Treat anxiety cbt

seVi this article I will analyze causes of panic attacks and panic disorder. Why panic attacks occur, and what leads to this? I will also give some tips on treatment regimens.

Some people believe that panic attacks occur due to a chemical imbalance in the brain and prescribe “treatment” with antidepressants.

Others are convinced that incorrect, irrational thinking is at the heart of fear and anxiety, and they are prescribing psychotherapy sessions (for example, cognitive-behavioral).

Still others write off the responsibility for the occurrence of panic attacks on children’s injuries and relationships with parents and believe that without psychoanalysis it is impossible to figure out here.

And the fourth in general are sure that panic is just a manifestation of some physiological failures of the body.

Treat anxiety cbt

So what to do? Who is right? Should I take pills or go to a psychologist? Or you can handle yourself? In this article we will figure it out.

What we have?

We have attacks of anxiety and fear with symptoms of accelerated heartbeat, fast breathing, sweating, which can occur suddenly and at any time.

The attack can be accompanied by disturbing thoughts (“something is wrong with me”, “I will die”), the fear of losing control and losing my mind, a feeling of derealization (feeling as if you are in a “smoke”).

Between attacks, there may be anguish anxiety, anxiety about the return of attacks, meticulous and tedious self-examination. All this is called panic disorder. (Forget the word “IRR”, there is no such diagnosis in the world medical practice!)

Panic, fear, anxiety, anxiety are natural and normal manifestations of the human psyche. The panic attack itself is a natural human “hit or run” reaction that occurs in every person in response to an immediate threat.

I also explain this in my video “the causes of panic attacks”

And even more in his free online course “3 antidotes to panic.” Subscribe to it right now in the form below:

The adrenal glands emit adrenaline, norepinephrine, hormones that cause the heart to beat faster, the body to strain, and the breath to accelerate.

In general, in this way, our body takes care of our survival: it quickly brings the body on alert, either for a quick escape or for a violent attack. Therefore, it is called “hit or run.”

Losing control over the body in such a state is impossible! On the contrary, “hit or run” is a state of supercontrol, super readiness to “take the legs in hand” and save yourself.

This is a natural reaction. Only in the case of a panic attack, it occurs as if outside its context, that is, out of danger. You are absolutely in no danger, but at the same time you experience all the symptoms of the “hit or run” reaction.

It’s like a “false alarm”, a fire alarm that turns on when there is no fire.

Treat anxiety cbt

So why do some people activate this mechanism even when there is no danger, disturbing their quality of life and peace of mind? Now we will talk about it.

Causes of Panic Attacks

I share the reasons for the panic attacks to be predetermining, supportive, and mixed. Predetermining causes are what directly caused panic disorder. Supporting reasons relate to why panic disorder continues, why some people suffer from panic attacks of 5, 10, 20 years and cannot get rid of them in any way. And mixed causes can be attributed to both.

For example, in the case of a viral cold, the predominant cause would be a virus infection.

And supportive – non-compliance with the treatment schedule prescribed by your doctor. Instead of staying warm, stay in bed, you walk, go to work and because of this your cold does not go away. This is a supporting reason.

Predetermining causes:

Genetic factors

In the course of studies of twins, the relationship of anxiety level with genetic factors was revealed. It was also proved that if a person has some of his close relatives, he suffered from chronic anxiety, then his chance of acquiring this disease increases. That is, we can say that there is some genetic, innate predisposition to panic attacks.

But do not get scared! This is just one of many possible causes of panic disorder, practically the only one that we (probably) cannot influence. Everything else we can change in ourselves and get rid of panic attacks!

Children’s injuries, relationships with parents

Many experts are now trying to solve the problem of panic attacks with the help of psychoanalysis: analysis of children’s injuries, internal conflicts, hidden complexes and offenses. And the first thing that comes to many people when they think about psychological help is exactly this kind of work.

However, there is no convincing evidence for the association of panic disorder with childhood injuries. Not all people with a “difficult childhood” are subject to panic. There is also no evidence of the effectiveness of psychoanalysis in ridding people of panic attacks.

Many people visit psychoanalysts, learn a lot about themselves, but the PA problem is not solved with the help of these conversations, which remain only conversations. But for the time being I won’t take out child injuries for the reasons of panic attacks. Even if childhood plays a role in the development of panic disorder, it is only as one of many causes. This time. And we can solve these consequences of long-playing problems here and now, not necessarily ripping the layers of the unconscious, plunging into hypnosis. These are two.

