Best Therapy Techniques for Overthinking & Panic Attacks
Author – Jigeesha Patil, Counseling Psychologist
Sometimes, people look absolutely normal from the outside but internally there is a war going on in their minds. The brain argues that it needs to rest. The body struggles for relaxation. But the thoughts are stubborn. They simply don’t stop. They can be related to situations that happened in the past, may or may not happen in the future. The brain gives different narratives and eventually the mind keeps fighting it.
Overthinking may also look like a person who is replaying old conversations on loop, wondering why the other person has not yet replied to their text or even lying restless at night despite being tired, wondering how they would react differently in past situations. The mind also gives uncomfortable situations and worst-case scenarios about which it keeps on thinking to find an escape.
Signs of Panic Attacks and Anxiety Responses
Without even realising that it not only affects the mind but also has severe repercussions on the body as well. We call this psychosomatics. The body goes into a fight, flight or freeze condition. This is our body’s mechanism for survival. As a result, a person may experience symptoms of panic attack like trembling hands, heart pounding fast, cold feet, excessive sweating and loss of breath. These are common signs of panic attack and anxiety responses in the body.
Thus, it is important to pay attention to these symptoms and act upon them as it is unhealthy for the mind and body if they are exposed to this for a long period of time.
You can learn more about overthinking and panic attacks.
CBT (Cognitive Behavioural Therapy)
Now you may have come across a number of therapies and techniques to treat overthinking and panic attack treatment. It is indeed confusing to look for an appropriate technique or seek help when the internet is flooded with so many options. However, therapists or psychologists don’t use any one specific therapeutic approach to treat any mental health issue. They learn about the condition and symptoms in detail and a tailor-made approach is designed based on the requirement of the client. This may include some techniques and tools from a number of therapies. The best therapy to treat this is none other than CBT, Cognitive Behavioural Therapy.
Let us break it down in simple language.
Cognitive Behavioural Therapy for panic attacks focuses on changing fearful thought patterns and reducing anxiety responses gradually. The concept of CBT is that a person’s thoughts, emotions and behaviour influence each other. So, in this therapy, the techniques include practices that are used to change or modify the way a person thinks, bringing changes in emotions and thus the behaviour.
It is widely used and is considered one of the best forms of cognitive behavioural therapy for panic disorder, anxiety, panic attacks and overthinking. When anxiety, panic attack or over thinking set in, fear becomes alive. This fear, in turn treats unpleasant situations as facts which can be just possibilities. This further starts showing up in our behaviour in the form of anxiety. If not treated then it becomes chronic.
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The approach of this therapy is to change the cognitive wiring from the root level. It teaches an individual to identify the negative thought patterns. Once they are identified, one has to check for their validation and replace them with a more balanced and actionable narrative.
CBT Technique Example
For an example, if a person starts overthinking if someone has not replied to their text.
Step 1: Identify the negative thoughts
They can be-
“I think she is mad at me.”,
“Have I done something wrong?”
or even start replaying old conversations to check what must have gone wrong.
Step 2: Challenge the thoughts
Is this the only possible reason why she must have not replied? Can there be any other reason? She must be busy. She must have forgotten.
Step 3: Rational Response
Accepting that she is just busy and move on from the thought.
What did we do here? We identified cognitive distortions. Cognitive distortions are basically some tricks that our brain plays and makes us believe something that is not even true. Examples of cognitive distortions are catastrophising, mind reading, fortune telling, black and white thinking, overgeneralisation, etc. CBT works on these distortions as they are the reason for most of the overthinking.
So basically, what we did was we caught the thoughts, labelled the error and finally stuck to the facts.
Socratic Questioning Technique
Another technique that is used in CBT to treat overthinking is Socratic questioning. In this technique, a person becomes a detective of his own mind. Next time you feel overwhelmed or anxious ask yourself these questions:
- What is the evidence that my thoughts are true or valid?
- Am I confusing how I feel with an actual fact?
- What is the best, worst and the most realistic outcome of this?
For an example, your boss made a passing remark saying, “We need to talk.” Now, your mind will start building stories.
Step 1: Identify the negative thought
“He is mad at me. He will fire me.”
Step 2: Label the error
Catastrophising: Here, I am jumping to worst case scenario that is losing the job.
Fortune telling: Predicting that only a bad thing will happen.
Now, start answering the Socratic questions.
- What is the evidence that my thoughts are true or valid?
Answer: None. His statement, “We need to talk.” does not mention any negative feedback or any mistake that I have done.
- Am I confusing how I feel with an actual fact?
Answer: My work performance is solid. It can be a routine meetup to discuss the further progress of the project. The thoughts that I am having are completely based on how I am feeling and usually out of nervousness.
- What is the best, worst and the most realistic outcome of this?
Answer:
Best: Unexpected promotion or an appraisal.
Worst: I am losing my job.
Realistic outcome: Status update on the project or few changes with feedback.
From Panic to Perspective
It can be just a vague office communication that happens in every workplace. I don’t need to sweat about it.
Practice makes a man perfect. These panic-causing thoughts will not change overnight because they have taken years and years for these thoughts to become deeply rooted in one’s mind. However, with patience and awareness, the change is possible. With consistency, it will become a habit.
How CBT Works with a Therapist
All these techniques are great, but it works at a deeper level when worked with a therapist for panic attacks and anxiety. A qualified CBT therapist can design a highly structured, collaborative approach to hit the blind spots that you may otherwise miss while applying it yourself.
This is how it would look like to use CBT techniques in a therapy session:
- Guided Discovery
Instead of figuring out which distortions you are using and applying Socratic questioning yourself; A therapist will listen to your complete story; They will highlight the pattern. They will read between the lines. For an example, if you make use of words like “always” and “never”; they will analyse if it is just a minor English-speaking mistake or you are Overgeneralising.
- Behavioural Experiment
Therapists don’t just work on changing the thoughts, they test them in real life. It happens in three stages – The Setup, The Action and The Review.
For an example,
The setup: If a client has a thought, “If I speak up in the meeting, everyone will make fun of me.” Now, the therapist will design a safe experiment for you.
The Action: The client agrees to ask just one question in the next meeting.
The Review: In the next session with the therapist, the client evaluates what actually happened vs what the client predicted.
- Core Belief Work
Overthinking usually arises from deep underlying issues one holds about themselves, known as “core beliefs”. A therapist uses the Downward Arrow Technique to highlight these by questioning, “If that were true, what would that mean about you?”.
For example:
Thought: “I messed up this report.”
Therapist: “If that were true, what does that mean?”.
Thought: “I am bad at my job”.
Therapist asks again: “And if that were true?”
Reply: “I am a failure.” (The core belief).
- Accountability and Custom Worksheets
A therapist provides personalised homework after sessions. They keep you accountable for tracking your thoughts in real-time, ensuring the techniques become automatic habits rather than just theories you read about.
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Conclusion
Overthinking is manageable. It is not a permanent personality trait. CBT teaches you the techniques to take a step back, study your thoughts objectively and take control over your mind.
To summarize the CBT toolkit for you:
Step 1: Identify
Use the Triple Column Technique and name or analyse distortions in present time.
Step 2: Challenge
Use Socratic Questioning to separate feelings. Anxious feelings from objective facts.
Step 3: Distribute
Use a pie-chart Technique and distribute the possible reasoning for those thoughts. This helps to stop taking 100% of the blame for external situations.
Step 4: Partner
Collaborative work with a therapist can help in safe experimentation with behavioural tests and reboot the deep and underlying core beliefs.
By practicing these steps religiously, anyone can train their mind to stop looping on “What ifs” and can focus on growth.
