Anti-Panic Medication Can Interfere With the Effectiveness of CBT
A variety of pharmacological treatments (anti-depressants and minor tranquilizers) have been shown to be effective in regulating panic attacks. However, Anthony and Swinson (2000) reviewed research which show that the addition of anti-panic medications to Cognitive Behavioral Treatment (CBT) for panic disorder can diminish the effectiveness of CBT. Furthermore, outcome studies examining long-term treatment outcomes show that patients who receive a combination of CBT AND drugs have higher relapse rates and a more significant resurgence of panic-related symptoms compared to patients who only received CBT. Otto and his associates (1992) reviewed research which showed an 89% recurrence rate of panic, after panic-free patients discontinued use of minor tranquilizers (benzodiazepines).
How Could Medication Hinder the Effectiveness of CBT?
Naturally, in the heat of Emergency Room Panic, panic relief is the top priority. You take medication to stop panic attacks. Can you believe it? The desperate desire to eliminate panic from your life with meds can feed the “fear of fear” cycle and perpetuate the recurrence of panic attacks. When you run from panic, panic begins to rule your life. Starting on medication can serve to provide immediate relieve but ultimately slows down the long-term solution to panic disorder.
Get Me Off the Panic Roller Coaster!
Large groups of panic patients have shared with me their experience of tapering off minor tranquilizers under physician supervision. The doctor outlines a tapering medication protocol with small reductions in medication each week or two weeks. The patient, routinely, hopes they will maintain their panic-free state during gradual reductions in medication intake. There remains an underlying core fear of panic attacks, which serves as a trigger (Anticipatory Anxiety, “What if Panic Returns?”). Frequently, at some point during the tapering process, the patient calls their doctor, alarmed at a resurgence of powerful panic. “I am feeling worst than I ever have!” Immediately, the doctor advises the panic sufferer to resume the higher dose of medication. This phenomenon creates a roller coaster effect and a fear that “I have to be on medication the rest of my life.”
This fear is false! I have helped thousands of patients “own panic disorder” without meds.
Panic in a Bottle
When you view medication as a method of eliminating panic symptoms like heart pounding, you use the drug to avoid and escape from panic symptoms. The more you run and duck and escape from fearful stimuli (heart pounding), the more the fear of the heart pounding feeling builds. The nasty part is that the fear reaction to heart pounding produces more adrenaline, strengthening the very heart pounding feeling that you want to eliminate.
Anti-Panic Meds and CBT Can Work Against Each Other
Sam*, a 26-year old project engineer, had successfully completed Phase One of panicLINK (takeCONTROL Training). However, he continued to carry his bottle of tranquilizers with him, whenever he went out, “just in case.” One day, while out in the field, he checked his pants’ pocket to make sure his tranquilizers were by his side. He felt a wave of dizziness sweep over him, as he realized he had left his trusty pill bottle at home. Without thinking, he raced home, found the bottle, inserted it into his pants pocket, and felt complete relief from the dizzy feeling and returned to work. He never took a pill!
Sam’s psychological reliance on knowing he could always take a pill to quell panic led him to give too much credit to the pill as a method of panic relief and diminish the recognition of the power of CBT methods.
When you start a medication protocol, it is easy to over-rely on meds for panic relief. You then under-rely on CBT as a powerful method of panic relief. Reliance on the comfort of using a pill for panic control can support an underlying fear of panic symptoms, mushrooming out of control. You can create doubt in your ability to stop panic without meds.
CBT teaches you a comprehensive method to REDUCE your fear of panic sensations. Sometimes, reliance on medication for panic relief can serve to INCREASE your fear of panic sensations. More importantly, you can lose sight of the power of CBT to block panic.
A CBT Drug Tapering Program
I have found that once a patient achieves a panic-free state with a combination of CBT and drug therapy, a separate CBT drug tapering program must be initiated to prevent the recurrence of panic. (*Note that any changes in medication must be made under the direct supervision of your prescribing physician). The primary focus of the CBT tapering program is to prepare the panic patient for a therapeutic encounter with panic symptoms. Extensive planning, preparation and systematic training in reducing the fear reaction to panic symptoms occur prior to initiating the medication tapering process.
Otto and Pollack (2009) have outlined a scientifically validated approach called “Stopping Anxiety Medication” (SAM) for integration of CBT into a medication tapering program. They have written SAM manuals both for providers and patients.
Give Me Fresh Live Raw Pure Super Charged Early Panic …the Stronger…the Better!
I would run a mile to treat pure fresh panic terror. Non-medicated, pure panic is much easier to treat effectively when compared to patients who have already been stabilized on meds and have only breakthrough panic.
Sherrie*, a 22-year old college freshman, was referred to me directly from the emergency room with her first terrifying panic experience and had not started on medication. It was much easier to teach her to feel the panic feelings without secondary fear. She had not started a pattern of running from the panic sensations. Since the panic was present on a daily basis, she had a great opportunity to practice changing her method of reacting to panic symptoms. Her symptom encounters rapidly became less terrifying and she lost her fear of the feeling without relying on meds.
Anthony and Swinson (2000), in their authoritative review “Phobic Disorder and Panic in Adults: A Guide to Assessment and Treatment,” state, “However, given the results of long-term studies, the first line of treatment for Panic Disorder (PD) and Panic Disorder with Agoraphobia (PDA) should be CBT. For patients who require additional treatment, medication can then be added.
Please see the Out of the Blue Blog entitled “A Guide to Selecting a Cognitive Behavioral Treatment Provider” to conduct research to find a CBT expert on Panic Disorder in your local area.
*References to real persons, places and events are made in a fictional context, and are not intended to be in any way libelous, defamatory or in any way factual.