in heart rate
• Decrease in respiration rate
• Decrease in blood pressure
• Decreases in skeletal muscle tension
• Decrease in metabolic rate and oxygen consumption
• Decrease in analytical thinking
• Increase in skin resistance

Regular practice of deep relaxation for 20-30 minutes on a daily basis can produce, over time, a general feeling of relaxation and wellbeing that benefits every area of your life. When you feel relaxed and at ease you are less likely to turn on the anxiety response and will find that you feel more in control most of the time.

Other benefits of deep relaxation include:

• Reduction of generalized anxiety
• Reduction of frequency and severity of panic attacks
• Prevention of stress becoming cumulative
• Increased energy and productivity.
• Improved concentration and memory
• Increase in ability to focus
• Reduction of insomnia and fatigue
• Deeper and sounder sleep
• Prevention and or reduction of psychosomatic disorders such as hypertension, migraines, headaches, asthma, ulcers etc.
• Increased self confidence and reduced self blame
• Increased availability of feelings. Muscle tension is one of the chief impediments to an awareness of your feelings.

How do you achieve a state of deep relaxation?

• Correct abdominal breathing
• Progressive muscle relaxation techniques
• Meditation

Progressive Muscle Relaxation Technique

Progressive Muscle Relaxation is a technique for achieving a deep state of relaxation. Tensing a muscle and holding it for a few seconds, then releasing that tension will produce a deep sense of relaxation, and will rid the body of the built up tension from living with high levels of anxiety on a daily basis.

Guidelines

• Practice for at least 20 minutes per day
• Find a quiet location free from distraction
• Ensure the room temperature is comfortable - not too hot, and not too cold
• Practice at regular times - on awakening or before retiring or before meals
• Assume a comfortable position - your entire body needs to be supported
• Loosen any tight clothing and take off shoes
• Make a decision not to worry about anything - if you have any other thought come into your mind, just let them go and bring your attention back to your relaxation
• Assume a passive, detached attitude

Technique

Progressive muscle relaxation is a technique where you tense and relax one at a time, all the major muscle groups of the body. The idea is to tense each muscle group hard for about 10 seconds, and then to let go of it suddenly. You then give yourself 15-20 seconds to relax and become aware of the contrast between the feeling of relaxation to how it felt when tensed. You then move onto the next muscle group until you have worked your way through your whole body. Often it is helpful to have some quiet, gentle music in the background.

Reference

Bourne,E.J.,(1995) 'The Anxiety and Phobia Workbook - A step by step program for curing yourself of extreme anxiety, panic attacks and phobias', MJF Books, New York., p.65-76 passim).

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Learn about critical incident debriefing, a tool for prevention of post-traumatic stress disorder (PTSD).

One day in 1993, my 7-year-old son was home sick from school and called me in my office to tell me that the World Trade Center had been bombed. I thought he was joking and told him so, but he said, "No Dad, I'm not kidding. Come and look at the TV." Some days later I was asked if I would volunteer to be available to victims of the bombing for critical incident debriefing. This was the first time I had ever heard about this process.

Critical incident debriefing is a tool for prevention of post-traumatic stress disorder. When the World Trade Center was bombed, people had to climb down up to one hundred flights of smoke filled stairwells. Those who worked in the Trade Center had no clue of what had happened; they just knew they had to get out of there at all costs. People emerged for hours, faces blackened with smoke, some injured and requiring hospitalization. Volunteers were needed who could help people talk about this experience, process the terror they experienced, and try to get on with their lives without suffering symptoms of post-traumatic stress disorder.

Critical incident debriefing is a prevention tool that works well for victims of traumatic events. It is one that you can do for yourself when you feel it's appropriate, either with friends and family, or in a support group with others. Of course, sometimes a trauma is such that you need to see a professional if you are going to get through it acceptably. However, it's a good practice to integrate into your life, because trauma is something that we all experience to varying degrees with some regularity.

I once conducted a critical incident debriefing for a small record company in Manhattan. This was a twenty person office, and there was a young man, Jose*, who was killed in a car accident. Jose was a college student by night, hoping some day to work in the recording industry. By day Jose worked as an office assistant in this small record company in the hopes of learning about the industry to which he aspired.

Jose was the kind of young man who, everyone felt, would go far in the business. He was bright, hardworking and charming, and his winning ways made him much beloved throughout the company. I met with this group of twenty employees about a week after Jose's death. None of them had been able to attend Jose's funeral which was held in another city, and they had never had an opportunity to grieve and mourn publicly and try to put some closure on the experience. They were a cohesive and cooperative group with which to work in that they all acknowledged that their functioning was adversely effected by the loss of Jose.

