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Introduction
Many people are suffering because of panic attack and live their lives avoiding situations that frighten them, but in an illogical way, such as being in the house, not travelling by car, plane, etc. This is all a way to reduce panic attacks and is not enough to end the panic and healing. A panic attack is an increased secretion of adrenaline in the bloodstream. A message of fear sent by the mind to the adrenal glands that there is an emergency and secrete this hormone. A panic attack is basically a type of anxiety, Livermore explained it as a sudden onset of intense discomfort or fear which reaches peak in just a limited period of time, some of the symptoms of panic attack includes; shaking, accelerated heart rate, and smothering. According to a report published by NICE CBT is recommended as one of the most effective form of treatments for panic disorder. Cognitive Behavioural Therapy (CBT) is basically a form of counselling that aids the process of changing the habitual behaviours and thoughts of an individual suffering from panic order, allowing the patient to control his or her behaviour and improve the symptoms associated with the condition.

Symptoms of Panic Attacks
Many people misinterpret panic attacks because they think they have had a heart attack or a stroke and other deadly conditions, all because of the lack of insight into the situation they are going through is just a simple panic.

Cognitive behavioral therapy: Focuses on modifying the patient's thoughts about himself and others through discussion, dialogue, and training to think in a positive and realistic way. According to Hahn et al., Cognitive Behavioural Therapy is a form of treatment which identifies the beliefs and thoughts of the patient influencing their behaviour. Cognitive Behavioural Therapy helps in creating a therapeutic alliance through looking at the certain behavioural patterns such as anxious and negative thoughts and the manner in which they influence an individual suffering from panic disorder. Once, this phase is complete then in the next phase a set of techniques is devised in order to revoke those thoughts and behaviours for facilitating the change process, this is done through adjusting the behaviour of the patient and decreasing the level of anxiety.

Intervention
CBT as compared to pharmacological or psychological treatment has proved to be more effective when it comes to treating patients with panic attacks. In various studies conducted by scholars like Reinecke, Thilo, Filippini, Croft, and Harmer CBT has outclassed all other forms of treatments and techniques, thus, scientific studies have proved CBT to be more effective when it comes to the reduction of the symptoms of panic attacks. In-spite of the fact that the treatment is longer in duration as compared to other forms of treatments the results of the Cognitive Behavioural Therapy are more effective and lasts for a longer period of time as compared to other form of conventional psychological treatments.

Treatment and Sessions
Cognitive behavioral therapy can be done individually or with a group of people. It can also be done by self-help books or a computer program. If you are in the individual treatment: Usually you will meet with the therapist between 5 to 20 sessions, every week or two and each session lasts between 30 to 60 minutes. In sessions 2-4 first, the therapist will check if you can use this type of treatment and you can also see if you feel comfortable with this type of treatment. The therapist will also ask you some questions about your backgrounds and the past of your life, although this treatment focuses on now Sometimes you need to talk about the past to understand how it affects you now. You decide what you want to deal with in the short, medium and long term. You and the therapist will usually start by agreeing on what you will discuss in this case.

Strategies of Cognitive Behavioural Therapy in Panic Attacks
Cognitive behavioural therapy for panic attacks involves a combination of interventions, some of which are given below:


 * Relaxation Exercise:  This is a technique which is more helpful in the initial phases of the panic attack   . Patient suffering from panic attack often become anxious over time, their level of anxiousness become so intense that their bodies become overwrought with muscle tension. This makes patient more  susceptible to anxiety. Thus, with the help of relaxation training, patients are usually trained to control their breathing, and ways through which they can decrease the overall physiological anxious arousal. This in turn helps in the reduction of future vulnerability towards anxiety.


 * Cognitive Restructuring: Through this technique patients who have grown more prone to the anxiety provoking thought patterns are trained to replace such thoughts with less anxious and a more balanced thinking pattern . Thus, this helps in reducing the level of intensity of the reactions of the patient towards the panic symptoms, and situations which generates a thought of fear in the mind of the patient. Furthermore, this also helps in reducing the overall duration as well as intensity of the panic disorder symptoms.


