Panic

Question 1

Introduction

Answer 1

• DSM-V
• Avoidance is key in maintenance in anxiety disorders especially panic and phobias (Denny, 1991)
• When confronted with a threat the brain and body changes to deal with it (fight/flight). Adrenaline is released to increase Heart rate and breathing; (Abramowitz et al, 2019)
• Escaping situations because of this leads to instant relief from anxiety which prevents learning that the Anxiety with time decreases
o Thus, they experience the same amount of anxiety every time they are in the situation (Papworth and Marrinan, 2018)
• Exposure can be done as flooding, but this can be overwhelming, therefore it is graded

Question 2

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Answer 2

Exposure is a means of enabling a person to confront feared situations, leading to a reduction in the associated anxiety.
• Exposure requires them to stay in the situation until anxiety decreases allowing learning of habituation.
o By confronting it, clients learn anxiety reduces normally (Habituation)
• There are four conditions
o 1. Graded
o 2. Prolonged -must stay in situation long enough for anxiety to decrease to allow learning. Can use a graph to demonstrate this to clients.
 Clients are likely to be unconvinced by this until they have tried it. First exposure should be lower grade. Recommended to stay in situation until the anxiety has halved
o 3. Repeated -allows generalisations about anxiety in situation to occur may need to be exposed several times a week. Clear rationale should be provided with encouragement
o 4. Without distraction – clients may use things to avoid full anxiety, e.g. directing attention elsewhere. Prevent feeling anxiety, reducing chances for habituation. Clients may need help recognising them and why they are counterproductive.

Question 3

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Answer 3

• There are 3 stages (Papworth and Marrinan, 2018)
o Orientate client to treatment
 Normalise the clients urge to escape/avoid the situation, explain the fight/flight/freeze response. Use client’s formulation to demonstrate consequences.
 Explain breaking the cycle and habituation.

Question 4

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Answer 4

o Generate a hierarchy of feared situations
 Guide the client in constructing a hierarchy of situations that cause anxiety, rating anxiety caused by each one, broken down by difficulty level.
 Practitioner can help – introduce ideas that the client may not have thought of to break items down in smaller steps

Question 5

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Answer 5

o Carry out exposure work
 Work through the items on the hierarchy
 Reinforce the importance of staying in the situation until anxiety reduced and the conditions necessary for exposure.
 Self-help materials can explain the importance, client can use this as a rationale.
 Practitioner can guide planning exposure work and helps to problem solve and difficulties using COM-B (Michie et al, 2011).
 As client build confidence, they are more able to move up hierarchy independently reporting on outcomes at each contact with practitioner. Progress reviewed at each contact, consolidates learning and recognition of the headway they are making in meeting goals.
 Even though sometimes the client, may not reach the top of the hierarchy by the end of treatment, they should have the skills and knowledge to continue up the hierarchy independently or with help from their support networks

Question 6

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Answer 6

•	Wells, 2013
•	Deacon and Abramowitz, 2004; Morton and Price, 2007  
•	Gil et al, 2001 
•	Silvers et al, 1999 - 
•	Menzies and Clarke (1993) 
o	E- Muris et al 1998 – 
•	Groups 
o	Panic Control Treatment has shown efficacy as an individual (Aaronson et al., 2008) and group CBT (Heldt et al., 2006)
CCBT
•	Schneider et al (2005)

Question 7

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Answer 7

• Client avoidance
o (Choy et at, 2007)
o (Michie et al, 2011),
o (Rachman et al, 2008)
• Reluctance by the practitioner to implement exposure
o Novice practitioners can find it difficult to tackle avoidance, lack confidence in habituation or worry client will be made worse by exposing to fears
 Practicing techniques on own fears can be useful (Thwaites et al, 2014)
 If practitioner employs the cognitive strategies to challenge their own fears about what might go wrong
 Supervision is important for exploring practitioners concerns and ensuring exposure techniques are implemented correctly.
o Becker, Zayfert, and Anderson (2004)
• Difficult to treat phobias that are unusual or expensive
o E– Powers and Emmelkamp, 2008
 Could become more accessible and easier to implement phobias that may be difficult to expose client to e.g. heights, flying and could provide safer method of exposing to situations e.g. driving.

Question 8

Conclusion

Answer 8

• ET can be used when clients are avoiding situations that cause them anxiety usually seen in Panic
• There is evidence to suggest the effectiveness of ET
• There are possible limitations to ET but there are ways these can be overcome.