What Are Panic Disorder and Agoraphobia?
Almost everyone feels anxious at times. But a panic attack involves such a high level of anxiety that it can feel as if you are having a heart attack, going insane, or losing control of yourself. During a panic attack, you may have physical symptoms such as shortness of breath, tingling sensations, ringing in your ears, a sense of impending doom, trembling, a feeling of choking, chest pain, sweating, and heart pounding. A panic attack, however, can produce the same physical symptoms as these medical conditions. When a person has recurring, unexpected panic attacks, is afraid of having more or worried about their meaning, and makes changes in his or her behaviour as a result, the person is said to have “panic disorder.”
Many patients who have panic disorder also experience “agoraphobia.” Agoraphobia is fear of places or situations where a panic attack may occur or from which escape might be difficult. For example, people with agoraphobia avoid being out alone, going to supermarkets, traveling in trains or airplanes, crossing bridges, being at heights, going through tunnels, crossing open fields, and riding in elevators. Many patients even experience panic when they are asleep, possibly because the large decrease in pulse rate during sleep elicits a compensating increase in pulse rate, resulting in feeling jolted out of sleep.
What does CBT for Panic attacks involve?
- Assessment of your panic attacks
- Review of a recent panic attack in order to derive the graphical representation of the vicious circle model (case formulation). We also promote learning about what your sensations mean from a biological point of view, but demonstrated in a Socratic manner and we outline the treatment plan tailored to your particular clinical needs.
- Discussion techniques. Throughout treatment, patients 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 is a major part of the treatment, and 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. Patients will repeatedly challenge their dysfunctional thoughts during treatment. Based on the theory that you may be experiencing a medical condition rather than an anxiety problem, I will facilitate situations where you will be able to gather evidence to support either one theory or the other. Other beliefs are also targeted and modified, increasing your level of distress or possible depression such as, “I am weak if I am not able to cope with my panic attacks”, “I need to always be with someone in a supermarket or I may faint”, etc.
- Another technique used to address your interpretations in the course of cognitive therapy is called “Behavioural Experiments”. These are experiments we design in session to test whether your predictions are accurate regarding your sensations when feeling panicky, the usefulness of your safety behaviours, or the consequences of your panic. Conclusions derived from these experiments will be part of gathering evidence whether Theory 1 (you really have a medical problem leading to the symptoms) or Theory 2 (you have a worry problem which maintain the panic symptoms) is more correct.
Anyone who has had a full-fledged panic attack knows that it is one of the most intensely uncomfortable states human beings are capable of experiencing. Your very first panic attack can have a traumatic impact, leaving you feeling terrified and helpless, with strong anticipatory anxiety about the possible recurrence of your panic symptoms. Unfortunately, in some cases, panic does come back and occurs repeatedly. Why some people have a panic attack only once-or perhaps once every few years- while others develop a chronic condition with several attacks a week is still not understood by researchers in the field.
The good news is that you can learn to cope with panic attacks so well that they will no longer have the power to frighten you. Over time you can actually diminish the intensity and frequency of panic attacks if you are willing to make some changes in your behaviours and thinking.
Cognitive-behaviour therapy has been shown in numerous studies to be the treatment of choice for anxiety disorders. It is particularly effective in helping people overcome panic attacks, with about 80% to 85% of people becoming panic free, usually within eight treatment sessions.