Courtesy of the Psychiatric Times: “Treatment components of CBT include education, breathing retraining, cognitive restructuring, interoceptive exposure, and in vivo (i.e., real world) exposure.
Education helps establish treatment alliance and teach key concepts, including the course of panic disorder, the nature of panic attacks, behaviors that maintain the panic cycle, the cognitive model, and the treatment rationale.
Breathing retraining was initially thought to reduce physical symptoms of panic, but it was later conceptualized as a way to demonstrate how hyperventilation can exacerbate physical symptoms.
The goal of cognitive restructuring is to identify and challenge anxious thoughts regarding a panic attack.
In interoceptive exposure, patients perform various exercises (e.g., hyperventilation, spinning in a chair) in a controlled setting in order to repeatedly confront anxiety-provoking physical symptoms. With exposure, patients learn that symptoms are not as dangerous as originally perceived.
In vivo exposure traditionally has been used in the treatment of agoraphobia (i.e., avoidance behavior). During in vivo exposure, patients confront the actual phobic situation, such as traveling alone or being in an airplane or elevator.
These treatment components are based on two CBT approaches to panic disorder: panic control treatment (PCT) developed by Barlow and colleagues, which introduced interoceptive exposure as a key element; and the cognitive therapy (CT) program developed by Clark, which emphasized cognitive restructuring.”