Lifted From Therapy: Techniques for Panic & Anxiety

Anxiety and panic are everywhere today, and disorders associated with them are commonplace. No matter which you’re managing, there’s no getting around the fact that therapy is the most effective means of dealing with anxiety or panic disorders, and the research backs that up. Not all treatment was created equal, however, and some methods reign supreme over others.

First, let’s look at the differences between panic and anxiety:

Anxiety is a state of readiness for something to happen; a feeling of apprehension. Panic is active fear of perceived immediate danger accompanied by a need to get away from/avoid the threat. Anxiety is longer-lived, but panic is more intense in the way it presents. And don’t worry, you’re not extra-strange: Most people experience both.

And now for a little more on what works:

Exposure Therapy

Anxiety is miserable, and it’s normal to try avoiding it when you can. Most people do this by avoiding certain situations that make them anxious, like someone with a fear of spiders who can’t buy her dog food at the pet store that sells tarantulas and totally isn’t me or anything. The trouble with avoidance is that it solves nothing because you never have the opportunity to overcome what you’re afraid of by being confronted with it. Aside from being inconvenient (for my dogs), avoidance usually just makes anxiety stronger on top of not being helpful in the first place.

Exposure therapy is meant to confront you with the object or scenario you’re afraid of. The aim is to give you a steadily increasing sense of control over the situation, allowing your anxiety to ramp down, and it’s done by either approaching the situation in real life or imagining it vividly, guided by your therapist. It’s often conducted alongside cognitive behavioral therapy.

Cognitive Behavioural Therapy

Cognitive behavioral therapy (CBT) establishes that it’s primarily our thoughts, not outside factors, that affect how we feel and determine anxiety. As an example, one person’s reaction to being invited to a movie is “Awesome!”, whereas mine might be “Oh no, I’m gonna say something stupid or they’ll say I look like an idiot in these pants.” The anxious thought isn’t necessarily rational, even though the precipitating event is the same in both cases. Cognitive behavioral therapy looks to address and challenge the thoughts in a constructive way, altering how you think to change how you ultimately feel.

Cognitive restructuring is a technique where you identify and challenge the negative patterns of thought that contribute to your anxiety, replacing them with more realistic, positive thoughts. It goes in three steps:

1. Identifying Negative Thoughts – When you have an anxiety disorder, you perceive situations as being more dangerous than they actually are. For example, someone with a phobia of open spaces might feel as though they’re dying simply by being in a field. Though this can be seen by others as an irrational fear, identifying them as the sufferer can be more difficult. Your therapist will help you to question what you thought when you began to feel anxious.
2. Challenging Negative Thoughts – This is when your therapist shows you how to properly evaluate the thoughts causing your anxiety. You question the reason for your upsetting thoughts, examine unhelpful beliefs that might be contributing and check the reality/likelihood of the negative predictions your anxiety brings about. You’ll weigh the pros and cons of avoiding and worry, and discuss how unlikely the imagined negative event is to result.
3. Replacing Negative Thoughts – When you’ve identified the irrationality of your negative predictions, you can replace them with thoughts that are more realistic. You can come up with a script of relaxing statements to make to yourself when you’re faced with something that triggers your anxiety — your therapist will work with you to develop a positive internal dialogue.

Interoceptive Exposure

Interoceptive Exposure (IE) is a cognitive behavioral therapy technique where the patient carries out some exercise/action that brings on the physical symptoms of a panic attack in a calculated environment, removing the pre-conditioned response that the symptoms will cause an attack to occur.

The pre-conditioned responses are usually agitated and kept going because of one of the following:

Reassurance-Seeking and Avoidance Behaviours – Attempting to avoid feeling the anxious sensations or avoiding where they generally happen means you’ve got far less experience with how dangerous they really are. Seeking reassurance or safety is just another method of avoidance, and keeps you from seeing there’s no true danger.

Interoceptive Conditioning – Eventually, your body becomes sensitive by learning that the physical symptoms come before moments of high anxiety, and thus are predictors of fear.

Perceived Meaning/Beliefs – Thinking negatively about the symptoms of anxiety/panic, (by saying “This is dangerous, I can’t deal with it” etc.) only increases the panic level, making it more likely that you’ll try to avoid the situation or seek reassurance.

Recently, Dr. Michael Telch of the University of Texas called interoceptive exposure ‘without question the single most effective technique for overcoming panic disorder.’ During IE, you elicit and maintain the sensation you’re anxious about, activate and then begin to learn ways around the harmful beliefs you hold regarding that sensation.

Therapy isn’t all you can do, of course. Medication, exercise, diet, and sleep can all play roles in anxiety management and control panic. Your doctor will likely recommend an approach combining a little bit of everything to help you find what works best for you, but there are some things you can do on your own in the meantime to help the process along.

Do your best to reduce stress – Don’t take on a bunch of extra responsibilities or work while you’re experiencing anxiety. Make time for fun every day (this is pretty huge). And it should go without saying, but try to keep away from people that cause you anxiety or make you nervous in a negative way.

Live the healthiest lifestyle you can – Exercise is a huge reliever of anxiety and tension, even if you don’t realize it right away, so make sure to put aside a little time for physical activity. Pay attention to your sleep, avoid negative coping mechanisms like alcohol and try to stay away from caffeine and nicotine, both stimulants that can worsen your symptoms.

Learn about your anxiety and panic – To best help your therapy along, you should have a basic understanding of anxiety and seek to gain more knowledge of the problem.

Open up to healthy relationships – Don’t make yourself more likely to succumb to anxiety by isolating yourself from others. Go out of your way to hang out with friends, talk to loved ones and maybe join a support group if you’re comfortable with that kind of thing.

Most importantly, remember there’s not an easy solution to anxiety or panic, and you’re going to be uncomfortable – maybe even feel terrible – at times, but that’s a natural part of confronting your fears. Your therapist is there to help guide you, and they’ll remind you that this is a long road, but worth it in the end. If you want to reduce your anxiety, you might have to combine therapy with medication, but the work you put in is what gets you to a better place in the end.