Does CBT work for seemingly genetic panic & anxiety?
July 26, 2018 5:12 PM   Subscribe

My family doctor suggested CBT therapy as an alternative to SSRI’s for generalized anxiety & panic. I’m considering it, but I’m skeptical.

I already attended a lot of therapy in the past, much of it CBT based. I think it did help with overcoming some erroneous beliefs, but I still have anxiety/panic.

In terms of beliefs that CBT can help with, I already feel like I’m good enough. I’m well suited to my work, I have a happy home life, I feel like an attractive person both inside and outside. I have a supportive long-term relationship and good friends. In many ways, there is literally nothing for me to be worried about. And yet this anxiety persists.

Many of my relatives and I have panic based on claustrophobia, even if we have never experienced a real trauma related to being in an enclosed space. It could be, being in heavy traffic while driving, being on a crowded escalator, being in a large crowd of people, and so on. It just seems to be a real lizard brain, instinctive panic. No cave divers in this bunch!

Medication alleviates these symptoms, but of course it does have side effects. So what could CBT do ? Will the therapist actually come with me to those panic inducing situations and help me work through it? Because I feel very skeptical about it. Especially with a strong family connection to the symptoms, along with generalized anxiety, part of me thinks this is just with me forever & I will always need some sort of treatment.

For those who have experience with us or in the know, do you have advice or thoughts on thisquestion?
posted by ElisaOS to Health & Fitness (14 answers total) 7 users marked this as a favorite
You may be straying into EMDR things.

Things I have heard are only positive, or nothing happened.
posted by sanka at 6:13 PM on July 26, 2018

It works. It may take time, but it totally works. I've suffered from GAD with panic attacks for years and with bi-weekly therapy I've made enormous strides in the past 2-3 years. Patience is needed and there is no instant gratification but it helped me go from GAD on meds to me managing my GAD med-free with CBT and exercise. I do still have my days, but it is a night and day difference. If you really put in the work it works.
posted by floweredfish at 6:15 PM on July 26, 2018 [2 favorites]

Many of my relatives and I have panic based on claustrophobia, even if we have never experienced a real trauma related to being in an enclosed space. It could be, being in heavy traffic while driving, being on a crowded escalator, being in a large crowd of people, and so on. It just seems to be a real lizard brain, instinctive panic.

None of the things I've had an anxiety attack about have ever been real things I've actually experienced; they've always been hypothetical situations where I've been extrapolating wildly. But CBT has been invaluable in dealing with my anxiety, both acutely and chronically. I can't say for certain that it will work for you, but it certainly seems worth trying.
posted by asterix at 7:49 PM on July 26, 2018 [4 favorites]

I would look into other types of modalities. ACT worked WAY better than CBT for me. It's acceptance and commitment therapy. There are tons of books you can use to self-study with. There is also a book called the Mindfulness and Acceptance workbook for anxiety (there's also one for depression). I'd also look into MBSR-- mindfulness based stress reduction. Reading Pema Chodron's books have been super helpful. I started with When Things Fall Apart. But she also has several books that deal with fear -- such as The Places that Scare You. There's also Exposure Therapy that is supposed to deal directly with overcoming specific phobias.

CBT was helpful when I was new to therapy. After learning the basics, I needed more. I once spent a summer that was solely CBT based on David Burns' the Feeling Good Handbook. It was a total waste of my time. I don't think any of us really improved. You just get overwhelmed with a bunch of cute activities to do and different labels for your different thoughts and you just need more than this if you have really severe mental health issues.
posted by jj's.mama at 9:24 PM on July 26, 2018 [4 favorites]

P.S. I don't want people to come away with my comment and think that CBT isn't helpful at all. I think it's helpful to a point. It helped me change my thoughts and learn about thoughts like that I shouldn't think I "should" or "shouldn't" do something. Or learn about ways our anxious thought patterns work-- catastrophizing, black and white thinking etc. So, like I said earlier, as a basic primer to therapy it helped enormously. But what is missing from CBT for me is more active strategies to keep moving forward and that's where the other modalities are useful. The summer program in CBT probably was a waste of time for me because I already knew the many labels and types of thoughts and there was nothing much more we did that stuck with me. You're welcome to memail me for more questions or support.

