the

1
the vicious circle of panic
physical sensations of anxiety e.g.
palpitations, breathlessness, pins needles,
sweating, feeling faint, etc
arousal triggers
sensory triggers
physiological arousal e.g. the body assumes it is
in imminent danger and prepares itself for
fight, flight or freezing
catastrophic thoughts e.g. I am going to die, I
am going to lose control, I am going to make a
complete fool of myself, etc
mental triggers
2
maintaining factors for anxiety states
potential threats situations, sensations, thoughts
Salkovskis PM Anxiety, beliefs safety-seeking
behaviour in Frontiers of psycho- therapy New
York Guilford Press, 1996
selective attention
appraisal of threat probability x
awfulness coping rescue
maintenance of arousal
failure to disconfirm
physiological biological changes
safety seeking behaviours avoidance, escape,
within-situation, neutralisation, checking,
reassurance
3
why anxiety disorders persist
selective attention
spontaneous imagery
safety seeking behaviours
persisting sense of threat
Clark DM Anxiety disorders why they persist
and how to treat them Behav Res
Ther 199937S5-27
memory processes
emotional reasoning
general level of tension
4
active ingredients of cognitive therapy
all procedures are explicitly used to
tackle distorted beliefs

• education
• verbal discussion methods
• imagery modification
• attentional manipulation
• exposure to feared stimuli
• safety behaviour manipulation
• numerous other methods

there is a strong emphasis on within-session expe
rimental work on working with high affect
Clark DM Anxiety disorders why they persist
how to treat them Behav Res Ther 1999 37 S5-27