Although they aren’t necessarily common, panic disorders affect between 2 and 3% of all American adults. In fact, 4.7% of American adults will experience a panic attack during their lifetime. These statistics are markedly higher for adults in their late teens to early twenties and doubled for women. For friends and family, it is important to know how to help someone having a panic attack.

Due to the concentration of cases in these demographics, the reality is that you probably know someone who has or currently does suffer from a panic disorder. In order to do what you can for them in the event of an attack, you must be able to recognize a panic attack and respond effectively.

What to Look For

The symptoms of a panic attack can vary from person to person. In some minor cases, they are almost indiscernible if you don’t know what to look for because the most common symptoms are mainly internal. Mental Health First Aid warns that panic attacks can manifest in several ways. The following list comprises the most common symptoms.

  • Shaking
  • Sweating
  • Numbness
  • Dizziness
  • Heart Palpitations
  • Chest Pain
  • Abdominal Distress
  • Shortness of Breath
  • Fear of “going crazy” or dying
  • Chills and Hot Flashes
  • Feeling Choked
  • Feeling Faint
  • Feeling that you are detached from reality

Given the nature of these symptoms, a bystander is only likely to notice general physical and emotional distress. You may note that they are breathing heavily or look visibly confused. Unfortunately, these symptoms could be associated with a long list of other medical conditions.
Therefore, your first priority is to assess the situation to establish what the person is going through.

Assessing the Situation

Differentiating a panic attack from a medical situation that requires emergency help can be difficult, so your ability to assess the situation will rely on your ability to communicate clearly and concisely. A person in the throes of a panic attack will only be able to process small amounts of information at a time. All of their internal systems are in over-drive, so you will need to be patient.

Ask and Listen

Start by asking short, basic questions.

  • “Has this happened before?” Wait for a response. Try a different question if you get no answer.
  • “Do you want an ambulance?”
  • “Have you been feeling stressed?”

Your goal is to figure out if they know what is happening to them and if they require emergency help. Regardless of whether you end up calling 911, you will need to manage the situation until the attack has passed or the ambulance arrives.

Managing the Attack

Your last question should always be, “What might help you?” If they need to be moved away from a crowd or sat down, offer aid. Once they’re settled, stop asking questions. Instead, provide gentle assurance. Stay calm, talk slowly, and help them to focus on their breathing by encouraging them to count to ten with you.

On average, the longest attacks can last between 20 and 30 minutes, but most panic attacks will only last 5 to 10 minutes. During this time, stay with them to ensure continuity and support while they recover.

After the Attack

Once the attack has passed, it is important to show that you genuinely care for their well-being. See if they need you to call someone to pick them up, and encourage them to reach out to a medical professional regarding their attacks.

Cognitive Behavioral Therapy can be used to teach patients how to recognize their triggers and manage their symptoms. In ten weekly sessions, the “Panic No More” program at Cognitive Behavior Associates will help patients to restructure their reactions to common anxiety behaviors and address avoidance behaviors.

According to the Sleep Foundation, depression affects around 20 million Americans. Still, many experts believe that depression remains an under-reported condition. On the one hand, the long-surviving negative attitude surrounding mental illness is a contributing factor. But, the subtle nature of depression itself is responsible for patients going undiagnosed for months or even years. And, insomnia and depression often appear together.

Depression is characterized by its gradual onset and the mixed appearance of symptoms. The result is that it can be difficult to know that you have it before it becomes severe. This is true even if you are the one affected by depression. Recognizing your depression can be tougher than you might expect.

The difficulty of diagnosis becomes worse when loss of self-worth is a common symptom. As a result, many individuals with depression are too worried about wasting another person’s time. They see their problems as insignificant. This mindset prevents them from seeking the help they need. 

Factoring in Sleep

There are many symptoms regularly associated with depression. These can include physical symptoms like tiredness and changes in weight. But the more dangerous ones are mental. These include difficulty concentrating, hopelessness, loss of self-worth, and suicidal thoughts. 

Almost all depression patients experience one symptom: sleep disorders. You can have trouble sleeping, called insomnia. Or, you might find yourself sleeping for extended periods, called hypersomnia. In either case, sleep disorders are repeatedly associated with depression. Experts see it both as a contributing cause and a core symptom, according to Duke Health

What the Research Says

In fact, people who experience constant insomnia are ten times more likely to develop depression. An academic article in Dialogues in Clinical Neuroscience comments on sleep disturbance. It says that it is “prevalent…and often unresolved by treatment” in cases of existing depression. 

In plain English, sleep disorders contribute to the start of depression. Not only that, but they make it worse over time. Unfortunately, current treatment plans often fail to treat the sleep disorder. Doing this opens the patient up to continued periods of depression until you can address the sleep disorder fully.

