Panic Attacks and Agoraphobia
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What is Panic Disorder?
Panic attacks are sudden and intense feelings of fear accompanied by physical symptoms, such as a pounding heart, shortness of breath, tingling sensations, and dizziness or light-headedness. They occur repeatedly and unexpectedly in the absence of any external threat.
Each year about one in 10 people experiences a panic attack, but only about one in 75 people has panic disorder. Panic disorder involves a series of unexpected, "false alarm" panic attacks. These unexpected panic attacks can interfere with a person's emotional life, relationships, and ability to work.
These periods of intense fear are referred to as "panic attacks". Most people with panic disorder also feel anxious about the possibility of having another panic attack and avoid situations in which they believe these attacks are likely to occur. Anxiety about another attack, and the avoidance it causes, can lead to disability in panic disorder.
Typically, a first panic attack seems to come "out of the blue," occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, racing or pounding heart, chest pains, dizziness, fear of fainting, difficulty breathing, tingling or numbness in the hands, flushes, sense of unreality, fear of losing control, and fear of dying or going mad. The symptoms usually last only a few seconds, but may continue for several minutes. However, in more severe cases, some symptoms can be present for days.
Panic disorder may progress to a more advanced state in which the person becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack. This condition is called agoraphobia. It affects about a third of all people with panic disorder. Typically, people with agoraphobia fear being in crowds, standing in line, entering shopping malls, and riding in cars or public transportation. Often, these people restrict themselves to a "zone of safety" that may include only the home or immediate neighbourhood. Thus, the person with agoraphobia typically leads a life of extreme dependency as well as great discomfort.
In addition to worry about panic attacks, individuals with Panic Disorder also report constant or intermittent feelings of anxiety that are not focused on any specific situation or event. An individual's preoccupation with health can become debilitating if other activities of the individual's life are left unattended to. In cases where the disorder is undiagnosed or misdiagnosed, the belief that an undetected life-threatening illness exists may lead to both chronic debilitating anxiety and excessive visits to health care facilities. Relationships may be strained or marred by conflict as panic attacks, or the fear of them, rule the affected person and those close to them.
TREATMENT OF PANIC ATTACKS
Several effective treatments have been developed for panic disorder and agoraphobia. A form of psychotherapy called rational emotive behavioural therapy has been found to be effective in the treatment of panic disorder. EMDR (Eye Movement Desensitation Reprocessing) could also be of benefit. Medication can be used to prevent panic attacks and also to reduce their frequency and severity, and to decrease the associated anticipatory anxiety. When individuals find that their panic attacks are less frequent and severe, they are increasingly able to venture into situations that had been off-limits to them. In this way, they benefit from exposure to previously feared situations as well as from the medication.
Cognitive Behavioural therapy
includes learning about panic attacks and their causes, and correcting the
thoughts that cause panic attacks. This treatment has been shown to be
highly effective at reducing panic attacks, with approximately 80 percent of
those going through these treatments being panic-free at the end of
treatment. The person is expected to participate in difficult and
uncomfortable activities. Work outside of the therapy sessions is required
to master new skills.
REBT consists of the following
components, each which will be described briefly: 1- Education, 2- Cognitive
Restructuring, 3- Breathing Training, 4- Relaxation Exercises, 5-
Situational Exposure, 6- Interceptive Exposure. Each component is aimed at
alleviating panic attacks, agoraphobic avoidance, chronic anxiety, and
depression associated with panic disorder (note: clinician's may apply only
those techniques that they determine are relevant to your problem).
Throughout treatment, clients are educated about panic attacks and the
development of panic disorder. An understanding of panic disorder is
believed to be an important part of the recovery process.
Cognitive restructuring, a major part of the treatment, is intended to
correct distorted thinking about panic attacks. The goal is to have patients
change their reaction to their emotional arousal and panic symptoms, and
learn to deal effectively with anxiety provoking situations. During the
early sessions of therapy, patients are asked to self-monitor their
thoughts, assumptions, and beliefs during anxiety provoking situations and
panic attacks. With the collaboration of the therapist, patients begin to
appreciate the role of cognition, beliefs, and appraisals in the evocation
or accentuation of anxiety and panic attacks. During the later sessions,
patients are taught to re-evaluate the validity of these distorted thoughts,
and change them to more rational, adaptive ones. In particular, patients'
"catastrophic misinterpretations" of panic-related somatic cues -- the
belief that these physical sensations are a sign that he or she is dying at
that moment -- are addressed. Patients will repeatedly challenge their
dysfunctional thoughts during treatment.
Breathing training teaches clients a pattern of slow, regular breathing
which prevents hyperventilation, an uncomfortable symptom of and cue for
panic attacks.
Relaxation exercises that involve progressive muscle tension are often
incorporated to lower general anxiety levels.
Situational exposure consists of structured and repeated exposure to anxiety
- and panic provoking ("phobic") situations. Based on the patient's
individualized list of feared situations, he or she undergoes exposure to
these situations while using coping strategies learned during therapy,
beginning with the least feared and moving to the most feared. This
typically takes place later on during therapy, once a patient feels more in
control of panic attacks. The aim of situational exposure is to eliminate
agoraphobia.
When necessary, Interceptive exposure may be conducted. Interceptive
exposure involves the structured and repeated exposure to panic-like
physical sensations. Based on the patient's individualized hierarchy of
feared internal sensations (e.g., dizziness, palpitations), he or she
undergoes systematic exposure to these sensations. The feared sensations may
be produced using idiosyncratic methods such as controlled hyperventilation
or physical exertion (e.g., running up a flight of stairs to get your heart
racing). This is necessary because patient's often become fearful of
harmless body sensations, such as those caused by exercise, caffeine, and
excitement.
IS THIS TREATMENT
FOR YOU?
As it may appear, the treatment requires a fair amount of work. Therefore, I
encourage patients to enter only when they feel committed to overcoming
their problem. Practicing what is covered during therapy sessions at home is
essential to getting better.
You may feel that the treatment itself is anxiety provoking. After all, why
would you want to go into situations which make you feel anxious? In my
opinion, as well as many other clinicians and researchers in this field, one
must confront his/her anxiety to get over it. However, please be assured
that patients move at a rate at which they feel comfortable. Clients are
given encouragement by the therapist to overcome this problem, but no one is
pushed into doing something he or she is not ready for. The therapist
understands the intense fear involved in this problem. The goal of the
therapist is to prepare the client to deal with each step in an effective
manner using the techniques described above. The client and therapist
maintain a friendly, collaborative relationship. The therapy focuses on the
present problem and how to alleviate it. If you are ready to make the
commitment, and the treatment sounds sensible to you, then there is no
reason to believe you can not get better.
People who experience panic and agoraphobia, are not "crazy" and do not need
to be in therapy for extended periods of time. Sessions depend on the
severity and length of the problem and the willingness of the client to
actively participate in treatment. On average, 16 sessions are normally
needed.
Don't Despair Help is at hand
Last Modified: 7 January 2006
Copyright ©2006 Silvia Buet
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