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Cognitive Behavioural Therapy

We all 'what if....'. What if this is causing much of the problem? .....It is!

We are what we think! And the way we think when we have an anxiety disorder only perpetuates the disorder. Cognitive therapy assists us in seeing the damage our thoughts cause and it enables us to work with and control the these thoughts. Recovery is a matter of altering our perception of what is happening to us and/or what will people think of us and changing our thought patterns to our new perception.

Cognitive Behavioural Therapy is a series of strategies specifically targeted to an individual's Disorder. These can include cognitive therapy, relaxation, breathing techniques and interoceptive exposure.

In this article we are going to draw on an expert to discuss this. Chris Edwards is a clinical psychologist, (B.Psych M.Psych) who specialises in Anxiety Disorders, Chris runs an anxiety disorder clinic in Adelaide, Sth Australia and is a former Chairman of the Anxiety Disorder Foundation of Australia..He has undertaken research into various aspects of Anxiety Disorders ran a GP training program into the diagnosis and treatment of anxiety disorders.

Jasmine Arthur Jones, interviewed Chris Edwards in April,1997 and the subsequent interview was serialised in the Panic Anxiety Disorder Association Inc Newsletter.

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J. Do you think that a person with an Anxiety Disorder can recover?

C. I think that the majority of people that have Anxiety Disorders, in particular Panic Disorder, I think the treatment outcome studies are showing that recovery is possible. The Cognitive Behaviour Therapy (CBT) studies using the Oxford model suggest that overall between 84 and 94% of people taking part in those studies are panic free at the end of treatment and they're going to generally maintain that over the follow up periods.

J. How long was the last follow up period, was it a year or..

C. Varying, I am giving results over a range of studies ... there is one and two year follow ups.

J. Oh right, that's really good, isn't it .. 

C. That's very good. Now, of course, not everybody is going to be able to go and get a little bit of CBT and get results that quickly because as we know Panic Disorders are caused by a number of different causes and those causes will generally predict the speed with which a person recovers.

J. So can you give us a simple explanation of what CBT is and how that would work for someone with Anxiety Disorder?

C. Lets start off with what CBT is and I think we have to look at it historically because the cognitive principles are derived from the work of our earlier philosophers such as Socrates and Epitites. Epitites said that it is not the things of this world that hurt us but what we think about them. So it taught us that within regard to a whole range of emotional disorders that our thoughts are very important. And that is regardless of the cause of the Disorder but once you have a Disorder your thoughts about the Disorder are very important. In particular, with Panic Disorder the thoughts are very important. I think if you a look at what a Panic Disorder is in terms of cognitive theory, a panic disorder is generally seen as misinterpretation of bodily sensations .. that is a catastrophic misinterpretation of bodily sensations. Now, once a person learns to misinterpret these sensations, a pattern tends to be fairly enduring. So the cognitive theory helps a person to assess the evidence which supports or does not support their beliefs about what is happening to them.

J. How would you start with someone with say a Panic Disorder, when they first come to you to start working with their thinking?

C. By a very careful cognitive Behavioural assessment of the person with the Anxiety Disorder. First of all you want to know what their beliefs are about how they developed the Disorder. You want to know what their beliefs are about their symptoms. You want to know what kind of avoidance behaviours they might be engaging which continue to maintain the symptoms. For example, people might be avoiding watching things on TV for fear that if they see something about somebody who has something it might make them worse hearing about it. Once you think about that, you can see that there is a fair amount of room there for cognitive distortions about the meaning of getting dangerous information. You know, people are certainly unique, and I think there are many commonalities between people with Panic Disorder, but each case is unique and you really do need to assess the individual or idiosyncratic beliefs of the individual. Now, once you have assessed them, the sorts of therapies that you generally do go over a whole range of issues. There are some cognitive strategies that you use, in addition to that there are a number of Behavioural strategies.

J. So does that include graded exposure to some extent?

C. No. I think people are changing their beliefs about what graded exposure means. In terms of graded exposure for cognitive therapy, certainly you may use some kind of exposure, but what we do is use a number of Behavioural experiments. That is, a person may go out and test a belief they have about a certain situation. Now, before the person goes out they are certainly armed with a number of strategies that they can use to help them overcome their beliefs in that situation.

J. That is the clue .. what is termed as graded exposure is not simply just forcing yourself into a situation without any strategies. You know the theory .. exposure to a situation therefore you'll lose the fear. You must have strategies to work with in the situation.

C. Yes. You certainly do. I think that approach is fairly naive and doesn't work with many people.

J. And rather cruel I feel ..

C. A definition of the cognitive theory of panic ... people who experience recurrent panic attacks .. they are said to do so because of a relatively enduring tendency to interpret body sensations as catastrophic. OK, so the sensations interpreted are normally those associated with ordinary anxiety responses such as being breathless, having palpitations, feeling dizzy, experiencing numbing of the extremities. So these are all ordinary sensations. Now what seems to happen is that when a person develops Panic Disorder there is generally an increased sensitivity to all bodily sensations so the person begins to interpret what are still normal body sensations as meaning that something quite bad could occur. The difficulty with Panic Disorder is generally they fear that something is about to occur right then and there. For example, a person might have Panic Disorder for many years and fear having a heart attack. But all of the evidence is that they haven't had one over all of the years that they have feared it, is insufficient evidence to contradict the belief that they might have a heart attack in the next minute, next hour, or the next day. So consequently, Cognitive therapy helps the person address those issues. I don't think it is a matter of simply telling the person their thoughts are incorrect, or that they have nothing to worry about because family members have been doing that all along and it doesn't seem to help. It is a matter of helping to guide the person to discovering their own evidence which either supports or doesn't support their beliefs about their symptoms.

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