Stopping Anxiety Medication: Panic Control Therapy for Benzodiazepine Discontinuation (PCT-BD)

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Product Details

  • ISBN-13: 9780127844510
  • Publisher: Elsevier Science & Technology Books
  • Publication date: 5/1/2000
  • Edition number: 1
  • Pages: 157
  • Product dimensions: 6.04 (w) x 9.02 (h) x 0.36 (d)

Table of Contents

Chapter 1 Purpose and Structure of the Program 1
Background 1
Development 1
Therapist Guide for PCT-BD 3
Patient Workbook for PCT-BD 5
Treatment Overview 5
Behavioral Model of Panic Disorder 7
Problems Associated With Benzodiazepine Taper 8
Program Interventions 10
Cognitive Interventions 10
Somatic Management Strategies 12
Interoceptive Exposure 13
Naturalistic and In Vivo Exposure 15
Individual Versus Group Treatment 15
Chapter 2 The Taper Schedule 17
Chapter 3 Session 1 23
Orientation to Treatment 27
Behavioral Model of Panic Disorder 28
Orientation to Alarm Reactions 28
Rapid Heartbeat and Rapid Breathing 30
Sweating 30
Nausea or Stomach Upset 30
Numbness and Tingling 30
Dizziness or Light-headedness 31
Tight or Painful Chest 31
Unreality or Bright Vision 31
Choking Sensations 31
Heavy Legs 32
Hot or Cold Flashes 32
Cognitive Reactions 32
Emphasis on the Self-Perpetuating Cycle 33
Agoraphobic Avoidance 35
Tense-Up Reaction 36
Anxious Apprehension (Anticipatory Anxiety) 36
Summary 38
Mechanisms of Pharmacological Treatments 38
Emergence of Symptoms With Medication Discontinuation 39
Treatment Interventions and Rationale 39
Somatic Skills 39
Cognitive Restructuring 40
Interoceptive Exposure 40
Diaphragmatic Breathing Training 41
Homework Assignments 42
Secondary Session Goals 43
Review of Provocation Studies (Optional) 43
Source of the Original Panic Attack (Optional) 44
Chapter 4 Session 2 45
Review of Diaphragmatic Breathing 48
Review of Home Practice 48
In-Session Practice Trials 48
Trial 148
Trial 248
Trial 348
Slow-Breathing Technique 49
Review of the Behavioral Model of Panic Disorder 50
Role of Cognitions in Panic Disorder 50
Initiation of Interoceptive Exposure 52
Progressive Muscle Relaxation 54
Rationale 55
In-Session Practice 57
Homework Assignments 59
Chapter 5 Session 3 61
Review of Homework 64
Diaphragmatic Breathing 64
Progressive Muscle Relaxation 64
Interoceptive Exposure 64
Fear-of-Fear Cycle Versus Relaxing-With-the-Sensations Pattern 65
Interoceptive Exposure 67
Head Rolling 68
Hyperventilation 69
Stair Running or Jogging in Place 69
Initiation of Medication Taper 70
Relaxation Training 71
Review of Full Relaxation Procedure 71
Introduction to the RC Procedure 72
Homework Assignments 73
Chapter 6 Session 4 75
Review of Homework 78
Diaphragmatic Breathing and Progressive Muscle Relaxation 78
Review of Interoceptive Exposure Practice 78
Review of Symptoms Associated With Medication Taper 79
Introduction to Catastrophic Cognitions, Probability Overestimations, and Countering Strategies 79
Cognitive Errors and Their Identification 79
Concept and Countering of Catastrophic Thinking 81
Concept and Countering of Probability Overestimations 83
Exposure to the Cognitions 84
Interoceptive Exposure 86
Progressive Muscle Relaxation 87
Homework Assignments 88
Chapter 7 Session 5 91
Review of Homework 94
Interoceptive Exposure 94
Diaphragmatic Breathing, Muscle Relaxation, and RC Procedure 95
In-Session Rehearsal of RC Procedure 95
Review of Symptoms Associated With Medication Taper 96
"Benzodiazepine Flu" Model 96
Review of Catastrophic Cognitions, Probability Overestimations, and Countering Strategies 97
Interoceptive Exposure 98
Rationale 98
Practice 100
Tube Breathing 100
Hand or Mirror Staring 100
Muscle Tension 101
Bending Over 101
Light Staring 101
Throat Tightness 101
Cognitive Coaching 102
Homework Assignments 104
Chapter 8 Session 6 107
Review of Homework 109
Self-Coaching 109
Diaphragmatic Breathing, Muscle Relaxation, and RC Techniques 110
Review of Symptoms Associated With Medication Taper 110
Review of Cognitive Errors and Use of Countering Strategies 111
Interoceptive Exposure 112
Review of Interoceptive Exposure Homework 112
In-Session Practice 113
Interventions for Sleeping Difficulties 114
Homework Assignments 114
Chapter 9 Session 7 117
Review of Symptoms Associated With Medication Taper 119
Review of Skills Learned 119
Interoceptive Exposure 119
Cognitive Misinterpretations 120
Somatic Responses 120
Appetitive Goals Versus Harm Avoidance 121
Review of Interoceptive Exposure Procedures 122
Review of Homework 123
In-Session Practice of Interoceptive Exposure 123
In Vivo or Naturalistic Exposure 123
Homework Assignments 124
Chapter 10 Session 8 125
Review of Symptoms Associated With Medication Taper 127
Review of In Vivo and Naturalistic Exposure 127
Appetitive Goals Versus Harm Avoidance 128
Generalization Training 129
Homework Assignments 131
Chapter 11 Booster Sessions: Sessions 9-11 133
Introduction 133
Overview 134
Review of Medication Taper Symptoms 135
Review of Treatment Progress 135
Specific Review Topics 137
Catastrophic Thoughts and Probability Overestimations 137
In Vivo and Naturalistic Exposure Versus Interoceptive Exposure 138
Somatic Coping Skills 139
Generalization Training 140
Session 9141
Overview 141
Homework Assignments 141
Session 10142
Overview 142
Homework Assignments 142
Session 11143
Appendix A Practice Logs 145
Diaphragmatic Breathing Practice Log 146
Muscle Relaxation Log 147
Symptom Induction Log 148
Homework Practice Log 149
Appendix B Responses to Relaxation-Induced Anxiety 150
Appendix C Responses to Anxiety Attacks Induced by Interoceptive Exposure 151
Suggested Additional Readings 153
References 155
Figure 1.1. A Model of the Etiology of Panic Disorder 6
Figure 1.2. Cognitive-Behavioral Model of Benzodiazepine Discontinuation Associated Difficulties 9
Figure 3.1. Somatic Symptoms of Alarm Reaction 28
Figure 3.2. Alarm Reaction Triggered by Fear or Danger 29
Figure 3.3. Fear of Fear: Cognitive Reaction 34
Figure 3.4. Fear-of-Fear Cycle 37
Figure 3.5. Learned Interventions to Stop the Fear-of-Fear Cycle 40
Figure 3.6. Discrimination Training: Chest vs. Diaphragmatic Breathing 42
Figure 5.1. Retraining To Choose Coping Responses to the Body's Alarm Reaction 66
Table 2.1. Benzodiazepines Commonly Used to Treat Anxiety and Panic 18
Table 2.2. Sample Taper Schedule for Clonazepam 19
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