Sudden stress

Sudden stressful circumstances (for example, the death of a relative, severe injury, abrupt changes in life) can also trigger panic attacks. However, this reason can only be considered in conjunction with other causes, because not all people experiencing severe stress, panic attacks occur. Often a stressful circumstance is only a trigger for panic attacks, whereas the tendency to anxiety could have been present in a person for a long time.

Chemical imbalance

Many old-fashioned psychiatrists will tell you with certainty that you have just something in your brain that is disturbed, which is why you have constant fear and anxiety. They will say this, without doing any research, by eye, without understanding other causes. They will assure you that for you there is no way out, except for life-long dependence on drugs.

This is surprising, given that the hypothesis of the appearance of panic disorder as a consequence of the imbalance of neurotransmitters in the brain is just a hypothesis. There is no evidence that PAs are generated due to the fact that something happens to our neurotransmitters. Even assuming that this is true, it is important to understand two important things:

  1. Your chemical exchange in the brain is not a self-contained phenomenon. It depends on many factors: your behavior, lifestyle, how you eat, sleep, think. Attempting to influence him with pills can be a struggle with the effect, not the cause.
  2. You can increase the production of serotonin and other substances responsible for the feeling of peace and happiness, not only with the help of pills, but with the help of various exercises, including physical education.

Mixed causes

Cumulative stress

This is a stress that accumulates throughout life. A person may experience systematic stress every day. In the absence of skills to cope with it, sooner or later, it can cause various ailments, including panic attacks.

But constant stress can be not only the cause of panic disorder, but also the reason why you cannot get rid of it, so I attribute it to mixed causes. If you, suffering from PA, continue to be exposed to daily stress every day, then it significantly complicates the way out of this state.

Personal factors

I would single out this reason among the rest. In my opinion, she plays one of the most important roles in panic disorder. Where people just don’t look for reasons for panic attacks: in their surroundings, in relations with their parents in childhood, in violation of the chemical balance, but not in themselves. By personal factors, I do not mean your childhood, but what personality traits you carry in yourself every day, here and now. Now I will say what it is about.

If it can be said that sudden stress can act as the seed from which the PA grows, then personality traits can become fertile ground in which the shoots of panic disorder sprout. Therefore, often, cutting off only a sprout and even picking out grain, we do not solve the problem, because sprouts of new phobias and anxiety sprout again and again on our soil.

Immaturity, sensitivity, general anxiety

Many of my clients, people with panic attacks, always had some common personality traits. This increased anxiety, a tendency to worry over trifles, suspiciousness. These qualities have manifested themselves in these people long, long before the onset of panic disorder. I had these qualities, because I myself suffered panic attacks.

A person with a PA, as a rule, possesses above-average intelligence, a flexible and agile mind, and a rich imagination. These are good properties of nature, but if they are knocked out of control, they are transformed into anxious suspiciousness, a tendency to invent all sorts of scary scenario scenarios (“I will fall from the bridge”, “I will go crazy and get into an insane asylum”) and lively present them in imagination. Their mind, multiplied by their tendency to worry, becomes an enemy to them.

This does not mean that our mind is our curse. Simply, if we learn to control anxiety, then it will become our friend, become a source of creative energy, new discoveries and ideas, and not a treasure trove of anxieties and phobias.

Negative attitudes and habits

One of the personal causes of panic attacks can be negative attitudes. For example, many people with PA always care too much about the opinions of others, have a painful inclination to please others, face social fears or perfectionism.

Or they consider that “I should never be wrong”, “I should always be right”, “I can never refuse anyone”, “I should always control everything” (the so-called Control Freaks). All these things can lead a person into a state of constant anxiety. And in the event of a panic attack, they are even aggravated.

Constant anger, irritation, stress, resentment – all this can also be causes of PA.

Lack of necessary mental skills

The culture in which you and I live does not instill the valuable habits of mind care. We all understand how important it is to take care of the body, maintain physical health. But few people think that our psychological health also needs constant care. We are not taught in schools how to properly relax, how to get rid of annoying thoughts, how to control our emotions, how to let go of fear.

The lack of these skills can lead to panic disorder and other ailments, in front of which a person is helpless and does not see any other way out other than pills. But if your leg is sick, you won’t just swallow painkillers? You will probably look for the cause of this pain? It seems logical.

But for some reason, the “treatment” of PA pills does not cause doubts in many people!

