Are you searching for the most effective way to release yourself from panic attacks? While Cognitive Behavioral Therapy (CBT) has long been hailed as the “gold standard” in treating panic disorders, a groundbreaking new study is shaking things up! EMDR (Eye Movement Desensitization and Reprocessing), traditionally used for treating PTSD, has now been shown to match CBT in effectiveness for panic attacks.

In a 2017 study by Horst et al., EMDR demonstrated results comparable to CBT, suggesting it may help in rewriting old fear memories through a process called memory reconsolidation. Could EMDR be the future of panic attack therapy?

In this video, we dive into the details of the study and compare these two powerful therapeutic approaches. Discover which one might be the best solution for you!

References:

Burck, E. (2019). Angst – Was hilft wirklich gegen Angst und Panikattacken?: Die effektivsten Strategien gegen Angst und Panik aus Sicht der Forschung. BoD – Books on Demand.

Faretta, E., & Dal Farra, M. (2019). Efficacy of EMDR therapy for anxiety disorders. Journal of EMDR Practice and Research, 13(4), 325-332.

Faretta, E. (2013). EMDR and cognitive behavioral therapy in the treatment of panic disorder: A comparison. Journal of EMDR Practice and Research, 7(3), 121-133.

Horst, F., Den Oudsten, B., Zijlstra, W., de Jongh, A., Lobbestael, J., & De Vries, J. (2017). Cognitive behavioral therapy vs. eye movement desensitization and reprocessing for treating panic disorder: A randomized controlled trial. Frontiers in Psychology, 8, 1409.

Every good anxiety therapy is based on numerous important learning processes. In classic behavioral therapy in particular, new learning experiences are constantly being made, which help to build up neuronal “safety networks”. The more often we learn that we are much safer in a feared situation than we thought, the deeper the corresponding safety memory traces become in our brain. So getting rid of fear actually means unlearning fear.
In this respect, it is not surprising that classic learning laws from learning psychology play a very important role in anxiety therapy…
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Studies (just a small selection):

Bandarian-Balooch, S., Neumann, D. L., & Boschen, M. J. (2015). Exposure treatment in multiple contexts attenuates return of fear via renewal in high spider fearful individuals. Journal of behavior therapy and experimental psychiatry, 47, 138-144.

Baggs, K., & Spence, S. H. (1990). Effectiveness of booster sessions in the maintenance and enhancement of treatment gains following assertion training. Journal of consulting and clinical psychology, 58(6), 845.

Burck, E. (2019). Angst-Was hilft wirklich gegen Angst und Panikattacken?: Die effektivsten Strategien gegen Angst und Panik aus Sicht der Forschung. BoD–Books on Demand.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour research and therapy, 58, 10-23.

Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour research and therapy, 46(1), 5-27.

Mineka, S., Mystkowski, J. L., Hladek, D., & Rodriguez, B. I. (1999). The effects of changing contexts on return of fear following exposure therapy for spider fear. Journal of consulting and clinical psychology, 67(4), 599.

Gearing, R. E., Schwalbe, C. S., Lee, R., & Hoagwood, K. E. (2013). The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depression and anxiety, 30(9), 800-808.

A thought experiment:

Imagine you had to write down the following sentence:

“My mother will win a million euros in the lottery tomorrow.”

So far so simple. Now imagine you have to write down another sentence:

“My mother will die tomorrow.”

You probably found the second idea much more difficult. Because you shouldn’t write something like that. It’s best not to think something like that in the first place. Because thoughts are powerful, aren’t they?

