In order to understand exactly what Cognitive Behavior Therapy involves, it’s necessary to de-construct the three-word term. By de-construct I mean that we will examine each of the three words separately to increase our understanding of the whole.
The first part of CBT is from the Latin cogito I think. Some of you might recall those Philosophy lectures about Rene Descartes and his famous ‘cogito, ergo sum’ – I think, therefore I am. In general conversation, we link ‘cognitive’ with an intellectual engagement. We hear about cognitive deficits caused by brain damage, so let’s say that the cognitive component of this therapy involves our brains, our thoughts. It explores how you think and react to things, and how those thoughts elicit an anxiety response or start your panic attacks. If you want to eliminate panic attacks, you have to recognize your role in creating and maintaining them via what I call unhelpful thinking, unhelpful habits of mind.
Behavioral or even behavioural
In this treatment model, the behavior component isn’t just about how you behave in the sense of what you do. It’s also about how you react before you do things, and it’s also about how many of those behaviours become a habit and almost automatic. The behavioural component is also about the range of responses your therapists make available to you. Your therapist will work with you to find alternative ways to react, to break down your automatic responses. Through CBT, when you see that lift (elevator) door opening, you’ll be able to react in a calm way instead of automatically panicking about using the elevator. Cognitive Behaviour Therapy is an extremely interactive approach.
The third part of CBT, therapy, is from the Greek therapea healing. The healing or therapeutic component is about what you and your therapist do. It might involve you learning relaxation exercises, but it’s also part of an ongoing conversation and series of observations about your thoughts, reactions and actions. My counselling Practice and my e-kit Calming Words involves helping people to learn to meditate and I encourage daily meditation as part of building up our reservoir of calm which is depleted daily by our hectic lives.
Eliminating Panic Attacks using Cognitive Behavior Therapy
Each anxiety or panic attack follows a well-documented cycle. In his very useful book, Facing Panic: Self Help for People with Panic Attacks, Dr Reid Wilson calls this the Panic Cycle. It’s a cycle because one step seems to follow another much as the wheel of a bike goes around automatically. If your local library does not have that book, ask them to get it in. It is one of the best resources on sale and it is short and to the point in easy to understand language.
First step in that Panic Cycle is where you have contact with stimuli which makes you feel anything from slightly nervous to downright terrified. For instance, if you have had panic attacks in the shopping Mall, you’ll feel terrified just entering those automatic doors.
In a Cognitive Behavior Therapy approach your therapist would have you look closely at that initial trigger. You may be asked to do something that seems paradoxical: you may be asked to increase the number of times you experience that initial fear. That’s called an exposure-based intervention, and it can happen in your therapist’s office or in the Mall. It’s a way of allowing you to see what you already know at a rational level. Namely, that there is nothing to fear. Cognitive Behavior Therapy allows you to think (cognitive) about your fear response (behavior) so that you can construct a more appropriate response (heal).
At the end of most panic attacks the anxiety reducing behaviour of choice is avoidance. You stay home, or you only go to the mall with a friend who knows about your problem, or you only go to the movies if you can sit on the aisle seat – ready for a quick escape.
You’re in charge. However, at both ends of the panic attacks cycle your reactions (cognitive responses) and behaviour (panic or escaping) are the cause of your continuing discomfort. Both sets of behaviour are inappropriate. Both can be discussed as a way of re-writing the script. What script? The one that says ‘enter mall, feel terrified’. It’s your thoughts that evoke your adrenaline (fear) response. Through Cognitive Behaviour Therapy, we can help you work with those thoughts and responses to re-align them so that you change your response to entering the automatic doors at the Mall – or whatever triggers your fear.
Dr Jeannette Kavanagh has a counseling and coaching Practice in Melbourne Australia, to help people find their unique solutions to anxiety and panic attacks. Visit her website www.calmingwords.com to sign up for a FREE MP3 Relax on Cue.