The lack of these valuable skills greatly prevents a person from overcoming his anxiety. Therefore, many people begin to master various techniques of relaxation, acceptance and awareness for the first time only in the office of a psychotherapist, a coach or in online courses of getting rid of panic attacks.

Health problems, bad habits

PA can be directly related to your lifestyle. It has been proven that bad habits associated with alcohol, smoking and using other drugs can increase anxiety. Sedentary lifestyle, poor nutrition and sleep: this can also exacerbate the symptoms of panic and lead to panic disorder. Also, some physiological diseases may have the same symptoms as PA, for example, hypoglycemia.

Supporting causes or major errors in panic attacks

And here is the most interesting. Then it will go exactly those reasons because of which people suffer from PA for so long and can not get rid of them. Disposal of PA can be described by the phrase: “to get out of the pit, you need to stop digging.” Then I will show how each person with PA himself, by his own efforts, digs a hole in which he gets bogged down deeper and deeper, making the most critical mistakes in the behavior and perception of seizures.

Merging with anxious thoughts, analysis

Alarming imaginary scenarios, obsessive thoughts, negative internal dialogue and introspection — all these words describe what happens to people both during an attack and between them. Thoughts appear: “what if I die,” “something is wrong with me,” “why this happens,” “I will suffocate.”

A person begins to think, analyze and the longer he does it, the worse it gets. One thought is followed by another: “what people will think of me,” “it will never end.” His mind plays an incredible frightening story in front of him, and the man begins to believe and frighten himself in this story.

He could experience hundreds of attacks, each of which did not lead to any terrible consequences, but during each new attack he would again begin to believe in the most incredible dark scenarios that had never happened, could not occur (and if they can, then with critical low probability). It seems to him that now the worst will surely happen!

I know about one interesting experiment. Scientists have divided people into 2 groups: one group – people suffering from PA, another group – people who have never encountered this. All people were given drugs that stimulate anxiety, such as those containing caffeine or carbon dioxide. So all subjects experienced symptoms of panic attack.

Only people who have not encountered PA before have suffered this calmly (“so what? I’m under the influence of caffeine, it’s quite natural that my heart beats fast”), the attack ended quickly for them. But for people with chronic anxiety, everything was more complicated. They were terribly frightened by the anxiety that had arisen, and disturbing thoughts (“my heart beats fast, probably a heart attack will happen or I will suffocate”).

Their reaction to the attack, thoughts about the attack increased the symptoms of the attack itself. If the heart beats fast, a person interprets this signal as a danger (“the heart must stop”), it is frightened, because of this the heart starts beating even faster, as a result of which new thoughts appear (“now I’ll just die, I must call fast! ”). And so on. It turns out a vicious circle.

It is the merger with disturbing thoughts that intensifies the attack. And it can also cause new seizures “out of the blue.” If a person thinks about it, start analyzing his condition (“is there no attack at all?”, “What is happening to me now”), how anxiety appears and a panic attack follows him.

I use the psychological term “merging with disturbing thoughts” (the English Cognitive fusion is my exemplary Russian translation of this term) to emphasize that it is not the disturbing thoughts themselves or the scary stories that cause the PA to not pass. And the fact that you believe these thoughts and stories!

According to one study, 100% of people attend various terrible thoughts about insanity, sexual perversions, violence, illness, and even suicide. But only a small part of them start to be frightened by these thoughts, to unwind them in their heads (“since I think about it, it means that I’m not normal”). This part is people with chronic anxiety, or prone to it.

Avoiding provocations

Personally, my attacks took place absolutely anywhere: at home, on the subway, at school, and

It seems that this is quite logical behavior. We do not want to have a seizure – we don’t go where it occurs.

But in fact, not everything is so simple. As you remember, a panic attack is a “hit or run” mechanism that runs without any external threat, like a “false alarm”. There is no danger, in fact, objectively in the store. Or in the subway. But the longer you avoid, the stronger and stronger the connection is fixed in your brain: “shop is dangerous” and the more often your brain starts to trigger “false alarms” in this place.

The first attack in the store could happen just like that. But, starting to avoid, you yourself gave your brain a command to associate this place with danger. By avoiding, you fix the mechanism of a false alarm in your head.

The cunning of avoidance is that for a time it envelops us with an illusory zone of comfort: it seems to us that we help ourselves by avoiding, but in reality, we are only tightening the alarm loop around us. Avoiding is not productive at all, it only pushes you to the fact that you begin to associate an increasing number of places with danger. The longer you avoid, the more panic disorder becomes. Not to mention the other inconveniences in life.

