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By Julie R. Hergenrather, Ph.D., A.C.T.
Panic Disorder is one of several types of Anxiety
Disorders. All Anxiety Disorders involve the presence
of significant fear, worry or nervousness that interferes
with daily functioning. Examples of Anxiety Disorders
include Phobia, Post-traumatic Stress Disorder,
Obsessive-Compulsive Disorder, Panic Disorder and
Generalized Anxiety Disorder.
Panic attacks, the primary symptom of Panic Disorder,
are extremely distressing and uncomfortable. Panic
attacks usually seem to "come out of nowhere,"
often taking the person completely by surprise.
During a panic attack, one experiences symptoms
such as a pounding heart, shortness of breath, chest
pain, dizziness, sweating, shaking, nausea, tingling
sensations, a feeling of choking and other physical
symptoms. Panic attacks are often accompanied by
the feeling that something terrible will happen
and by an overwhelming urge to escape. In fact,
it's not unusual for a person to think he is having
a heart attack or some other medical emergency because
the physical symptoms are so extreme. Sometimes
people go to the emergency room because they become
so frightened that they might be in serious medical
trouble.
Panic attacks can occur within other types of Anxiety
Disorders. The criteria for Panic Disorder include:
- Recurrent unexpected panic attacks
- Concern about having more panic attacks
- Worry that the panic attacks are actually heart
attacks or signs the person is "going crazy"
- Change in behavior to try and avoid panic attacks
Panic attacks are not dangerous. But the experience
of a panic attack can be extremely uncomfortable.
Who gets Panic Disorder?
Some estimates suggest that one out of seventy
five people experience Panic Disorder. The exact
causes are unclear, but Panic Disorder often occurs
in response to ongoing, major life stresses. Genetics
may also play a role, because Panic Disorder tends
to run in families. As noted, people with other
Anxiety Disorders can experience a panic attack
from time to time.
Treatment for Panic Disorder: Medication
The medications most often recommended in the treatment
of Panic Disorder and other Anxiety Disorders are
tranquilizers like Xanax, Valium, Ativan and Klonopin.
These medicines work to calm the over-aroused central
nervous system, slowing heart rate and breathing
and producing a pleasant and relaxed sensation.
Most experts agree that such medicines are best
used infrequently and on a short-term basis, since
they can be addictive. Also, if used regularly,
patients usually experience a "re-bound"
panic as well as other withdrawal symptoms when
medication is discontinued. Finally, medication
results in only temporary relief of panic attacks.
Studies shows that anywhere from 75% to 95% of people
with Panic Disorder successfully treated with medication
have a panic attack within 90 days of discontinuing
medication.
Sometimes antidepressants, like Paxil, are prescribed
in the treatment of Panic Disorder. Again, when
medication is discontinued, relapse rates can be
high. Antidepressants however, do not result in
withdrawal symptoms when discontinued.
Treatment for Panic Disorder: Cognitive Behavior
Therapy
Cognitive
Behavior Therapy specifically targets the behaviors
and beliefs that maintain Panic Disorder. During
a panic attack, because the physical symptoms are
so extreme, people believe they are in danger or
vulnerable, and often have what are called "catastrophic
thoughts" like "I'm dying," or "I'm
going to faint" or "I'll lose control."
These catastrophic thoughts only serve to increase
the already heightened physical arousal. It's difficult
to calm down when you're thinking something horrible
is about to happen!
Essentially, what happens during a panic attack
is a misinterpretation of the very real and very
uncomfortable physical symptoms. A pounding heart
is thought to be a signal of heart trouble, dizziness
caused by rapid, shallow breathing is thought to
lead to fainting, and the thought that others will
notice the anxiousness is embarrassing. The misinterpretation
of what's happening leads to more and more anxiety
and hence even more physical reactivity. Thoughts,
or cognitions, greatly influence physical symptoms
in panic. Behavior can become affected because people
start to avoid situations in which they fear having
a panic attack. For example, going to the grocery
store, to church, or out to lunch with friends may
all seem too scary because the possibility of having
a panic attack is so nerve wracking.
Cognitive behavior therapy teaches people to re-interpret
the physical symptoms in balanced ways. With CBT,
people can begin to tell themselves, "This
is only a panic attack. I've had them before and
they always go away," instead of "something
terrible is wrong. I must be going crazy!"
Relaxation training is also important in alleviating
Panic Disorder. Finally, learning that one can manage
panic when and if it occurs is important for decreasing
the intensity and the frequency of panic attacks.
CBT teaches skills and techniques that involve both
behavior change and changes in beliefs about the
symptoms. Ultimately, people don't feel out of control
anymore, and they can resume their normal lives,
even if they have lived with panic attacks for years.
Cognitive behavior therapy is highly effective
in the treatment of Panic Disorder. Studies show
that up to one year after successful treatment,
the relapse rate is 0 - 10%.
Getting Your Quality of Life Back
Panic Disorder clearly interferes with quality
of life. It's hard to enjoy life, even the simple,
everyday things, when you are worried about having
a panic attack. Fortunately, Panic Disorder can
be treated successfully. If you or someone in your
family needs help, please call us.
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