Panic Formulation

The Panic Formulation worksheet helps therapists to identify the cognitive, affective, somatic, and behavioral factors contributing to clients' panic attacks.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

Overview

Panic attacks are experiences of intense fear with a rapid onset. Drawing upon Clark's cognitive model of panic, this worksheet helps clinicians and clients unravel the triggers and progression of panic attacks. It provides a structured approach to identify and address misinterpretations leading to panic.

Why Use This Resource?

This tool helps mental health professionals to systematically explore their client's panic attacks.

Facilitates understanding of panic attack triggers.
Identifies unhelpful appraisals of symptoms
Identifies safety behaviors.
Promotes collaborative exploration of panic episodes.

Key Benefits

Insight

Gain insights into the triggers and onset of panic attacks.

Understanding

Understand how panic attacks quick escalate from an innocuous sensation to intense fear.

Hope

Once your clients to understand how panic is maintained, you can instill hope by collaboratively exploring ways to break the maintenance cycle.

Who is this for?

Panic Disorder

Repeated, unexpected panic attacks and persistent concern or behavioral change related to future episodes.

Agoraphobia

Avoidance of situations where escape might be difficult or help unavailable during a panic attack.

Social Anxiety Disorder

Panic symptoms sometimes emerge in feared social or performance situations.

Integrating it into your practice

Situation

Identify the specific circumstance or trigger of the panic attack.

Emotions

Explore the emotional responses experienced during the attack.

Somatic

Identify physical sensations accompanying the panic.

Interpretation

Uncover catastrophic thoughts and predictions.

Cycle

Map the escalation of the panic attack cycle.

Safety

Investigate safety behaviors and their impact, both in the immediate and longer term.

Theoretical Background & Therapist Guidance

Drawing upon David Clark's cognitive theory of panic, the Panic Formulation worksheet emphasizes the role of catastrophic misinterpretation as the core of panic attacks. This worksheet facilitates the identification of triggers, emotional and physiological responses, and the role of safety behaviors. By understanding these components, and how they fit together, therapists and their clients can collaboratively work to overcome experiences of panic.

What's inside

A comprehensive worksheet detailing components of a panic attack.
Case examples illustrating how panic can present.
Structured questions to guide therapists and clients through an exploration of panic.

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FAQs

It provides a structured approach to identifying and addressing the elements maintaining panic attacks, supporting cognitive and behavioral interventions.

Encourage the use of self-monitoring records to pinpoint factors potentially overlooked.

Sometimes. Where panic is comorbid with other conditions, therapists may decide to address the symptoms of panic.

How This Resource Improves Clinical Outcomes

The Panic Formulation resource enhances clinical outcomes by:

Fostering a deeper understanding between therapists and clients regarding panic mechanisms.
Supporting the development of targeted intervention strategies.
Facilitating the reduction of maladaptive safety behaviors.
Enhancing clients' coping skills and confidence in managing panic.

References And Further Reading

Barlow, D. H., & Craske, M. G. (2006). Mastery of your anxiety and panic. Oxford University Press.

Bernstein, D. A., & Borkovec, T. D. (1973). Progressive relaxation training: A manual for the helping professions. Research Press.

Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.

Clark, D. M., & Salkovskis, P. M. (2009). Panic disorder: Manual for improving access to psychological therapy (IAPT) high intensity CBT therapists. (in) K. Hawton, PM Salkovskis, J. Kirk. & DM Clark (Eds), Cognitive Behaviour Therapy: A Practical Guide.

Ehlers, A. (1993). Interoception and panic disorder. Advances in Behaviour Research and Therapy, 15(1), 3-21.

Limmer, J., Kornhuber, J., & Martin, A. (2015). Panic and comorbid depression and their associations with stress reactivity, interoceptive awareness and interoceptive accuracy of various bioparameters. Journal of Affective Disorders, 185, 170-179.

Pompoli, A., Furukawa, T. A., Efthimiou, O., Imai, H., Tajika, A., & Salanti, G. (2018). Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychological Medicine, 48(12), 1945-1953.

Schmidt, N. B., et al. (2000). Dismantling cognitive-behavioral treatment for panic disorder: questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417.

Seligman, M. E. P. (1988). Competing theories of panic. In Rachman, S., & Maser, J. D. (Eds.), Panic: Psychological Perspectives, pp. 321-330. Lawrence Erlbaum Associates.

Taylor, S. (2001). Breathing retraining in the treatment of panic disorder: Efficacy, caveats and indications. Scandinavian Journal of Behaviour Therapy, 30(2), 49-56.

Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34.

Yoris, A., et al. (2015). The roles of interoceptive sensitivity and metacognitive interoception in panic. Behavioral and Brain Functions, 11(1), 1-6.