The Added Trouble with Insomnia and Depression

All sleep disorders have the potential to interfere with quality of life. Hypersomnia can negatively impact your ability to hold a job or succeed in school, but insomnia has yet another effect. 

Being unable to sleep prevents your body from getting enough rest. So, first, your depression affects your interactions with other people. Then it limits your ability to focus. Finally, you’re also fighting the added effects of exhaustion. 

How Common is Insomnia?

The Anxiety and Depression Association of America found that chronic sleeplessness affects 10-35 percent of the US. Obviously, people all over feel its effects. Research shows that sleep loss has noted effects on attention and working memory. This serves to compound already existing symptoms of depression. 

In addition, sleep loss from insomnia impairs physical parts of the brain. Specifically, it harms the brain’s waste disposal symptom. What this means is patients become vulnerable to physical brain diseases. Such illnesses can even further weaken their ability to manage the symptoms of depression as they age. And they are difficult to treat.

Start With Sleep

Even if you are currently managing your depression, don’t ignore the importance of treating your sleep disorder. Don’t think of it as a separate entity. It can be contributing to your condition. But, your condition also might cause it. 

You may need a small team to help you through this, and that is okay. 

Depression is a multi-faceted disease. So, it naturally requires a wide range of expertise to treat it on all fronts. At Cognitive Behavior Associates, your care providers work with your doctor and therapist to manage your condition from multiple angles. Such an approach gives you the best chance at extended recovery.

For anyone reading this who hasn’t found aid, there are people ready to help. Please call the National Substance Abuse and Mental Health Services Administration Hotline at 1-800-662-4357. 

If you are contemplating self-harm, remember your life does matter. Please call the National Suicide Prevention Hotline at 1-800-273-8255. 

The experts at Cognitive Behavior Associates estimate that roughly 7% of the American population experiences social anxiety on a regular basis. That means that at every one hundred plus person wedding you attend, there are probably at least other six people who know exactly how you feel. That being said, the precise way in which each person processes anxiety is unique to the individual. Therefore, even when you clearly aren’t alone in your discomfort, it can still feel as though you are.

How Anxiety Works

Generally speaking, the National Institute of Mental Health classifies social anxiety as a feeling of fear or foreboding before and during a social interaction. Oftentimes, the person experiencing the anxiety is afraid that they others will evaluate them based on their ability to interact “normally.” It is the fear of being judged and being found insufficient that drives the intense avoidance of possible shame or embarrassment.

As a result, many people with social anxiety find the condition to be a self-fulfilling prophecy where their anxiety causes interactions to feel strained, resulting in their being rebuffed or avoided by others. Unfortunately, these experiences tend to intensify social anxiety over time, so early treatment is one of your best defenses.

Seeking Treatment

Therapy is, fortunately, becoming a far more acceptable part of our society, which is finally allowing people from all walks of life to seek the help they desperately need without the fear of judgement. Your current medical provider is a great place to start. Describe your symptoms including their severity and frequency. In some cases, keeping a symptom journal can be helpful both during initial diagnosis as well as during treatment.

There are two paths your treatment can take: therapy and medication. In most cases, your medical provider will suggest a combination of both, especially if therapy alone is initially unsuccessful after a designated trial period. If your doctor advises that you begin taking medications right away, make sure you are fully informed regarding their purpose and potential side effects.

The Medication Route

The National Institute of Mental Health identifies three main categories of medications used to treat anxiety. They include anti-anxiety medications, anti-depressants, and beta blockers.

  • Anti-anxiety Medications: Benzodiazepines are the most common family of anti-anxiety medications. Highly effective at quickly treating symptoms for short periods of time, these drugs can also illicit a withdrawal response, so your doctor will want to taper your dosage prior to switching you to a long-term treatment solution.
  • Anti-depressants: Despite their name, anti-depressants can also be an effective mode of treatment for anxiety, as they change the way your brain uses certain chemicals, potentially altering the way you process stress. Unfortunately, anti-depressants do take time to take effect, and you will likely try a few different medications before finding one that works for you.
  • Beta-Blockers: These medications are used to treat the physical symptoms of social anxiety, including rapid heartbeat and shaking. They are only a temporary solution, as you use other methods to treat the underlying issue.

The Therapy Route

Although you may use medication throughout your struggle to put your anxiety in its place, therapy offers a potential, permanent solution to many patients. Cognitive Behavioral Therapy(CBT) is one of the most common treatment paths for people who need a space to challenge the self-distortion that is responsible for their anxiety in the first place.

During CBT, patients are taught to identify the thoughts, emotions, and behaviors that lay the foundation of their social anxiety. By figuring out what is causing the adverse reaction, patients can, with the guidance of experienced counselors, begin to rework their behavior and deal with stress in a new way. By taking patients through the growth process, counselors are able to help patients give themselves a new lease on life, one that isn’t controlled by their anxiety.

