APA Psychotherapy Videotape Series II: Specific Problems and Populations. Cognitive Therapy for Panic Disorder
Lefkowitz, Elissa Tolle, Journal of Cognitive Psychotherapy
APA Psychotherapy Videotape Series II: Specific Problems and Populations. Cognitive Therapy for Panic Disorder David M. Clark. Washington, DC: American Psychological Association (www.apa.org). $99.95 (videotape and manual).
This videotape and companion manual aim to demonstrate the treatment of panic disorder utilizing cognitive therapy. The videotape shows a spontaneous and unscripted session between David M. Clark and a professional actor, based on a real case example. The actor is quite convincing in his portrayal of a patient with panic disorder.
The videotape depicts session 2, whereby Clark begins by outlining the agenda for the session. While in future sessions the agenda might be set more collaboratively, it is appropriate at this early stage for the clinician to model agenda setting for the patient in a didactic fashion. Clark begins the first agenda item by referring back to the "vicious circle of Greg's recent panic attack," which was conceptualized in session 1. This is an excellent example of the usefulness of early conceptualization of the panic cycle incorporating physiological changes, cognitive interpretations, emotions, and safety behaviors. Clark carefully reviews each component of the cycle with the patient, and engages the patient by asking questions in the Socratic method such as, "How do you think we can use this (cycle) as a way of stopping the panic?"
For the second agenda item, Clark begins to generate alternative hypotheses, and sets up the expectation that he and the patient will test these competing ideas by gathering evidence for both. The two hypotheses generated are (a) there is something wrong with the patient's heart (which the patient currently endorses), or (b) the problem is the belief (cognition) that there is something wrong with his heart. Thus, the remaining focus of the session is holding these two ideas in mind, and searching for evidence for both.
Clark does an excellent job demonstrating the use of multiple cognitive and behavioral interventions to gather information to generate doubt in the original belief. For example, he has the patient verbalize the rationale and advantages of an exposure approach by answering the question, "Would it be helpful to discover that if you didn't sit down during an attack, that nothing too terrible happened?" The patient is then able to see for himself, via an experiment where he continues to exercise although he feels panicked, that he will not have a heart attack. As a result of the varied interventions used during the session, the patient's belief in the thought that there is something wrong with his heart decreases by about 30%. At the end of the session, Clark assigns homework for the patient to help him gather more evidence about his original beliefs.
As a clinician, Clark is highly skilled at demonstrating cognitive therapy, not only because of his adherence to the fundamentals of such treatment (i.e., structured session, creating an agenda, engaging the patient in cognitive restructuring, focusing on the here-and-now, and assigning homework) but also by demonstrating that any clinician, despite their theoretical orientation, must be adept at creating a positive therapeutic alliance. As such, Clark constantly checks in with the patient (e.g., "Does that sound OK?"), maintains eye contact, conveys warmth, validates the experience of the patient's symptoms (i.e., "The symptoms are real, your heart is beating faster"), and uses listening skills such as paraphrasing, clarification, and summarizing. …