Panic Disorder Therapy
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According to the DSM-5, panic disorder is defined as sudden and repeated panic attacks—episodes of intense fear and discomfort that reach a peak within a few minutes—during which the individual experiences physical symptoms such as chest pain, heart palpitations, breathlessness, vertigo, or abdominal distress, sometimes accompanied by the fear of losing control or dying. The symptoms may resemble those of a heart attack or other potentially fatal medical condition. Panic disorder is frequently diagnosed after other serious illnesses have been ruled out by medical tests or emergency department visits.
Panic disorder affects roughly 2% to 3% of American adolescents and adults, and it affects women twice as much as males. Panic attacks are common in young adulthood, although not everyone who has one panic attack develops the disorder.
Panic attacks are severe and fleeting. They cause physical sensations such as difficulty breathing, rapid heart rate, tense muscles, and chest tightening. They last between 20 and 30 minutes. One or two such attacks are common in a person’s lifetime. However, if these attacks are recurring or the individual experiences continuing fear of another attack, they may be suffering from panic disorder.
Medication and therapy are effective medications for panic disorder. Appropriate professional treatment can help decrease or avoid panic attacks by lowering the symptoms or worries associated with having an attack. Relapses are possible, but they can be adequately addressed.
Cognitive-behavioral therapy (CBT) trains patients to recognize the connections between their thoughts, beliefs, and behaviors. CBT can help establish mastery over anxiety and panic symptoms by modifying erroneous thought processes that maintain anxiety and gradually exposing the person to anxiety-provoking symptoms or events.
Individuals suffering from panic disorder may help from therapy in the following ways:
Recognize their erroneous perspectives on life pressures such as other people’s actions or life circumstances.
Recognize and replace panic-inducing thoughts to reduce their sense of helplessness.
Learn stress management and relaxation techniques to help in the treatment of symptoms.
Systematic desensitization and exposure therapy are used, in which individuals are encouraged to relax and then envision the things that give them anxiety, going from the least fearful to the most fearful. Gradual exposure to a real-life situation has also been successfully employed to help people overcome their concerns.
Several medications have been shown to be beneficial in the treatment of panic disorder. Antidepressants are one type of medication that must be used for several weeks before symptoms subside.
SSRIs, or selective serotonin reuptake inhibitors, work in the brain by activating a chemical messenger called serotonin. Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram are some of the most widely given SSRIs for panic disorder (Celexa). When panic disorder is combined with obsessive-compulsive disorder, social phobia, or depression, SSRIs are used to treat it. When patients first start taking SSRIs, they may experience nausea, sleepiness, diarrhea, or sexual side effects, but these symptoms will improve over time. A dosage modification or switching to another SSRI may help resolve the issue. Clients should share any side effects or concerns with their doctor so that any medication modifications are done.
Patients may be prescribed benzodiazepines, such as alprazolam (Xanax) and lorazepam (Ativan), to help with more acute symptoms of panic disorder. These drugs relieve symptoms rapidly and have few negative effects other than sleepiness, but repeated usage may lead to medication dependence. They are not suggested for patients who have a history of alcohol or substance abuse.
When taking medications, it is important that patients are educated about potential adverse effects, the rationale for the type of medication provided, and any drugs or substances that may counteract or interfere with the effects of the medications. Before discontinuing the prescribed medication, or if the medication does not appear to be alleviating symptoms, the doctor should be consulted.
Panic disorder is diagnosed when a person has unexpected panic attacks that contain at least four of the following symptoms:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Shortness of breath or a sensation of smothering
- A choking feeling
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Feeling detached from oneself or reality
- Fear of losing control or of impending doom
- Fear of dying
- Numbness or a tingling sensation
- Chills or hot flashes
Furthermore, at least one panic attack happens following a month of persistent fear of another panic attack or its repercussions, such as feeling out of control or modifying one’s behavior to avoid an attack. A panic attack cannot also be caused by substance abuse, a medical disease, or another mental health disorder.
Although the causes of panic disorder are unknown, many factors have been related to the disorder. Those who are particularly prone to anxiety, neuroticism, and negative emotions may be at greater risk. Physical and sexual abuse in childhood is a risk factor, as is separation anxiety in childhood, though less frequently. A loss or stressor, such as the death of a loved one event a negative drug encounter, can precede a first panic attack. Genetics are also thought to play an impact.
Researchers have used both animal and human studies to define the specific areas of the brain that are involved in anxiety and fear. Because fear developed to shield us from danger, it triggers an automatic defensive response without conscious thought. The amygdala, a region deep within the brain, is thought to control this fear response. The amygdala, despite its tiny size, is highly complex, and current research suggests that anxiety disorders may be connected with aberrant activity inside it.
Certain medications can provide relief in as little as half an hour to an hour. Valium or diazepam, Ativan or lorazepam, Xanax or alprazolam, and Klonopin or clonazepam are examples. These drugs can be extremely helpful during a panic attack.
What is the next step?
If you or someone you love is considering individual therapy or counseling, please contact Through The Forest Counseling. We are a team of professionals who have the expertise to help.
Call us at our office to schedule an appointment with one of our highly skilled clinicians at Through The Forest Counseling.