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24 Cards in this Set
- Front
- Back
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Give an example of a Panic Attack, employing Clark's 'Hook' model
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- Event: Assignment is late. Drink Red Bull as rushing to hand it in.
- Trigger: Rapid Pulse, Sweating - Automatic Thoughts: "Something's wrong!" - Emotion: Anxiety - Bodily Reaction: Clammy, difficulty breathing, pounding heart, dizzy - Focus on sensations: Wipe brow, look to find somewhere to sit, feel your chest for beating heart - Intensification of Sensations: These things become more obvious. - Catastrophic Misinterpretation: I'm going to have a heart attack! I'm going to die! - PANIC - cycle begins that leads to an attack. |
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What are Panic Sequelae?
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- you become hypervigilant to symptoms of attack - thus, noticing them more
- You avoid things that could trigger these symptoms e.g exercise, situations where the attacks occured - You experience anticipatory anxiety - it could happen again, when? where? how? |
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Who are two people whose work has been intstrumental in the treatment of Panic Attacks?
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Paul Salkovskis
David Clark |
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According to Salkovskis and Clark, what is the focus of Cognitive Treatment for Panic?
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- Identification and Modification of Misinterpretations of bodily sensations.
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What is the link between a client's previous experience and panic attacks? Give an example.
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Often, because of past experiences, a client has reasons for linking their bodily sensations to the catastrophies they are fearing will occur
E.g. Childhood friend who had asthma nearly died because couldnot breathe = Breathlessness = I am about to suffocate to death! |
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What, according to Salkovskis and Clark, are the 2 major components of Cognitive Treatment for Panic Attacks?
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1- Strategies that are put in place to help clients challenge the misinterpretations they make about bodily sensations as they occur in an attack
2- Modification of beliefs about sensations by getting clients to reconsider the observations upon which they base their misinterpretations, and by considering alternative observations. |
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What is the Course of Treatment proposed by Salkovskis and Clark for Panic Attacks?
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- Assessment - identification of key bodily sensations and misinterpretations, constructions and application of individualised vicious circle model.
- Test validity of the model by discussion AND Beh. experiments. - Devising and Implementing further tests to be used between therapy sessions, including exposure - Consolidation and summary of what has been learned - Treatment maintenance strategies |
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What are 3 Discussion Techniques used to help patients consider evidence for and against catastrophic and noncatastrophic interpretations of sensations?
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- Education - providing new information which contradicts patients neg. interpretations.
- Providing a Framework for helping patient understand the importance of events in past experience. - Identification of sequence of thoughts and symptoms in unexpected attacks - helping to account for apparently unexplained attacks. |
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What are belief ratings useful for duriing therapy with Panic Attacks?
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They monitor progress of cognitive restructuring.
E.g. How much do you believe you are going to faint in a panic attack now? |
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What 2 broad categories are Behavioural Experiments for Panic Attacks grouped into?
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- Ways of demonstrating the true cause of patient's symptoms (panic induction)
- Ways of testing patients catastrophic predictions about the consequence of symptoms. |
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What are some techniques (Behavioural Experiments) used to induce a Panic Attack? How effective are they?
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- Hyperventilation - 60%
- Word-Pairs - 75% - Imagine last Panic Attack ? |
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What does one do with Inducing an Attack?
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Discuss the Panic Induction experience in terms of the Cognitive Model of panic - linking cognitions to the sensation of Panic.
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What are some ways of testing a clients catastrophic predictions about the consequences of their symptoms? Give an example.
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- By getting them not to engage in protective behaviours that are upholding their predictions.
E.g. Not holding onto something to show that they won't collapse. |
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What do tests of catastrophic predictions show the client?
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- That their protective behaviours were only upholding their fears, and that show the client that their past attacks have actually disproved their fears (e.g I'm going to collapse, even though in all my attacks I've never collapsed).
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What are panic diaries used for?
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Used to record and answer misrepresentations as they occure. Serve to identify sensations, beliefs and also record success.
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Is there evidence to support the idea that purely cognitive procedures reduce panic. Are there any guidelines around this?
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Yes. But, it seems that cognitive procedures need to focus on changing clients misinterpretations of bodily sensations. - Salkovskis and Clark.
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What would a session structure for Panic Disorder look like?
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Much like standard CT:
- Bridge, update, med check - Agenda - Review Homework - Identify and examine different interpretations of sensations - Test out hypotheses in session and for h/w - Review session - Feedback |
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How would you go about eliciting the Cognitive Model of Panic Disorder?
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- Focus on the middle an attack - at its worst. Really get a good picture of the attack.
- Elicit descriptions of sensations and then what made them think their thoughts (e.g. I'm going to die) - What was the link between sensations and panic? E.g. pain in chest = sign of heart attack (helps them see their driving beliefs). Identify information processing errors (e.g. Catastrophizing) - Get them to rate their beliefs about their misinterpretations - Go back to do functional analysis of triggers. - Share the Hook diagram - tell them your belief that their panic fits with the model. - Fit the model together with the client. |
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What are 4 components of Panic Treatment?
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1- Indentify Catastrophic Bodily Sensations (Cognitive Model, etc)
2- Generate alternative interpretations of sensations 3- Test validity of catastrophic and non-catastrophic sensations 4- Relapse Prevention |
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How could you go about generating Alternative, non-catastrophic interpretations?
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- Psychoeducation - cognitive explanation of symptoms, inform about panic cycle, socratic questioning to fill gaps
- Use Intervention 5 Points in Clark Model |
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What are the 5 Intervention points in the Clark model for panic?
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1 - Trigger - what events, things could have triggered (not eating breakfast), identify interventions.
2- Automatic Thoughts - Teach them to explore and evaluate these thoughts. Other explanations for them? 3- Identify Bodily Reactions - explore options for controlling these (e.g. relaxation, controlled breathing) - teach lack of benefit in safety behaviours and avoidance behaviours 4- Distraction to allow sensations to decrease (e.g. call someone up) 5- Identify Catastrophic Misinterpretation - teach client to recognise symptoms and that they do not mean what they think they do. Behavioural experiments and Induction are CRUCIAL here. 4- |
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Why are Behavioural experiements and Induction crucial for Panic Treatment?
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- because otherwise relaxation, breathing, etc can help but can also prevent from getting over Panic Disorder.
- Coping doesn't get them to test the validity of their erroneous cognitions about sensations. - They need to experience and see that the sensations don't lead to their fears. |
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What is the Primary Behavioural Experiment used in Panic Treatment?
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Panic Induction
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What are some factors concerning Panic Induction that help make it effective?
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- Replication of panic sensations
- Client's analysis of differences and similarities to panic attack - Making of non-catastrophic conclusions about panic attacks - Listening to induction tape at home - speeds therapy progress - Duplication of induction at home - Elimination of safety behaviour - can be done through graded tasks (e.g. decrease calls to wife, increase driving alone,etc ) - Education that helps the client see how some aspects of their behaviour can maintain problems (e.g. avoiding situations) through giving them no opportunity to disprove the erroneous thinking |