One of my clients, who, with my help, began to travel on the subway (and before that avoided), told me: “how, it turns out, the subway is convenient!” You can understand it. Before that, she traveled around Moscow only on ground transportation, as she was afraid to go down into the subway. And in the capital, with its traffic jams, ground transportation is hell!

Fear of seizures

For many people, panic attacks are not as terrible as what happens between them. Following the attacks, the person appears anxiously awaiting each new attack. Even when there is no attack, it will still be tense, in the anxious anticipation of the new PA. “What if an attack comes, what then?” Such anxious expectation, fear of attacks, fear of fear puts the body in a state of constant danger. And this condition can provoke new seizures. An attack is like a stray dog, the more you fear it, the more likely it is that it “attacks” you.

People who get rid of the fear of attacks, which cease to frighten the idea that the attack can return, because they have learned to overcome them, eventually get rid of the attacks.

Negative reaction to an attack, resistance

It is quite natural that when unpleasant, intense emotions come, a person has a completely understandable and normal desire for this to disappear as soon as possible. He does not want to experience these emotions, trying to resist. There is an alarm about anxiety (“well, it’s back again, and when it’s over. It’s probably forever!”), Fear about fear (“how awful! Again an attack! That will soon finish me off! How to remove it? Why do I have nothing Does not help?” ). In psychology, this is called secondary fear, that is, secondary fear.

Primary fear – these are the primary symptoms of an attack: accelerated breathing, palpitations, sudden fear. But the secondary fear includes, how you react to these symptoms: “my heart beats so often, and suddenly it stops!”, “How this sense of derealization got me, there is no salvation!”. Secondary fear – these are all your alarming scenarios about the future, “but what if I lose my mind”, all this uncontrollable mechanism of catastrophe: “what if I die of an unknown disease”. This includes disturbing thoughts and resistance.

And this “secondary fear” actually accounts for 80% of all the unpleasant effects of an attack! This is the operating mechanism of the PA and the trigger for new attacks. You yourself, with your reaction, intensify your attack, fuel it with your thoughts, increase your anxiety, inflate it with your imagination.

In the attack itself, there is nothing very scary: it is just a “hit or run” mechanism that triggers the release of adrenaline and then stops just as it began. Yes, it is unpleasant, but it passes and carries no danger. But it is precisely the reaction to all this that makes the attacks so unpleasant and makes them come back.

Attempts to resist these symptoms resemble attempts to extinguish a fire with gasoline. This tactic does not work here. It is not the fear itself that needs to be removed, but the reaction to fear, then you stop reinforcing it and it leaves! When a person fails to respond to fear by fear, when he lets go of resistance, he is already very close to getting rid of the PA.

What to do about it and why do people suffer panic attacks for so long?

We see that, firstly, there are many reasons. It turns out that the one who believes that the causes of the PA in the behavior, and the one who sees them in the physiology of the organism and the brain, and the one who goes into psychological analysis are right. But in each case it is impossible to reduce everything to something one, prescribing pills to a person and releasing them on all four sides, as many doctors do. Hand on heart, we can say that they are fully responsible for drug addiction among many of their clients.

Secondly, it becomes clear why panic attacks are such an “insidious” ailment. What prevents many people from getting rid of it? Why do many of them suffer from PA for so long? Because the intuitive actions that first come to mind: to resist, avoid, analyze your thoughts at the moment of fear – all this leads to the opposite result: fear increases.

Acting instinctively, as the mind tells us (after all, it seems logical to avoid the place where fear arises or to resist fear), we, on the contrary, plunge deeper and deeper into panic disorder. The man himself, by his actions, digs a pit for himself, as I said.

So what then helps to get rid of panic attacks? How to stop digging this hole?

The most effective method of getting rid of fear is paradoxical. It is not based on the suppression of fear, but on its acceptance, not on attempts to remove fear itself, but on attempts to reduce the reaction to it. When we achieve this, the fear goes away.

