Panic Control Treatment

Description of the Strategy

Panic disorder (PD) is characterized by the sudden onset of intense fear or discomfort accompanied by various, and often intense, physical sensations that develop abruptly and reach their peak within 10 minutes. Although it is necessary for these attacks to be both recurrent and unexpected in order to meet diagnostic criteria for PD, it is clear that even after an initial attack, most people begin to associate the physical sensations they experience with a particular event or situation. For example, if an individual experiences “unexpected” heart palpitations and shortness of breath in the morning, they are more likely to associate those symptoms with the large cup of coffee they drank for breakfast rather than make no association. Similarly, if an initial panic attack is experienced while on a crowded subway during the stress of an early morning rush hour commute, it is likely that the situation may be subsequently avoided or endured with dread.

Thus, when people are fearful of activities or events, they will tend do things that they feel will prevent the events from occurring. The result is that many individuals with panic engage in elaborate safety and avoidance behaviors, such as keeping medications on hand or leaving a situation before the anxiety can begin. Because the feared situation is avoided or tolerated with the aid of a safety behavior, the individual will usually assume that when the feared event does not occur, it is the result of these actions rather then the event's rarity.

For many individuals, the process of experiencing an “unexpected panic attack” in particular situations is followed by the subsequent avoidance of those situations in an attempt to prevent the recurrence of unpleasant physical sensations. This cycle often results in debilitating avoidance and eventual treatment-seeking behaviors. Therefore, it comes as no surprise that the most effective forms of treatment for PD with/or without agoraphobia are ones in which the somatic symptoms of panic are reproduced and experienced acutely by the individual in such a way that they can reality test the actual danger of these symptoms, termed interoceptive exposure. This form of treatment is in contrast to the typical treatments for PD, which tend to focus solely on external situations that evoke panic symptoms (situational exposure).

Thus, much as agoraphobia is avoidance of external fears and situations, interoceptive avoidance is defined as the avoidance of situations or activities, such as exercising or drinking caffeine, in which the individual is likely to experience feared somatic sensations.

As a result of this new concept and new research aimed at understanding the importance of interoceptive cues and avoidance in individuals with PD, Barlow and Craske developed a new psychological treatment for PD they called “panic control treatment” (PCT), which has interoceptive exposure as a central component of its treatment model and has been met with wide acceptance by fellow clinicians and sufferers of panic attacks.

Fundamentally, PCT combines the principles of traditional situational exposure with the newly developed interoceptive exposure and psychoeducation about the physiology of panic, which all work to [Page 420]modify cognitive misconceptions. Thus, the three components of panic targeted by PCT are (1) physical sensations, (2) cognitions, and (3) behavioral avoidance. In addition, PCT relies heavily on work, including exposure, in which the client engages outside of the therapeutic environment.

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