P.P.S. I adopted a cat from a shelter and that was enormously helpful for my anxiety and really changed my life in so many positive ways! Just another suggestion if you like pets and don't have any yet :)
posted by jj's.mama at 9:32 PM on July 26, 2018

CBT definitely helped my generalized anxiety disorder. It helped me to label my day to day thoughts. At first it was small things like stopping and figuring out oh this thought is catastrophizing. And slowly I learned to stop doing that as much by replacing the anxiety thoughts with a neutral thought. But CBT wasn't enough on it's own to help my big irrational phobias that switch my brain into panic attack mode.
posted by ilovewinter at 10:50 PM on July 26, 2018

I'm a CBT therapist. CBT is an evidence-based treatment for panic disorder, even if it is genetic. It sounds like a lot of the CBT you've gotten has been heavy on cognitive components (meaning- you're working on changing your thoughts), whereas the CBT manual for panic disorder is a lot heavier on the behavioral components (meaning- working on confronting situations that have been avoided because of how shitty it feels to be in them). I find treating panic disorder very rewarding because people come in saying basically exactly what you told me and then they no longer have panic disorder by the end of treatment- it works REALLY well. Basically, you make a list of all of the situations that cause you panic symptoms and start with the easiest ones and practice sticking with the panic until it goes away in those situations (which it does, I promise). Once you feel like you've mastered those, you do the slightly less easy ones, but those are even easier than they would have been before because you've already practiced the easy ones. It takes about 12 sessions. My patients tell me they end up feeling super empowered because they end treatment with power over situations that used to have power over them.

EMDR is absolutely **NOT** a treatment for panic disorder. To my knowledge, ACT has not been studied rigorously for panic disorder.

Feel free to memail me if you want more details or suggestions about finding a therapist.
posted by quiet coyote at 10:55 PM on July 26, 2018 [4 favorites]

(Disclaimer: My therapeutic path did not involve any kind of psych meds. I've only ever done cognitive therapy, CBT, and am currently in EMDR. I'm not one of those folks who ever felt that being in therapy was a mark against me. I always knew it was for health, that seeing therapists and seeing to my mental/emotional health was an adult responsibility.)

In my early adulthood to about my 40s, I did only cognitive therapy, and I found it helpful for navigating situational depression, and for working through tough and troublesome things that happened to me throughout life.

In my late 40s, to handle free floating, serious anxiety (situationally to do with navigating the end of a relationship that had turned ugly, with manipulation, emotional abuse, and gaslighting), I started seeing a CBT therapist, and after a few months of work on accepting and integrating the CBT skills, as well as finding the end of that relationship, my anxiety had almost disappeared. It was really good for me. It added to my maintenance skills in emotional and mental health, and I still use CBT skills today.

Lately, in response to traumatic and vague memories of Adverse Childhood Experiences, I have been in EMDR therapy, which, honestly, feels like superspeed, superfocused, superintense, focused CBT. While I do EMDR therapy I'm not only working through emotional trauma inducing memories and figuring out ways to sort of energetically, emotionally process and address them, but I'm also integrating the EMDR style of doing things, much like CBT taught me some serious coping skills. EMDR is a little magical (for me), in that I've never really achieved this intensity/potency of processing before (while holding buzzy little paddles). I highly recommend it to folks whose therapists feel they're ready for it.
posted by kalessin at 10:58 PM on July 26, 2018 [1 favorite]

Will the therapist actually come with me to those panic inducing situations and help me work through it?

What you are describing is Exposure Response Prevention or Exposure Therapy.

I think you would have to find what works by trial and error. What works for one person wont for another. If you’re just really averse to CBT, you don’t have to do it. Try a different modality, or medication.

Do you have a perfectionist streak? I think you could work on letting go of that. I ask because you state that your life sounds like it’s going well EXCEPT for this one nagging thing.

Anxiety can definitely be alleviated some through lifestyle practices (eating well, sleep, support system of family & friends), but for some of us, it’s going to always be here, a lifelong presence. I know that is true for me. I used to imagine I could become a different person, more serene and smooth, but I’ve come to accept this is who I am. Some days are better than others, and I’m not going to let my anxiety drive the boat, but it might always be a passenger. I like who I am.

I also wonder, is there some generational trauma in your family, such as war, genocide, slavery, or forced migration? It might be enlightening to research that. Scientists and doctors are continuing to unwrap this mystery of epigenetics. It could add another dimension to your experience.
posted by shalom at 6:47 AM on July 27, 2018 [2 favorites]

quiet coyote has it right on the money. To answer your question, yes, the therapist will come with you to the situations that provoke those anxious, panicky feelings and will coach you through remaining there while you experience the anxiety. That is the key.