Addicition: Exploring a Complicated Disease

Historically, addiction was treated as a personal failure. It’s often associated with a lack of faith or fortitude, an assumption that comes with lasting effects. Even the early 20th century attempts to understand addiction recovery studied the condition from a perspective of superiority over their subjects. It led researchers to tie the condition to defective genes with little more than family history and the pseudoscience of eugenics to support their hypothesis. The result is that those who suffer addiction now hold the weight of those assumptions to the point where they cease to be an individual in the eyes of society.

Continue reading “Addicition: Exploring a Complicated Disease”

Cognitive Behavior Associates’ Dr. Lauren Shapiro Awarded National Science Foundation Grant Focused on Reducing Dating Aggression

Are sweaty palms and vulgar language evidence of a potential sexual predator?

(Beverly Hills, CA) November 06, 2016 – Does locker room talk lead to dating violence? Does a racing heart or sweaty palms during a fight with a boyfriend or girlfriend increase a young person’s risk of inflicting physical abuse? Dr. Lauren Shapiro, USC researcher and psychologist at Cognitive Behavior Associates (CBA) is focused on informing prevention and intervention efforts that would ultimately work to better understand and reduce risks of dating aggression.

Becoming involved in dating relationships is a developmental milestone for adolescents and young adults. Patterns begin to emerge and are maintained within formative dating years. These recurring patterns can fall under both emotional and physical behavior and provide important contexts for the development of intimate relationship skills.  Moreover, those who establish aggressive ways of relating to romantic partners are more likely to use the same aggressive interactional style during arguments with their children.

Awarded a prestigious grant by the National Science Foundation funded through the Social, Behavioral and Economic Sciences (SBE) Postdoctoral Research Fellowship, and working within the lab of renowned Dr. Gayla Margolin, Professor of Psychology and Pediatrics at USC, Dr. Shapiro will research dating aggression in young adults from an interdisciplinary perspective.

“When sound research informs prevention efforts, we can better target substantial societal problems,” said Dr. Lauren Shapiro, researcher and psychologist at CBA. “It is important to understand how certain patterns of behavior within intimate relationships are established as well as how these behaviors are maintained over time.  Young couples are setting the stage for relationships later in life, so developing our understanding of psychological, physiological, and social components of dating aggression can help us move toward reducing these harmful behaviors in young couples.  Additionally, broadening our understanding of dating aggression can help us identify protective factors that might reduce aggressive behaviors later on—both within romantic as well as parent-child relationships.”

Working closely with leaders in the fields of psychology and engineering, Dr. Shapiro will utilize cutting-edge technology to measure different channels of arousal such as vocal arousal (e.g. yelling), physical arousal (recording momentary changes in perspiration and other functions of the autonomic nervous system), and behavioral arousal (e.g. crying) to examine how past experiences with relational aggression relate to current dating aggression.

About Cognitive Behavior Therapy Institute and Cognitive Behavior Associates: 

Cognitive Behavior Associates (CBA), founded and directed by Joel L. Becker, Ph.D., is one of the largest cognitive behavior therapy practices in Southern California. Clinicians practice the most current treatments supported by empirical research. CBA specializes in short-term, problem-focused therapy for a full range of psychological disorders. The Institute provides CE education opportunities for clinicians.

Partnering with Cognitive Behavior Therapy Institute, Tri-City Mental Health Center will Offer Patients Cognitive Behavior Treatment for Psychosis

CBTI, Tri-City Mental Health Center Partnership

(Beverly Hills, CA) September 20, 2016 – Mental illness often leaves families in crowded emergency rooms or in psychiatric hospitals, leading to higher costs and poorer outcomes. In order to offer the best in patient care Tri-City Mental Health Center (TCMHC), a Joint Powers Authority, that serves the Cities of Pomona, Claremont and La Verne for low-income families, has partnered with Cognitive Behavior Therapy Institute (CBTI) one of the largest cognitive behavior therapy training institutes in Southern California to train its clinicians in Cognitive Behavioral Therapy for Psychosis (CBTp).

CBTp addresses chronic and often debilitating psychotic spectrum illnesses characterized by hallucinations, delusional thinking, paranoia, reduced social interaction, emotional expression and motivation. While antipsychotic medications are effective in managing many of the symptoms of the illness, between 30%-40% of those taking therapeutic doses of medications will continue to experience hallucinations, delusions and be impaired by negative symptoms of the illness.

“CBTp is an empirically supported mental health intervention, said Antonette Navarro, Executive Director of Tri-City Mental Health Center. “The ongoing training of TCMHC staff allows us to provide patients the very best in care which is essential to TCMHC’s mission to be both a place of healing, and resource within the community.”

“It’s exciting to see mental health agencies investing in training clinicians in cutting edge evidence based treatments,” said Dr. Melissa Magaro trainer and psychologist at Cognitive Behavior Associates (CBA). “TCMHC also offers the ongoing support needed when implementing new approaches.”

