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You will note that both behavioral and cognitive approaches involve
exposing yourself to the frightening situation, but the exposure is done
for different reasons (Hoffart, 1993). The conditioning oriented
behaviorist simply directs you to break the connection between the
situation and the fear response. Any old exposure will do (if it is long
enough). The cognition oriented therapist, however, collaborates with
the patient to clarify the patient's hypotheses about what will happen
in the frightening situation. Examples: if the nervous person says "I'll
fail" or "they will reject me" or "I'll blush and sweat and that will be
awful" or "I'll get so upset, I'll go crazy" or "if I panic, I'll die" etc., the
cognitive therapist suggests another more realistic alternative
outcome. Then it becomes a simple matter of testing these different
hypotheses (or schema), i.e. find out what will really happen in the
scary situation. One might ask "how could I test my notion that they
will laugh at me... that I will faint... that he will get mad...?" This will
involve exposure to the situation to test the distressed person's
thoughts and explanations about his/her fears. Always have an
understanding friend with you.
We must give up our defenses against the fears. Hoffart described
an agoraphobic patient who avoided and protected herself from the
feared situation in every way possible: she attended to shop windows
instead of people, tensed muscles to avoid shaky knees, held on to a
railing if she got light-headed, always thought "how can I escape
quickly?", avoided speaking to people, and went home at the first sign
of stress. Some of her hypotheses about what causes or prevents her
fear (as well as her expectations about the consequences of a full
blown panic attack) will need to be tested. The outcome of the "tests"
will surely result in her giving up her defensive "solutions" to the fear,
her changing her thinking and gaining self-confidence. Gradually, the
fears should decline and the self-efficacy build.
Cognitive therapy for people suffering panic attacks might involve
these kind of procedures:
1.
Since patients with a panic disorder are super alert to their
bodily functions and prone to misinterpret bodily sensations,
such as breathing hard, palpitations, or dizziness, it is useful to
find out what sensations they are concerned about and get the
patient to reconsider their conclusions. Suppose a person
panics while shopping because he starts to feel dizzy and then
fears he will faint and maybe die. He is constantly watching for
signs of dizziness and it never occurs to him to question his
conclusion that getting dizzy means he is near death. The
therapist may find out that the patient has never actually
fainted and then may ask why he thinks that is. The patient
may say, "because I hold on to something." Then there is a
discussion of fainting being caused by low blood pressure, but
the patient recognizes he has a strong pulse. Soon the patient
reasons that he could determine if he is going to faint by
checking his pulse. Later that day with the therapist, the
patient, checking his pulse frequently, tests the reality of his
