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Cognitive-Behavioral Therapy for the Treatment of Panic Disorder

CBT: Combining Behavioral and Cognitive Therapies


Updated May 27, 2014

The American Psychiatric Association recommends a form of psychotherapy called cognitive-behavioral therapy (CBT) for the treatment of panic disorder. CBT combines the fundamental concepts of behavioral therapy and cognitive therapy. To get a better understanding of CBT, let’s look at the basic concepts of these two approaches.

Behavioral Therapy

A behavioral therapy approach focuses on how your behaviors are contributing to and maintaining your symptoms and difficulties. It is believed that maladaptive behaviors are learned through a conditioning process and that bad, or unwanted, behaviors may be unlearned. For example, let’s say you have a fear of heights. Behaviorally, you may avoid tall buildings, escalators, or any place or circumstance that brings you higher than your tolerable comfort level. But this avoidance behavior doesn’t help your situation; it does, unfortunately, serve to reinforce your fear of heights.

Behavior Modification

To unlearn this behavior, a therapist may employ a behavioral modification technique. Behavioral modification techniques used in the treatment of anxiety disorders may include teaching the client more appropriate responses to situations, teaching self-monitoring skills, teaching relaxation techniques and exposure techniques to extinguish the fears associated with certain situations.

Systematic Desensitization: An Example of a Behavior Modification Technique

To illustrate how the behavior modification technique call systematic desensitization would be used, let’s say you have a fear of heights. Your goal is to go to the 100th floor observation deck of a building. First, you would be taught some relaxation techniques to help you control the anxiety you experience when faced with your fear of heights. After you have accomplished these techniques, you will be given gradual exposure to your feared situations. The goal is to use the relaxation techniques learned to counteract your previous fear response.

You first step in this systematic desensitization scenario is to approach the building. You don’t need to go in, just walk up to the outside door. Should you experience anxiety, you will call on the relaxation techniques you’ve been taught. You will continue to expose yourself to this situation until you are able to successfully counteract your anxiety response will your relaxation response.

Next, it may be time to enter the building. Again, you desensitize your fear response by exposing yourself to the fear and using the relaxation techniques you learned previously. Now, you're ready to go up to the elevator, then board the elevator and ride up one floor, and on it goes until you have achieved your goal of reaching the observation deck with minimal distress.

Cognitive Therapy

The term cognitive refers to our thought process and reflects what we think, believe and perceive. There is no doubt that what you are thinking affects how you are feeling. If you’re thinking about a tragic news event, it’s unlikely that you will feel joyous and want to laugh out loud. If your thoughts revolve around worry about what may or may not happen, it would probably be hard to feel relaxed and content.

A cognitive therapy approach focuses on how your thoughts perceive and give meaning to your world. Distorted and unrealistic thoughts result in misinterpretations that are believed to contribute to and maintain your symptoms.

Let’s say you are in a movie theater and have a panic attack. You sense you are in immediate danger or experiencing a life-threatening event, and you abruptly leave the movie theater. Once outside, you calm down a little. By the time you reach the safety of your home, you feel a sense of relief.

A week later, your friend calls to invite you to an afternoon showing of a movie you really want to see. You automatically think, “No, I can’t do it; if I go to the movie theater, I’ll have another panic attack and perhaps this time I’ll die or go crazy.” You graciously decline the offer by making up a reasonable excuse.

So, how is this way of thinking contributing to your difficulties? First, you have erroneously attributed the movie theater as the cause of your panic attack. You are making the assumption that, “If I stay out of the theater, I won’t have another panic attack.” Second, you have the mistaken belief that your panic attack was a tragic life-threatening event to be avoided at all costs. In reality, this line of thinking has not helped your situation. Unfortunately, it is laying the ground work for reinforcement of an illogical fear.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy reflects the importance of both behavioral and thought processes in understanding and controlling anxiety and panic attacks. The focus of treatment is on inadequate, obstructive, and damaging behaviors and irrational thought processes that contribute to the continuation of symptoms. For example, uncontrolled worrying (thoughts) about what may or may not happen if you have a panic attack may lead to avoiding (behavior) certain situations.

CBT has been scientifically studied for the treatment of panic disorder. Research has suggested that this form of treatment is effective in alleviating many of the symptoms of panic and restoring one’s ability to resume usual activities.


Kaplan MD, Harold I. and Sadock MD, Benjamin J. "Synopsis of Psychiatry, Eighth Edition" 1998 Baltimore: Williams & Wilkins.

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