But more and more studies suggest that the conviction (metacognition) that thoughts are powerful and uncontrollable contributes to the development and maintenance of mental disorders such as depression, generalized anxiety disorder, obsessive-compulsive disorder, etc. For example, anyone who is convinced that a thought such as “My mother/father could die soon.” is not just a thought, but a dark premonition that will materialize because we had this thought, with most likely feelings of anxiety, guilt and depression. If, on the other hand, we realize that thoughts are often nothing more than insignificant “brain farts”, of which we produce thousands every day, we remain relaxed and unimpressed. modern psychotherapy – especially metacognitive therapy – also makes use of these insights and achieves sometimes unprecedented therapeutic success…

Countless studies show: If you want to overcome your fear, you would do well to face it. Whether it’s a fear of spiders, dogs, lectures, heights, thunderstorms, small rooms, dental treatment, etc., as soon as we manage to shed our avoidance behavior, we can make the important experience that the feared situations are nowhere near as dangerous as we originally feared (or sometimes even fun).
But what mindset allows us to get the maximum therapeutic benefit from a confrontation? A classic study by Southworth and Kirsch (1988) with subjects suffering from agoraphobia provides exciting answers…

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Studies (small sample only):

Southworth, S., & Kirsch, I. (1988). The role of expectancy in exposure-generated fear reduction in agoraphobia. Behavior Research and Therapy, 26(2), 113-120.

Burck, E. (2019). Angst-Was hilft wirklich gegen Angst und Panikattacken?: The most effective strategies against anxiety and panic from a research perspective. BoD Books on Demand.

Many believe in them. Many have one. Lucky charms are objects that have accompanied us through many difficult situations and to which we attribute that we have survived these dangerous situations because they have brought us luck. But can talismans also be used therapeutically? Can they be used as reminders of anxiety situations that have already been successfully overcome? Do they give us the peace of mind we need to overcome new scary situations with ease? Or is carrying lucky charms ultimately even a counterproductive safety behavior that slows down progress?
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Studies (just a small selection):

Culver, N. C., Stoyanova, M., & Craske, M. G. (2011). Clinical relevance of retrieval cues for attenuating context renewal of fear. Journal of Anxiety Disorders, 25(2), 284-292.

Dibbets, P., Moor, C., & Voncken, M. J. (2013). The effect of a retrieval cue on the return of spider fear. Journal of Behavior Therapy and Experimental Psychiatry, 44(4), 361-367.

Dibbets, P., Moor, C., & Voncken, M. J. (2013). The effect of a retrieval cue on the return of spider fear. Journal of Behavior Therapy and Experimental Psychiatry, 44(4), 361-367.

Shin, K. E., & Newman, M. G. (2018). Using retrieval cues to attenuate return of fear in individuals with public speaking anxiety. Behavior therapy, 49(2), 212-224.

The evidence is very clear: the more we embrace fear (exposure, confrontation), the more it will release us from its grip. But what can help us to successfully confront fears? And how can therapeutic fear confrontation be made even more effective?
The video contains four tips that have been derived directly from studies and are effective both in everyday life and in anxiety therapy.

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Studies (only a small selection; more studies can be found in the book “Angst – Was hilft wirklich… “):

Craske, M. (2015). Optimizing exposure therapy for anxiety disorders: an inhibitory learning and inhibitory regulation approach. Behavior Therapy, 25(2), 134-143.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behavior research and therapy, 58, 10-23.

Gearing, R. E., Schwalbe, C. S., Lee, R., & Hoagwood, K. E. (2013). The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depression and anxiety, 30(9), 800-808.

Kirsch, I., Tennen, H., Wickless, C., Saccone, A. J., & Cody, S. (1983). The role of expectancy in fear reduction. Behavior Therapy, 14(4), 520-533.

Trivasse, H., Webb, T. L., & Waller, G. (2020). A meta-analysis of the effects of training clinicians in exposure therapy on knowledge, attitudes, intentions, and behavior. Clinical Psychology Review, 80, 101887.

Weisman, J. S., & Rodebaugh, T. L. (2018). Exposure therapy augmentation: A review and extension of techniques informed by an inhibitory learning approach. Clinical Psychology Review, 59, 41-51.

The Power of cogntive reappraisal in anxiety therapy can be very strong. If we find good cognitive reappraisals anxiety can be overcome. For example we can try to speak of protection attacks instead of panic attacks…

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Studies (just a small selection):

Goldin, P. R., Ziv, M., Jazaieri, H., Hahn, K., Heimberg, R., & Gross, J. J. (2013). Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: randomized clinical trial. JAMA psychiatry, 70(10), 1048-1056.

