How is depersonalization treated by cognitive therapy

Panic attacks

According to psychologists, there are four components that play a central role in an anxiety disorder: the fear-inducing thoughts, the fear-inducing feelings, the physical symptoms and the fear-maintaining behavior.

In the event of a panic attack, some tried and tested "SOS methods“Against acute physical and psychological symptoms. You can treat the panic attacks well with the help of one psychotherapy. It starts with the fear-inducing thoughts, feelings and behaviors.

Immediate and first aid measures in the event of a panic attack

  • Do a breathing exercise: When the fear arises, breathe in and out intensely several times: first breathe in deeply through your nose (you can imagine sucking the air into your stomach) and slowly (in three short bursts) breathe out again through your mouth. The important thing is to focus only on deep breathing and continue doing this exercise until the panic subsides and you feel better.
  • First aid for hyperventilation: If you hypenventilate, you should immediately hold a paper bag (not a plastic bag, there is a risk of suffocation!) Or a handkerchief in front of your nose and mouth and breathe in and out. Because the quick panting during hyperventilation removes a lot of carbon dioxide (CO2) from the blood, which causes the respiratory center to have problems with automatic breathing. There is a higher amount of carbon dioxide in the exhaled air. Repeated inhalation of this “collected” air in the paper bag quickly increases the carbon dioxide content in the blood. This then activates the respiratory center normally again.
  • Relax the muscles: Tension promotes the development of panic attacks and also intensifies them. Most commonly, the shoulders, neck, facial muscles, hands, and buttocks are tense. If you notice this tension, it is best to concentrate on each individual part of the body and try to loosen it.
  • Direct thoughts on something else: If you start to feel anxious, you shouldn't be frantically paying attention to the smallest body reaction, but rather distract yourself mentally. When you focus your concentration on something completely different, you can take your eyes off the panic and drain it of energy. For example, look at a picture in the room in detail: what can be seen on it? What colors is it? What do you like about it? This measure comes from behavior therapy and will distract you from the panic attack.

Treat panic attacks through cognitive behavioral therapy

If you're looking to get rid of your panic attacks, cognitive behavioral therapy (CBT) has been shown to be particularly effective. The basic principle of this therapy is: Everyone can unlearn what they have learned and how to behave. This also includes dealing with fear.

During cognitive behavior therapy, you make your own Thought patterns and behaviors rationally aware. Then practice together with your therapist to change both so that you can deal with certain situations more constructively. This affects both the symptoms of the panic attack and the factors that trigger them.

At the beginning of the panic attack therapy, the therapist will explain what exactly happens in the body during a panic attack and that it is not dangerous. This knowledge alone reduces the fear of many of those affected.

One of the biggest fears about having a panic attack is passing out and falling over. Through psychotherapy it becomes clear to you that the dizziness and anxiety do not have any physical causes, but “only” arise from fear. The more you think about this during an anxiety attack, the less you will feel like you are about to fall over. It also helps many to find out about the physical symptoms of a heart attack or asphyxiation. Then you will know in the future by virtue of your intellect that you are not suffering either.

In addition, cognitive behavioral therapy is also about that Triggers the panic. For example, anyone who gets a panic attack during stressful work phases can ask themselves whether their own workload is not too high, whether they define themselves too strongly through professional success and how they can relax more in everyday life.

If, on the other hand, the fear arises in situations in which you are in a large crowd (restaurant, supermarket, train, etc.), you may ask yourself why it is happening there? Are you perhaps too perfectionist and fearful of embarrassing yourself in front of others? Then perfectionism and / or a social phobia may be the subject of panic attack therapy.

By the way, it's not about never feeling fear again. That wouldn't work either, because it is one of the central feelings of human beings. Because fear helps us with real dangers. For example, we quickly flee from a fire or immediately change the side of the street when a dog barks angrily. Rather, cognitive behavioral therapy helps you find ways to reduce anxiety and deal with it more calmly. For example, people with agoraphobia can choose a table near the restaurant door or sit outside in the aisle in the cinema. If that reduces their fear, it will already help them.

However, there is one thing that people with panic attacks should definitely not do: avoid the places or situations that trigger the feelings of fear! Because this misconduct maintains fear and often intensifies it instead of containing it. For example, if you initially “only” avoid the supermarket in which you have had an anxiety attack, you may soon avoid other shops in order to never experience something so terrible again. At some point, shopping may no longer be possible at all. Then another family member has to do this or a supplier brings the groceries. But even then, the fear does not go away; it can appear in other situations, for example in overcrowded train stations, on the bus or at a concert. In severe cases, anxious patients never leave their home at all.

Treat panic attacks with exposure therapy

People with panic attacks need to learn not to run away from fear or to fight against it (which can make it worse), but rather to face it. This is the basic principle of exposure therapy or exposure therapy. Some experts call it the most important method to successfully master panic attacks in the long term.
You and your therapist go to a specific location or situation that has already triggered a panic attack in you. It is crucial that your therapist is there. So you cannot use a strategy to relieve your fear, such as taking a sedative. And you develop the feeling that you will get help immediately in an emergency - you are, so to speak, protected from fear.

For example, you can ride in an elevator with your therapist or be in the flow of visitors in a large department store. The fear that arises should be tolerated and learned to endure. You will notice that the feeling of fear is unpleasant, but subsides after a few minutes and has no dangerous consequences. The more often you have this conscious experience, the more a habituation effect sets in - and the fear level drops. You can also deal with your fear in a more controlled manner afterwards. Ideally, panic attacks will stop occurring at some point.

Panic attacks and medication

There are also medications for panic attacks. You can reduce the anxiety and intensity of panic attacks. However, drugs are not recommended as the sole therapy, but only in combination with behavioral therapy.

The following drugs are used for panic attacks:

  • Antidepressants: Doctors usually use drugs from the group of selective serotonin reuptake inhibitors (SSRIs). Selective serotonin norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants are another option. SSRIs and SNRIs have fewer side effects.
  • Benzodiazepines ("Sedatives"): They work faster than antidepressants, but can lead to physical dependence and should only be used for a short time.