De-Constructing Cognitive Behavior Therapy (CBT)
When we de-construct the term, we look at each of the three words separately to increase our understanding of the whole.
Cognitive – from the Latin cogito I think.
Some of you may recall those philosophies 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 through what I call unhelpful thinking, unhelpful habits of mind.
Behavioral or even behavioral
In this treatment model, the behavior component is not just about how you have 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 behaviors become a habit and almost automatic. The behavioral 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 life (elevator) door opening, you'll be able to react in a calm way instead of automatically panicking about using the elevator. Cognitive Behavior Therapy is an extremely interactive approach.
The third part of CBT, therapy, is from the Greek theraphyía healing. The healing or therapeutic component is about what you and your therapist do. It may involve you learning relaxation exercises, but it's also part of an ongoing conversation and series of observations about your thoughts, reactions and actions. Many therapists encourage daily meditation as part of helping clients to build up their reservoir of calm which is depleted daily by their hectic lives.
Eliminating Panic Attacks using Cognitive Behavior Therapy
Each anxiety or panic attack follows a well-documented cycle. In his very helpful book Facing Panic: Self Help for People with Panic Attacks Dr R Reid Wilson calls it The Panic Cycle. It's a cycle because one step seems to follow another much as the wheel of a bike goes around.
First step is where you have contact with a 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 behavior 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 behavior (panic or escaping) are the cause of your continuing inconvenience. Both sets of behavior 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 Behavior Therapy, we can help you work with those thoughts and responses to re-align them so that you change your response to the automatic door at the Mall – or whatever triggers your fear.