So far the discussion of cognitive therapy has been dominated by reference to depression, but in order to illustrate how the approach can be modified and applied to other emotional disorders we will briefly mention David Clark's (1986) cognitive model of panic, which will be discussed in more detail in Chapter 6.
The key theme in both Beck's general approach to anxiety (Beck & Emery, 1985) and in Clark's (1986) application of the approach to panic disorder is that the individual is considered to be prone to the detection of threat or danger in both the external environment and the internal environment. Whereas in generalised anxiety the perception of danger or threat may range across a variety of issues concerned with dependency, competitiveness, and control over self and others, in panic disorder the focus is primarily on bodily sensations. The individual interprets normal anxiety symptoms such as breathlessness, increased heartbeat, dizziness, and loss of control in a catastrophic manner; for example, a pounding heart may be interpreted as evidence for an imminent heart attack, dizziness may be interpreted to signal a stroke, and a feeling of loss of control or derealisation may be interpreted to mean impending madness. This catastrophic misinterpretation maintains the high level of distress experienced in a panic attack; it may also lead the individual to become hypervigilant for particular bodily sensations and likely to avoid situations or activities (e.g., exercise) that produce similar sensations (e.g., Clark, 1988). Despite the avoidance of certain situations and activities, however, the hypervigilance will still lead the individual to detect small physical sensations due for example to caffeine, excitement, or mild anxiety, which push the individual into the vicious circle. In relation to the cognitive treatment derived from the model, again there is good evidence for the effectiveness of the therapy (Roth & Fonagy, 2005).
One of the criticisms that we have raised previously about the cognitive therapy approach was that it focused on a single level of representation, the propositionally based schema (see Chapter 3). We argued instead that in line with the analysis of meaning in psycholinguistics two levels of representation were necessary, one that was propositionally based, and one that reflected a higher level of representation such as that of mental models (Power & Champion, 1986). We suggested that if cognitive therapy simply focused on the truth value of propositions in therapy, and if therapeutic practice was primarily the disputation of the truthfulness of such propositions (e.g., "I am a failure"), then the therapist might miss crucial higher-order meanings of such a process. For example, the therapist might persuasively dispute the patient's statement "I am a failure", yet leave the patient feeling worse rather than better! This effect could result from the patient's interpretation of the therapeutic encounter as confirmation of his or her worthlessness because the therapist was so much more intelligent (see below for an extended discussion of this issue). Teasdale (1993) has extended these criticisms of the general cognitive therapy model, but has pointed out that one of the strengths of Clark's approach to panic may be that it serendipitously takes the individual's model of the problem as its starting point (rather than the lower-level specific propositions) and then offers a new model to the individual for the understanding of panic and anxiety. The hope must be, therefore, that this serendipitous strength of the specific approach to panic can feed back into the more general cognitive therapy approach.
One other aspect of the cognitive therapy model is that in both Clark's and Beck's approaches the use of terms such as "cognitive" and "automatic" can have somewhat different meanings from how the terms are used in cognitive science (see Chapter 2). For example, although "catastrophic misinterpretations" appear to be conscious interpretations, they seem to be equivalent to "negative automatic thoughts" in the more general theory. The question is therefore to what extent are catastrophic misinterpretations automatic or to what extent can they become automatic if they occur regularly? If, however, catastrophic interpretations are necessarily conscious, then there are a group of panic attacks that are not accounted for by the theory (see Chapter 6). We must also ask why is one individual likely to misinterpret a threat or a sensation in a catastrophic manner but another individual does not. These questions are of course ones that should help to refine and develop the theory rather than undermine it; they will be considered in greater detail in Chapter 6 when Clark's model is discussed more thoroughly.
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With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.