CBT for Panic Disorder

Examples of Amanda's online exercises


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Amanda's Thought Challenge Exercises Watch the Stress Log Tutorial

Amanda's Stress Log Example - 1

Amanda describes a panic attacks she had in a bus on her way to work. She starts by describing the situation, then she selects the feels she had at the moment with their intensity. Amanda finishes this activity by describing the automatic negative thoughts she had at the moment and how certain she was of their accuracy at the moment.

Amanda has challenged the thoughts in blue

Click on them to see her Thought Challenge exercises

9/4/2012 8:30AM

Sitting in the bus going to work

Afraid 100%

Anxious 100%

I can't breath


I am going to suffocate


I am dying right now



Note how Amanda doesn't mention her own feelings or thoughts in the "situation" box. She only describes the facts of the situation. Under "Thoughts", note how she didn't write "I think I am dying" or "I might be dying". Even while having the panic attack, Amanda was not absolutely certain she was dying, but she expresses this uncertainty by choosing a percentage of certainty lower than 100% (90% in this case). This separation of the frightening idea ("I am dying") from its certainty will be very helpful when she challenges this thought.


Amanda's Stress Log Example - 2

Amanda is trying to fall asleep the night before an important presentation at work. She is feeling depressed and anxious, but she is starting to identify the automatic negative thoughts that explain her negative emotions.

9/4/2012 11:30PM

Lying in bed, past midnight, trying to fall asleep

Depressed 80%

Anxious 90%

Tomorrow's presentation will be a disaster


Everybody will notice I'm anxious when I'm presenting


It will be unbearable to me that people notice I'm anxious



When describing the situation Amanda could have also mentioned this was happening the night before an important presentation, in order to further clarify the context.

Having a presentation the next day is only an indirect reason for Amanda to be feeling anxious and depressed. The reasons for her symptoms become clearer once we learn what was in her mind at the time.

Drastic and absolute terms, like "disaster,""everybody," and "unbearable" are usually part of automatic negative thoughts. Amanda's automatic negative thoughts can explain why she was so upset. They should be challenged .


Amanda's Stress Log Example - 3

Amanda has a minor panic attack when having to get into an elevator with her boss. In this Stress Log she reports how she felt anxious and ashamed and she describes the automatic negative thoughts she had at the moment.

9/6/2012 10:30AM

About to go in the elevator with my boss

Ashamed 90%

Anxious 100%

I will have a panic attack in the elevator


My boss will see me sweating and realize there is something wrong with me


Going in that elevator will ruin my career



It is often not the situation itself (going in an elevator), but our interpretation of the situation ("going in that elevator will ruin my career") that causes intense negative emotions. Sometimes the emotions Amanda feels (embarrassed) are not what could be expected from the situation or from her more conscious negative thoughts. She has benefited from exploring ideas that were deeper in her mind at the time with her therapist. Cognitive therapists are watchful for emotions that are not clearly exaplined by the automatic negative thoughts elicited. They could be a clue for a deeper layer of assumptions and core beliefs that it is clearly worth exploring (since they are causing symptoms).

Sometimes negative thoughts are like a running commentary in the back of our minds. At the time, Amanda was only aware of having the words "Oh! No!" in her mind. But her therapist helped her bring all these other thoughts to consciousness by asking her what she thought "Oh! No!" implied.