 * Mindfulness: Linde defined this as a meditative technique which is utilised for overcoming anxiety in patients suffering from panic attack. This technique helps the patients to experience certain spiteful physical impressions without responding towards these experiences in a negative manner. Hence, using this cognitive behavioural technique the vicious cycle of anxiety and provoking thought patterns of panic and fear is broken, allowing patient to control his or her thoughts and anxiety level.
 * Exposure technique: With the passage of time as patients are able to antagonize a number of thought provoking situations using different Cognitive Behavioural Therapy techniques such as mindfulness, and relaxation training, exposure training later on helps the patients in facing situations which they normally tend to avoid. Thus, under this treatment people are put in challenging situations, in order to neutralise their fear from certain thoughts or situations which might increase their level of anxiety or panic. There are two forms of exposure techniques:

'Interoceptive exposure:' This is a form of exposure where the aim of the treatment is to treat the catastrophic interpretations which are made by the patient during the panic attack. Under this technique the patient is provided a step by step procedure to respond towards certain thoughts or feelings in a relaxed and comforting manner. This exposure is usually performed with the help of intentional provocation of the symptoms through utilising activities such as physical exercises. A simple illustration of this could be use of a swivel chair to address the feeling of dizziness.

'In vivo exposure:' This is a form of intervention which is applied for overcoming the issues such as agoraphobic avoidance. During this treatment a list of situations as well as places are made which the patient must avoid such as fear of heights or darkness. van Ballegooijen etal., stated that this form of exposure can only prove to be effective when it is prolonged, and repeated frequently. Throughout the therapy it is essential to monitor the changing behaviour of the patient.


 * Stress Reduction: For some patients reduction of stressors can serve as an essential form of treatment for panic disorder. Stress reduction using cognitive behavioural therapy consists of a combination of two techniques given below:
 * 1) Learning to react towards different situations in a calm and relaxed manner
 * 2) Reduction of unnecessary stress to reduce level of anxiety, resulting in improving the overall quality of life

According to a research conducted by Tully et al, CBT for panic attacks lasts somewhere around 12 sessions from some patients, it has been determined that majority of the patients start to show positive results during the first few sessions of the therapy. Thus, some people respond towards the training more aptly in just few number of sessions, while some patients might require at least 12 or more than 12 sessions; depending on the complexity of the panic disorder.

Beck’s Cognitive-behavioural therapy for Panic Disorder
Beck proposed a well-structured model for treatment of panic attacks.

Hence, the initial phases are dedicated to the assessment of the patient, and training the patient to manage anxiety. With the passage of time as the session progresses more attention is given to the different sort of interventions such as in vivo exposure interventions to challenge the negative behaviour of the patient and engage him or her in a behavioural therapy. Final phase of the therapy focuses of consolidation of all the gains achieved throughout, and relapse of the prevention efforts.

Limitations of CBT
The critics of the CBT like Wolf, and Goldfried stated that there are certain limitations of CBT; as the technique might not be effective when it comes to people suffering from more complex form of mental health issues or specifically people who also suffer from some sort of learning disabilities. In another study conducted by Porter, and Chambless the researchers criticised CBT for its limited focus stating that the technique focuses moreover the patient and his or her capacity to influence changes in their behaviour or thoughts, which is not appropriate when a patient is already suffering from a mental issue. The limited structure of CBT ignores a number of other factors such as family, and the emotional problems which the patient might have suffered in the past. Thus, critiques like Porter, and Chambless [14] have proposed to utilise techniques such as psychodynamic counselling for treating panic attacks.

Efficacy of CBT
According to RCT’s conducted by Bruinsma et al., , it has been proven that CBT helps in decreasing the level of anxiety in patients with panic attacks. CBT is also quite effective when it comes decreasing the relapse rates, while at the same time it also increases psychosocial functioning of the patient. Finally, in another study conducted by Kircher et al., it was determined that CBT also helps the patients in overcoming agoraphobia which leads towards improvement in the quality of life of the patients. CBT is a highly structured approach which follows a strict hierarchical pattern involving both the therapist as well as the patient. During this technique the therapist motivate the patient to break down his or her behaviours and thoughts and trap them inside a negative cycle allowing the patient of learn skills and strategies which he or she could apply in their real life to cope with the disorder in a more effective and appropriate manner. Hence, the benefits of CBT outweigh the limitations of the technique making it more effective form of treatment as compared to all other forms of therapies or treatments.