Presenter: Rachel Strohl, Psy.D.
View the webinar’s corresponding slides here
This presentation will discuss panic attack symptoms in adults. Webinar attendees will learn how to identify panic attack symptoms in several of the common anxiety disorders, including Panic Disorder, Social Anxiety, Generalized Anxiety Disorder (GAD), and Obsessive Compulsive Disorder (OCD). The focus will be on the evidenced-based treatment for Panic Disorder: Cognitive behavioral therapy (CBT). The components of CBT that will be explained include psychoeducation, relaxation, cognitive restructuring, and exposure. Case examples and illustrations will be provided.
Dr. Strohl received her Bachelor’s degree in Psychology from George Washington University, Washington, DC. She received her Masters of Psychology and Doctorate of Clinical Psychology at Rutgers University, Graduate School of Applied and Professional Psychology (GSAPP). She is a New Jersey licensed psychologist. Throughout Dr. Strohl’s graduate training, she worked at the GSAPP Psychological Clinic providing individual cognitive-behavioral therapy through the CBT Clinic for Anxiety and Depression. She worked under the supervision and training of Dr. Allen Weg. Dr. Strohl also had the opportunity to co-lead several CBT groups focused on anxiety with Dr. Weg at Stress and Anxiety Service of NJ. She presently serves on the Board of Directors at the New Jersey Obsessive Compulsive Foundation.
Comments(10)
DixonM says:
August 15, 2019 at 12:35 pmI have Tourette’s and Anxiety (OCD, General Anxiety Disorder, and Panic Disorder). My tics, anxiety, and depression/isolation all seem to perpetuate each other, creating a vicious cycle. How do I break free from that cycle?
Dr. Strohl says:
August 15, 2019 at 12:35 pmI’m so sorry to hear about your struggles. One of the most difficult things about Tourette’s syndrome is not just the tics but the issues of OCD, anxiety, and depression that often accompany it. I’d say the most important step in breaking the cycle is working with someone who has experience with Tourette’s syndrome in the accompanying disorders. Hopefully, this person can help you prioritize which issues are the most important and teach you skills focused on those particular issues. For example, if your depression is a byproduct of being isolated and your isolation is a byproduct of avoiding others due to anxiety or tics, then you would start by focusing on the anxiety or tics. Conversely, if your depression is making it hard for you to do the work it takes to improve your anxiety and tics, then you focus on that first. I hope this is helpful.
AFrick says:
August 15, 2019 at 12:37 pmHow do you distinguish between a mental tic (TS) & a cognitive distortion from a panic disorder?
Dr. Strohl says:
August 15, 2019 at 12:44 pmTypically, a “mental tic” tends to be similar to an intrusive thought that we would see in OCD. Mental tics are just repetitive thoughts that are irritating or don’t make sense. Others describe them as mental compulsions that they feel like they have to repeat. Once again, these often don’t make sense but the urge to do them is strong. A cognitive distortion is a way of seeing things that negatively impacts how you perceive the world. Think of them as common ways of misinterpreting or exaggerating reality. In the case of panic disorder, typical cognitive distortions are, for example, emotional reasoning: “I can’t tolerate these feelings,“ or mislabeling: “these sensations mean there’s something seriously wrong with me.” What might be confusing is if you have Tourette’s and panic disorder you may find yourself thinking repeatedly about your health, future panic attacks, etc. This would be what we call worry, rumination, or perseveration, which is different from a mental tic. A mental tic tends to be a random, often nonsensical, thought that just repeats over and over and over again.”
(Thanks to my esteemed colleague Dr. Robert Zambrano who specializes in the treatment of Tourette’s syndrome for his consultation on the mental tics of TS)
WRhombus says:
August 15, 2019 at 12:37 pmHow would you apply cognitive distortions in thought work?
Dr. Strohl says:
August 15, 2019 at 12:43 pmAs stated in AFrick’s reply, a cognitive distortion is a way of seeing things that negatively impacts how you perceive the world. Think of them as common ways of misinterpreting or exaggerating reality. The steps of cognitive restructuring therapy include identifying the trigger if present, then the feelings (e.g., anxious, overwhelmed), then the automatic thought. It’s helpful to ask yourself, “what was I just telling myself to make me feel (insert feeling words) this way?” Once you have captured several of your negative automatic thoughts, then you can identify the cognitive distortions in the automatic thoughts. The cognitive distortion list was created by Dr. David Burns and lists ten cognitive distortions, such as all or nothing thinking, jumping to conclusions, overgeneralization, etc. Once you have the label, you can start changing your thinking, e.g., helping yourself think in “shades of gray” to challenge all or nothing thinking.
CBiens says:
August 15, 2019 at 12:38 pmRegarding relaxation techniques, you recommend calm activities, what’s your feeling about something more physical such as walking or swimming?
Dr. Strohl says:
August 15, 2019 at 12:42 pmGreat question! I’m a strong believer that you do what works for you. If walking and swimming are calming activities for you, then I would encourage you to do it. Sometimes people report feeling more relaxed during or after a more strenuous, adrenaline-filled activity. Sometimes with panic disorder, a person will avoid these activities because they’re afraid that the heart racing and physical sensations can trigger a panic attack. As we discussed during symptom cue exposure work, it’s important to feel the uncomfortable feelings to learn that you can tolerate them. So whether you consider these activities relaxing or exposure work, they’re certainly encouraged and supported.
DorothyG says:
August 15, 2019 at 12:38 pmAre the relaxation techniques better done alone or with a friend or child?
Dr. Strohl says:
August 15, 2019 at 12:42 pmDuring practice times, it can be supportive to learn new skills, such as sensory grounding or paced breathing, with your friend or child. However, I would recommend not relying on that person to be there when you start implementing relaxation skills in your stress management tools. You would aim to use the skills alone if needed, and not rely on another person to coach you through every time. It’s also helpful to learn the practice skills in a similar setting that you will be implementing them. If you’re having panic attacks in your car, then you might start by practicing in the car. We certainly want you to be able to generalize your relaxation skills in different settings, but situational learning can be helpful. Another example is if you’re planning on using your relaxation skills in a work meeting, then I wouldn’t recommend practicing the techniques in bed before going to sleep. You’d be surprised, but we associate learning and environments, and we don’t want you getting sleeping at a work meeting!