The lifetime prevalence of schizophrenia is estimated to be between .3% and .7% and those are affected suffer significant social and occupational limitations. CBTp is a talk therapy that aims to reduce distress and impairment by teaching ways to challenging dysfunctional ways of thinking, developing more effective behavioral ways of coping and empowering clients to move forward in their recovery. The CBTp Clinician Training Program provided by Dr. Magaro includes full day trainings and case consultation.


Tri-City Mental Health Center provides a diverse spectrum of mental health services and education.  With a commitment to serve in a caring, nurturing atmosphere, they strive to promote optimal health and improve the quality of life for every individual and family living in their three cities community.  Learn more at:


Cognitive Behavior Associates (CBA), founded and directed by Joel L. Becker, Ph.D., is one of the largest cognitive behavior therapy practices in Southern California. Clinicians practice the most current treatments supported by empirical research. CBA specializes in short-term, problem-focused therapy for a full range of psychological disorders. The Institute provides CE education opportunities for clinicians.

For more information visit

Cognitive Behavior Associates Welcomes Megan L. Wagner, Ph.D., BCB

Psychologist Adding BioFeedback to List of Treatment Programs

(Beverly Hills, CA) July 20, 2016 – Cognitive Behavior Associates (CBA) is pleased to announce that Megan L. Wagner, Ph.D., BCB has joined the practice, adding Biofeedback to its list of services. Biofeedback is empirically supported for anxiety reduction as well as managing chronic pain including headache pain (migraine, tension, and mixed), temporomandibular disorder (TMD), and other chronic pain conditions.

“I am very excited to welcome Dr. Wagner to CBA,” said Dr. Joel Becker founder and director of Cognitive Behavior Associates. “She provides a great blend of clinical education with a strong commitment to providing the leading technology in patient care.”

Dr. Wagner will join CBA as a Staff Psychologist instituting the biofeedback treatment program, as well as further develop the practice’s existing chronic pain management program by incorporating Acceptance and Commitment Therapy (ACT).

Dr. Wagner received her Ph.D. in Clinical Psychology from George Mason University, and Bachelor’s degree in Psychology with a concentration in Biological & Evolutionary Sciences from the Schreyer Honors College at Penn State University. She later completed a postdoctoral fellowship at the VA Loma Linda Healthcare System, where she received specialized training in Clinical Health Psychology, focusing on understanding and treating problems related to the complex interrelationships of mental and physical health. She is board certified by the Biofeedback Certification International Alliance.

For information on the practice or to schedule an appointment with Dr. Megan Wagner, please call (310) 858-3831.


Cognitive Behavior Associates, founded and directed by Joel L. Becker, Ph.D., is one of the largest cognitive behavior therapy practices in southern California. We specialize in short-term, problem-focused therapy. Our cognitive behavior therapy (CBT) treatments are individualized for a full range of psychological disorders.

All of our clinicians are licensed to practice in the state of California and practice the most current treatments supported by empirical research. Each clinician differs in areas of expertise and interest, and these factors are taken into account when matching a client with a clinician.

It is our philosophy that a patient who is well-informed about their disorder will be more successful in therapy.

We try to make use of a collaborative relationship between the client and the therapist, as well as consultation with all other health care providers. Being as clear as possible about what treatment will consist of allows us to provide the best quality services to each of our clients.

Pregnant Women & New Moms Suffer Silently from Depression – Screening Can Help

Cognitive Behavior Associates Women’s Wellness Program Offers Depression Screening

When the U.S. Preventive Services Task Force announced in May that depression screening is needed for pregnant women and new mothers, we in the healthcare community understand that pregnant and new mothers can feel particularly overwhelmed and/or isolated during their transition into motherhood. Cognitive Behavior Associates (CBA) group practice offers a brief depression screening that can help women identify the symptoms they are having, offering an opportunity to have a conversation about their concerns, and guidance on how to better cope with life’s stressors.

Research findings show that Cognitive-Behavior Therapy (CBT) as well as other lifestyle practices such as mediation, diet, and exercise can have a major positive impact. The CBA Women’s Wellness program, uses CBT to help women understand how the physical and emotional transition into motherhood, along with daily life stressors has an impact in their mental health. Depression is the leading cause of disease-related disability in women around the world. According to the U.S. Preventive Services Task Force, nine percent of pregnant women and 10 percent of new moms will go through a major depressive episode.

Sometimes just talking to someone, being heard, and gaining an understanding of your symptoms can have an impact. CBT teaches women how their thoughts influence their emotions, and how specific behaviors can have a positive impact on their emotions. CBT has helped people with anxiety, depression, obsessive-compulsive disorder, and other psychological challenges for decades.

For more information or to set up an appointment, please call (310) 858-3831.