Your body mounts an anxiety response to help you survive significant threats. So if a bear jumps out at you in the woods, you are ready to fight or flee to save your life. With anxiety/panic, your body is mounting that threat response to situations that are not actually all that dangerous to you. Like a false alarm. The problem is, that over time you have those panic symptoms, you do everything you can to get out of that situation (because that is a natural response), and your body and brain say to themselves "great job! We just saved you from that!" You start to experience anxiety/panic in more and more situations because your body and brain are sending the misinformation that you are actually in danger and are actually saving yourself by escaping or avoiding that danger. The false alarms start to happen more often.

In CBT you will work with a therapist to build a hierarchy of anxiety provoking situations and then move gradually from the less threatening situations to the more threatening situations. Your therapist will help you develop skills to manage the symptoms as they come up and also the skills to carefully observe whether there is a threat right there in front of you. The thing is, that fight or flight response is really difficult on your body. It takes a ton of metabolic energy, and so is only supposed to last a short time and not to happen at all if there isn't actually a threat. So if you can go into an anxiety-provoking situation, hang in there for a bit with your therapist coaching and you carefully observing, your brain and body essentially start to realize that there's no real threat there. They naturally shut off the panic response and sort of reset your alarm system with the understanding that there's no need to have that fight or flight response in this situation again.

So the goal is to reset your system to keep on recognizing the real threats, but to keep itself quiet for the imagined ones. It's incredibly effective for most who try. I would also add that there is often a strong family history of anxiety difficulties in people who have anxiety themselves, so it is working for those with a clear genetic contribution and those that may not.
posted by goggie at 10:12 AM on July 27, 2018 [1 favorite]

If you've already tried CBT based therapy in the past, it may be better to try something else. CBT in therapy and self-help books didn't help me much. I had been feeling anxious without much thoughts behind the anxious feelings. ACT, which includes Mindfulness, helped me a ton. Mindfulness helped me be more present in the world and accept the anxious feelings as they arose, which in turn somehow reduced them.

I'm curious - did your doctor say why they suggest therapy before SSRIs? Have you tried SSRIs before? Have people in your family who have the same symptoms tried it with success? The medication route isn't an easy fix-all. There are trial periods with different types of side-effects. Some people still need to do other things with the medication to ease their anxiety. Indeed it has helped a lot of people once they find the right dose and type, but maybe it's worth looking at other options first - or in conjunction - if your doctor has good reason for suggesting therapy first, and if you are doing well day-to-day.

I'll add other things that helped me, but may not apply to you: relieving stressors in life,
getting better sleep, taking supplements for things I were low on (vitamin D, vitamin B(s), magnesium, and calcium), exercising, meditation, eating healthier, removing foods that caused indigestion, going off birth control, and going on thyroid medication. I'm probably a special case since I didn't experience generalized anxiety until recently, but with those adjustments, I haven't been feeling anxious anymore. The last two items were probably what helped the most, but the other things in the list definitely helped too.
posted by LovingMyself at 1:26 PM on July 27, 2018

Rather than asking "Should I do CBT instead of taking medication?" it might help to turn this into two questions: "Should I do CBT?" and "Should I try SSRIs"? The answer may well be "yes" to both.
posted by nebulawindphone at 2:19 PM on July 27, 2018 [2 favorites]

Oops, I just saw your previous questions - it looks like medication is working for you. I'd say even with medication it wouldn't hurt looking into CBT and other techniques as well. Even though I've been feeling better, I'm still practicing and learning more about ACT because it has helped with other aspects of my life.
posted by LovingMyself at 2:42 PM on July 27, 2018

@LovingMyself, whoa, are you my twin? I've done everything you mention (sleep, avoid stress, same vitamins, exercise, meditation, thyroid meds). I unfortunately still have panic in certain situations unless I'm on an SSRI.

My doctor suggested CBT as a way to manage the panic, so I can avoid the sexual side effects & possible weight gain associated with SSRI's.

@shalom not so much perfectionism as a desire not to panic in certain situations, especially ones related to driving. I parent two small children and am concerned for their safety as well as my own.
posted by ElisaOS at 8:05 PM on July 27, 2018 [2 favorites]

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