The cognitive component of CBT helps patients to understand how the way they think about their symptoms affects their experience. For example, being fearful of the symptoms can create a feedback loop, increasing the length and intensity of the ‘fight or flight’ response and continuing the length and severity of the panic attack. Conversely, challenging these thoughts can lead to control of panic and agoraphobia.
The behavioural component may involve exercises to induce symptoms as a teaching and mastery tool. An example is getting a patient to hyperventilate (a form of interoceptive exposure) to induce symptoms. This can be undertaken during a consultation or the patient may undertake this as part of their ‘homework’.
The behavioural component often also involves patients gradually challenging themselves within triggering situations while giving them skills to manage their panic in vivo exposure.
Face-to-face therapy is generally limited to 5–10 sessions of 1 hour, often weekly, over a maximum of 4 months. Sessions may be delivered individually or within a group.
Patients can expect to be asked to undertake homework and to monitor their symptoms. Weekly sessions provide a chance to review the progress of homework exercises. The frequency and severity of panic attacks are monitored by the patient and are a guide to progress.