Cognitive therapy for panic

Domain II · Behavioural & cognitive · David M. Clark, Paul Salkovskis · 1986 · Oxford

What it is

Cognitive therapy (CT) for panic disorder is a structured, time-limited individual therapy built on Clark's (1986) cognitive model. According to the model, panic attacks come from catastrophic misinterpretation of body sensations. Palpitations become "I'm having a heart attack", dizziness becomes…

Format

• Format. CT is individual and outpatient, with weekly sessions. The manual gives 5 to 15 sessions as typical. The 1999 trial describes standard CT as 12 to 15 one-hour sessions. Each session has the same structure:
• Patients record the sessions and listen back as homework. Near the end, sessions are spaced further apart to build self-reliance.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Stopping practice as soon as symptoms ease.
• Any medical doubt about chest pain. Check with the GP first.
• Monitoring that increases body-checking. Keep entries brief.
• The therapist backing off or soothing. Stay with the evidence.
• Education used as reassurance. Move on to exposure to test it.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.