Goldin, P. R., Manber-Ball, T., Werner, K., Heimberg, R., & Gross, J. J. (2009). Neural mechanisms of cognitive reappraisal of negative self-beliefs in social anxiety disorder. Biological psychiatry, 66(12), 1091-1099.

Goldin, P. R., Ziv, M., Jazaieri, H., Werner, K., Kraemer, H., Heimberg, R. G., & Gross, J. J. (2012). Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder. Journal of consulting and clinical psychology, 80(6), 1034.

Kivity, Y., & Huppert, J. D. (2016). Does cognitive reappraisal reduce anxiety? A daily diary study of a micro-intervention with individuals with high social anxiety. Journal of Consulting and Clinical Psychology, 84(3), 269.

Picó-Pérez, M., Radua, J., Steward, T., Menchón, J. M., & Soriano-Mas, C. (2017). Emotion regulation in mood and anxiety disorders: a meta-analysis of fMRI cognitive reappraisal studies. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 79, 96-104.

Based on a pilot study, we delve into the results of a virtual reality exposure treatment for spider phobia. The study involved 40 participants undergoing a single session of therapy, followed by either 90 minutes of sleep or staying awake.

The findings are remarkable — sleep following exposure therapy demonstrated superior reductions in self-reported fear and catastrophic spider-related cognitions compared to staying awake (p = 0.045, d = 0.47; p = 0.026, d = 0.53, respectively), both measured one week after the therapy session. Notably, these reductions were correlated with higher percentages of stage 2 sleep.

Join us as we explore the conclusions drawn from this study, suggesting that post-therapy sleep enhances therapeutic effectiveness. The potential mechanism lies in the reinforcement of new, non-fearful memory traces established during the psychotherapeutic intervention. These results unveil a non-invasive alternative to traditional approaches, offering valuable insights into optimizing therapeutic memory processes without the need for pharmacological or behavioral interventions.

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Studies (just a small selection):

Kleim, B., Wilhelm, F. H., Temp, L., Margraf, J., Wiederhold, B. K., & Rasch, B. (2014). Sleep enhances exposure therapy. Psychological medicine, 44(7), 1511-1519.

Sara, S. J. (2010). Reactivation, retrieval, replay and reconsolidation in and out of sleep: connecting the dots. Frontiers in behavioral neuroscience, 4, 185.

Simon, K. C., Gómez, R. L., & Nadel, L. (2020). Sleep’s role in memory reconsolidation. Current Opinion in Behavioral Sciences, 33, 132-137.

Stickgold, R., & Walker, M. P. (2005). Memory consolidation and reconsolidation: what is the role of sleep?. Trends in neurosciences, 28(8), 408-415.

Woud, M. L., Cwik, J. C., Blackwell, S. E., Kleim, B., Holmes, E. A., Adolph, D., … & Margraf, J. (2018). Does napping enhance the effects of cognitive bias modification-appraisal training? An experimental study. PloS one, 13(2), e0192837.

Those who suffer from anxiety often hear, “You must learn to control fear with meditation, autogenic training or breathing techniques …”

But is control really always the most effective method?

Study:

Eifert, G.H., & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34 (3-4), 293-312.

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Studies (small selection only):

Eifert, G.H., & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34 (3-4), 293-312.

Ivanova, E., Lindner, P., Ly, K. H., Dahlin, M., Vernmark, K., Andersson, G., & Carlbring, P. (2016). Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial. Journal of anxiety disorders, 44, 27-35.

Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior therapy, 35(4), 747-766.

Meuret, A. E., Twohig, M. P., Rosenfield, D., Hayes, S. C., & Craske, M. G. (2012). Brief acceptance and commitment therapy and exposure for panic disorder: A pilot study. Cognitive and Behavioral Practice, 19(4), 606-618.

When should you face your anxiety? Does the time of day have an influence on the success of therapy? And what role does cortisol play in this? Researchers at the University of Saarbrücken conducted a very interesting study on this…

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Studies (small sample only):

Lass-Hennemann, J., & Michael, T. (2014). Endogenous cortisol levels influence exposure therapy in spider phobia. Behaviour research and therapy, 60, 39-45.