Free Panic Cycle Worksheet: Clark's Cognitive Model of Somatic Catastrophising & Interoceptive De-escalation
Panic · CBT · Manualised
A visual psychoeducational diagram and personal mapping tool based on Clark's classic cognitive model of panic. This template helps clients map how benign somatic sensations are misinterpreted as immediate life threats, creating a spiral of intense physical panic.
Underlying mechanism: Interoceptive Catastrophising & Adrenaline Psychoeducation
What it helps with
- Psychoeducation on the biological, evolution-backed "fight-or-flight" adrenaline surge.
- Mapping the somatic trigger chain: trigger event -> perceived threat -> apprehension -> physical symptoms -> catastrophic misinterpretation.
- Breaking down terrifying assumptions (e.g., chest tightness means an imminent heart attack) using objective medical reality.
- Tracking interoceptive avoidance (e.g., avoiding caffeine or exercise due to physical hyper-focus).
How clinicians use it
- In session 1 or 2 of cognitive therapy for panic disorder as the primary formulation tool.
- As an active, collaborative in-session worksheet to map the client's specific somatic cascade (e.g. hyperventilating).
- Prior to launching planned interoceptive exposure trials (e.g. hyperventilating on purpose in-session to test safety).
Clinical Interoceptive Exposure Tips
- Somatic Triggers: Collaboratively list the client's primary feared bodily symptoms (e.g., dizziness, breathlessness).
- In-Session Tests: Introduce brief interoceptive trials (straw-breathing, spinning) to safely replicate sensations without the real-world threat.
- Cognitive Re-labelling: Work continuously to replace catastrophising thoughts with simple biological descriptions ("This is harmless adrenaline").
What the worksheet looks like
| Cycle Stage | Clinical Manifestation (Pre-filled Example) | De-catastrophising Alternative Interpretation |
|---|---|---|
| 1. Internal somatic trigger | Sudden slight increase in heart rate due to walking up stairs quickly. | Normal cardiovascular response to exertion; heart rate is built to adapt. |
| 2. Catastrophic misinterpretation | Cognitive barrier: "My heart is racing, I am about to have a heart attack and die." | "My heart is working beautifully to pump oxygen. It is strong, not failing." |
| 3. Apprehension & adrenaline surge | Intense terror, triggering additional adrenaline release, worsening somatic cues. | Accepting adrenaline: "This is just adrenaline. It peaks and drops in minutes." |
| 4. Escape / Avoidance action | Fleeing the room, sitting on the floor, calling emergency services. | Committed action: "I will stand here, breathe slowly and let adrenaline pass." |
Clinical cautions
Always verify the client has received a standard medical evaluation to rule out cardiac, respiratory or thyroid conditions before attributing chest tightness or rapid pulse solely to panic.
References
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
- Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford Press.
Part of
Panic and Agoraphobia Recovery Pack
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