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A formulation based on Clark's cognitive model of panic — mapping the vicious cycle of catastrophic misinterpretation of body sensations.
This formulation maps the panic cycle: a trigger leads to a sense of threat, which produces anxiety and body sensations, which are then catastrophically misinterpreted, feeding back into the sense of threat. Safety behaviours prevent you from learning that the sensations are harmless. Work through it with your therapist using a recent panic episode as an example.
Use at the formulation stage with clients presenting with panic disorder. Clark's cognitive model should be the framework when the client demonstrates catastrophic misinterpretation of bodily sensations as the primary maintaining factor.
Build the formulation from a recent panic attack, starting with the triggering situation or sensation and mapping the vicious cycle: sensation → catastrophic misinterpretation → anxiety → intensified sensations. Use the client's own words and experience throughout.
For clients with nocturnal panic attacks, include the role of interoceptive sensitivity during sleep-wake transitions. For clients with agoraphobic avoidance, extend the formulation to include avoidance and safety behaviours as factors that prevent disconfirmation of catastrophic beliefs.
Ensure medical causes of symptoms have been appropriately investigated before attributing all symptoms to panic. The formulation should acknowledge any genuine medical conditions while identifying the cognitive amplification process. Not appropriate if the primary presentation is PTSD with panic-like flashback responses.
The specificity of the catastrophic misinterpretation matters therapeutically. 'Something bad will happen' is too vague to target effectively. Push for the specific feared outcome: 'I will have a heart attack', 'I will faint', 'I will lose control and embarrass myself'. The more specific the misinterpretation, the more precisely it can be tested.
Suitable for clients working with panic, formulation, clark, cognitive model, cbt, catastrophic misinterpretation, vicious cycle. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Gather normalising evidence by surveying others about whether they experience the same body sensations and fears — challenging the belief that your experience is abnormal.
Log interoceptive exposure exercises that deliberately produce feared body sensations to break the link between sensations and catastrophic interpretations.
Record panic episodes with triggers, sensations, catastrophic thoughts, safety behaviours, and actual outcomes to identify patterns and build evidence against catastrophic predictions.
Challenge catastrophic misinterpretations of body sensations by examining evidence and generating realistic alternatives.