I proceeded to explain to them for a short while about the nature of psychological trauma and loss. I talked about how there were limited opportunities for expression of grief in this situation, and how important it was for all of them to talk about the loss of Jose whenever they felt a need to do so. I explained the stages of coming to grips with a loss and used a technique called "normalizing" when I explained the varied symptoms that they were all experiencing at that point.

After this, I encouraged everyone in the room to reminisce about Jose, and also to talk about their experience of this loss. I facilitated the discussion with a goal of making people feel comfortable expressing very vulnerable emotions with their co-workers. This was a very heartfelt and touching experience, and the participants said they were very grateful for this help in learning to deal with their loss. They also reported improved functioning to their supervisors in the next few weeks. This was helped by the fact that the company decided to hold a memorial service for Jose in a neighborhood church. Everyone who had something to say about Jose was welcomed to get up and address the group, and they ended the memorial with a silent prayer for Jose.

Dealing with the turbulent emotions that arise after a trauma by talking about them, seeking support, and performing rituals of closure can help you get through a traumatic time without having to experience the unsettling aftershocks of a post-traumatic stress disorder. If you or someone you know has recently undergone a trauma, be sure to seek help of this nature for yourself or for others as soon as possible. Let your trauma become a thing of the past.

* The names of all individuals have been changed to protect their identities.

About the author: Mark Sichel, LCSW is a psychotherapist in private practice in New York City. He created the website, Psybersquare.com and is author of Healing from Family Rifts, a guide to mending even the most difficult family estrangements.

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Your life is not in danger. During a panic attack, the sufferer is often convinced that s/he is having a heart attack or a stroke, and is dying. THIS IS NOT SO. The symptoms of heart attacks and strokes are quite different from those of extreme fear.

A panic attack is maintained by fear. Are you brave enough to try the technique of 'paradoxical intention'? All you have to do is to WILL the panic attack to hit you. Invite it. Dare it. This is particularly effective for people whose panic is predictable: occurs in particular circumstances. Go into the feared situation and say within your head: "Come on, you wretched panic: hit me! Go on! I'm not afraid of you!" If it helps, have a trusted friend with you for support.

The panic will be helpless against you, will not be able to touch you, AS LONG AS YOU REFUSE TO BE AFRAID OF IT!

A panic attack is not a sign that you are going crazy. It is true that you are in the grip of something and therefore 'out of control' of yourself, but the symptoms and feelings are very different from those of any mental illness. They are exactly the same as those of a person in extreme physical danger. They occur in response to A SIGNAL YOU ARE MISINTERPRETING, THEN THE FEAR IS MAINTAINED BY WHAT YOU THINK ABOUT YOUR FEELINGS IN RESPONSE TO IT. The fear is real. It is not an illusion or a hallucination. You are not crazy.

A panic attack is not a sign of weakness. Anyone can have them, in the right (well, wrong) circumstances. I once had one while watching my daughter stand on the bottom rail of a wrought iron safety fence, at the top of a very tall tower. I had the unreasonable feeling that, regardless of the laws of physics, she could topple over the fence (which was above her chest height) and fall to her death. I knew this was unrealistic, but could not stop an extreme fear reaction. Fortunately, I knew enough to bring myself out of it, and it has never recurred. Had I been less knowledgeable about psychology, I might now have a full-blown phobia.

You can control it. Just knowing the above facts can help a person get rid of panic attacks, EVEN IF THEY HAVE BEEN A PROBLEM FOR MANY YEARS. When you feel the next panic attack coming on, say to yourself: "This will be uncomfortable, but it cannot kill me. It's not a sign that I'm going crazy. If I can stop being scared, it will never come back. Anyone can have a panic attack."

Feelings of terror or impending doom, including full-blown panic attacks may be side-effects of drugs such as marijuana, amphetamines, caffeine taken to excess, or for certain people, even certain food additives.

Control is the Key

Here is a very slightly modified extract from my book, 'Anger and Anxiety: How to be in charge of your emotions and control phobias.'

"Abigail was shopping at the local supermarket when she suddenly had a 'queer turn'. Her vision went blurry, and there were spots dancing before her eyes. She felt dizzy, and had to hang on to her trolley to avoid falling. Heavens! she thought, I'm having a stroke or a heart attack!

Immediately she had this thought, she felt a pain in her chest. It was as if a steel band was constricting her lungs — she just couldn't get enough air. Her heart was beating so hard she could feel it. And it was very rapid. Her face and body were covered with cold sweat.

Somebody noticed her distress, she was looked after and driven home. This terrible experience did not recur for awhile, even back in the same shop. But months later, in a different place, suddenly it happened again.

After this, the panic attacks (as Abigail now knew them to be) occurred with increasing frequency, always in a crowded store. Then they spread to other situations. When I met Abigail, I had to go to her house to see her — she was unable to leave home.