Perspective Methods for Overcoming Panic Attacks


If you ask a random person about how he imagines working with a psychologist, then he will surely say something about the couch on which the patient lies and dumps his whole past on the psychoanalyst. Such a stereotype. But “classical psychoanalysis” with the analysis of children’s injuries, internal conflicts does not show effectiveness in working with anxiety disorders. Everything has changed a long time ago, new topical ways of dealing with anxiety have appeared. As written in one book about therapy acceptance and commitment:

Treat anxiety cbt

“Strong changes have occurred in psychology. If in 1920 we could observe a client lying on a sofa who talks about his childhood experiences. So today we can enter the room [psychotherapy] and see clients who are sitting with their eyes closed, doing nothing, or frozen in a position of yoga or eating raisins very sooooo. You can even hear the client say, “I’m confused,” and the therapist will answer him: “Excellent! Finally we are moving somewhere! ”

Approximate translation of an excerpt from the book “A CBT practitional guide to ACT”

It can be said that the cognitive-behavioral direction is the “generally accepted” method of therapy in the West. This therapy has been shown to be more effective in treating anxiety and panic. However, everything is rapidly changing and CBT (cognitive-behavioral therapy) is replaced by a new wave of psychotherapeutic techniques, for example, dialectical behavioral therapy (DBT) and acceptance and awareness therapy (ACT), which inherit many of the techniques from MBSR ( stress based on awareness).

Many experts and studies suggest that these newer areas are superior to the effectiveness of CBT. And I agree with that. I think ACT is the most promising way to work with anxiety. The principles of ACT at one time helped me get rid of panic attacks. All these methods work precisely with the attitude of a person to their attacks, in which lies the main cause of PA. Unfortunately, there are few specialists in our country. But they are. For the time being, this trend is only developing here.


What are the pills:

  • Antidepressants of different classes (fluoxetine, cipromil, amitriptyline and

Tranquilizers – do not “treat” anxiety. They temporarily stop the symptoms. At the same time, they cause addiction, not only mental, but even physical! After withdrawal of tranquilizers, anxiety symptoms either worsen or remain at the same level. In no case, long-term anxiety from them passes. And of course, a whole bunch of side effects are added to this, including lethargy, reduced intellectual functions, reduced attention and concentration, reduced interest in life.

I wrote this many times and will repeat it again. No pills cure panic disorder! You can never do some pills. They are needed only to prepare a person for therapy (not important under the supervision of a specialist or independent), to bring him out of a state of acute anxiety and depression, so that he can begin to solve his problem. They work only in the context of therapy, but not by themselves! (Or when nothing else helps, as an extreme measure)

There is a chance that pills can only exacerbate panic disorder. When a person begins to rely too heavily on medications, he is no longer sure that deliverance from PA lies in his power! He begins to believe less in himself, act less and thus interferes with his recovery. And this is what will be discussed next.

Independent work on getting rid of panic attacks

It is important to understand that all the last points are not mutually exclusive alternatives. Even if you work with a psychotherapist, this does not exclude your independent work, because, no matter how good the specialist is, he will not solve your problem for you. The same goes for pills, even more.

However, you can get rid of panic attacks without a therapist. You can do this without pills. One can learn to overcome fear, get rid of anxiety and obsessive thoughts in a natural way during an attack.

My example is proof of this. I have not had PA attacks for a long time, but I will not be afraid of them, even if they return, because now I know what to do with them. But you will never get rid of panic attacks without your personal efforts aimed at your recovery! As long as you do not take it, you cannot talk about any solution to the problem.

I see that most people are not ready to work on their problem, they are not ready to look for ways to get rid of anxiety. Most people just want to talk about their problem, but do not want to do something.

They want a “magic pill.” They have no desire to act, to help themselves, to take care of their health. I want to go by itself. With this instant!

And I see how they suffer because of it. All this time, such a person is waiting for when magic finally comes and panic attacks pass by themselves. So you can wait a very long time. Wait and suffer. Why wait? When you can start right now and get rid of PA forever!

I have listed many causes of panic disorder. It may seem to someone that the path of getting rid of PA is very difficult and thorny. Yes, of course, it requires patience, but not everything is so difficult.

Everyone can get rid of the PA! With the help of techniques of awareness, mindfulness, you can solve the problems of negative attitudes, suspiciousness, merging with disturbing thoughts. With the help of relaxation techniques, proper nutrition, exercise it is quite possible to stabilize the nervous system and feel better. With the help of exposure methods there is a great opportunity to get rid of avoidance, and with the help of adoption methods you will learn how to overcome and release fear and even children’s insults and conflicts! You will deal with panic attacks at a deep level. At the level of their root cause, and not at the level of the effect!

Some of these techniques are described in my article “How to get rid of panic attacks.”

It’s not that hard!

Subscribe to my free course “3 antidotes to panic”

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