Using CBT to Overcome Panic Attacks
By Roger Tilton, Ph.D.
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Identifying Sensations And Thoughts

The first step in overcoming panic attacks is to identify the bodily sensations you are experiencing and the catastrophic thoughts you are having about these sensations.   It is important that you separate your thoughts and sensations.  For example, “I feel like I’m going to faint” is actually a sensation of lightheadedness and a thought or belief that you are about to faint.  “I feel like I’m choking” is a sensation of tightness in your throat and a thought or belief that you will choke and not get enough air. 

Identify and separate your sensations and thoughts by writing them down in two columns: one titled "Sensation" and the other titled "Thought".  Keep in mind that sensations do not cause anxiety. It is your beliefs about sensations that cause anxiety.  

Coming Up With An Alternative Explanation

Once you are able to separate and clearly identify your sensations and thoughts, the next step is to write down an alternative and more objective explanation for the sensation.  After writing down the sensation and the catastrophic thought, add a third column titled "Alternative Explanation.”   If you have more than one sensation that you fear, do this for each sensation.  For example:



Alternative Explanation

Tightness in my throat

"My throat is tightening up, and I won't be able to breathe."

This is a harmless sensation of anxiety and has nothing to do with my breathing.


"I'm going to faint."

This is a symptom of anxiety or hyperventilation, not fainting.

Feeling of unreality

"What if I'm going to lose it and go crazy?"

This is just a harmless sensation of anxiety, which will go away when my anxiety subsides.


Looking At The Evidence

As you do this, ask yourself which explanation has been more accurate in your experience so far – your catastrophic thought or your alternative explanation?  What, if any, evidence supports your catastrophic thought and what evidence does not support it?  Which of the two appears to be the more reasonable explanation?

Becoming More Objective At Times Of Greatest Anxiety

When you are very anxious, the tendency is to believe your catastrophic thoughts of danger, so you need to work at becoming increasingly more objective about your thinking at times of greatest anxiety. It is important at these times to write down your sensations, thoughts, and alternative explanations and then look as objectively as possible at the evidence.

The very act of writing things down during a panic attack can itself help you to assume a more objective perspective.  At first, you will find that you are able to accept your rational alternative explanation when you are not anxious, but that it is harder to do so when you are highly anxious.  This is understandable, but as you work towards becoming more objective about your thinking during times of high anxiety and panic, you will find that your degree of belief in your irrational thoughts will begin to diminish.

As your degree of belief continues to diminish, you will see that your level of anxiety decreases along with it.  When your degree of belief approaches zero, your anxiety will be gone.

As you go through this process, you will see how very close the relationship is between your thinking and how you feel. The key to mastering panic attacks is to fully realize – while you are having a panic attack – that your catastrophic thoughts are merely untrue thoughts that you need not accept.  When you no longer believe these thoughts, there is nothing left to feel anxious about!  At that point, you will fully understand that a panic attack is just a false alarm that you can turn off at will.


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