This is 'agoraphobia'.
I don't know what set off the first attack. It could have been a temporary drop in blood pressure. She could have been coming down with an ear infection which affected her sense of balance. Perhaps some smell, or a combination of things around her, brought back a long repressed terrifying situation from her infancy. Whatever it was, she misinterpreted the symptoms as life threatening. Then she panicked in response to this fear.

While this first panic attack was in full flight, Abigail was surrounded by sights, sounds, smells, touches on her skin, sensations within her body, thoughts in her head. Any of these, or any subtle combination of them, had the chance of becoming new triggers for the fear. For example, the new 'signal' might have been the sight of a packet of self raising flour while a particular tune was being played on the store's sound system, combined with the feel of the cold steel of the shopping trolley's handhold. This particular complex (whatever it was) didn't recur for a few months. When it did, it was in a different place. It set off the second panic attack. Again, there was a good chance that a new constellation of sights, sounds, smells, feelings, whatever, would become a signal for the fear.

So, over time, the fear could be induced by a growing number of signals, until Abigail was imprisoned by her fear of the fear.

[I have to say here that there are different, competing explanations for how agoraphobia arises. I believe that the 'classical conditioning' model I described is correct — otherwise I wouldn't have used it. However, there is no controversy over the method for controlling agoraphobia. The method is described in Chapter 5 (page 23).]

Classical conditioning is how we pick up our automatic ways of responding to our experiences: to the world around us, to the sensations in our body, to the thoughts and emotions within our consciousness. A tune or a smell can vividly bring back apparently forgotten memories, or merely the emotions you experienced back then. You might respond with strong emotion (positive or negative) to a stranger. Unknown to you, you are reacting to some similarity between this person and somebody from your past. Parents tend to treat their children in exactly the way they were treated when little, often without realizing it. Prejudices, likes and dislikes, ways of responding to novel situations are all affected by conditioning from the past.

We couldn't function without having this storehouse of automatic ways of responding. But sometimes, our conditioned habits are no longer relevant, or, as in this example, they are unfortunate and distressing.

About the author: Dr. Bob Rich, author of Anger and Anxiety, is a psychologist based in Australia. He is a member of the Australian Psychological Society, College of Counselling Psychologists Associate Member, and Australian Society of Hypnosis.

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Cognitive therapy for panic disorder is very effective. Read about this treatment for panic attacks.

Cognitive therapy for panic disorder is a relatively brief (8 to 15 sessions) treatment derived from the cognitive theory of panic disorder. According to this theory, individuals who experience repeated panic attacks do so because they have a relatively enduring tendency to misinterpret benign bodily sensations as indications of an immediately impending physical or mental catastrophe. For example, palpitations may be interpreted as evidence of an impending heart attack. This cognitive abnormality is said to lead to a "positive" feedback loop in which misinterpretations of body sensations produce increasing anxiety. This in turn strengthens sensations, producing a vicious circle that culminates in a panic attack.

Treatment for panic attacks starts by reviewing with the patient a recent panic attack and deriving an idiosyncratic version of the panic vicious circle. Once patient and therapist have agreed that panic attacks involve an interaction between bodily sensations and negative thoughts about the sensations, a variety of cognitive and behavioral procedures are used to help patients challenge their misinterpretations of the sensations. The cognitive procedures include identifying observations that are inconsistent with the patient's beliefs, educating the patient about the symptoms of anxiety, and modifying anxiety-related images. The behavioral procedures include inducing feared sensations (by hyperventilation), focusing attention on the body or reading pairs of words (representing feared sensations and catastrophes) to demonstrate possible causes of patients' symptoms, and stopping safety behaviours (such as holding on to solid objects when feeling dizzy) to help patients disconfirm their negative predictions about the consequences of their symptoms. As with cognitive therapy for other disorders, treatment sessions are highly structured. An agenda is agreed on at the start of each session, and repeated belief ratings are used to monitor within-session cognitive change. In addition, frequent summaries are used to guarantee mutual understanding. At the end of each session a series of homework assignments are agreed on as well.

Controlled trials in the United States, England, Germany, The Netherlands, and Sweden (see Clark, 1997, for a review) show that cognitive therapy is an effective treatment for panic disorder. Intention-to-treat analyses indicate 74% to 94% of patients become panic free, and the gains are maintained at follow-up. The effectiveness of the treatment does not appear to be entirely due to nonspecific therapy factors as three trials have found cognitive therapy to be superior to alternative, equally credible, psychological interventions.

Source:

• (1) Clark, D. M. (1997). Panic disorder and social phobia. In D. M. Clark & C. G. Fairburn (Eds.), Science and practice of cognitive behaviour therapy (pp. 121-153). New York: Oxford University Press.

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