Question:
Treating Panic Disorder ?
Answer:
Panic attacks and panic disorder can be very disabling conditions for
the people who suffer from them. Sometimes they can lead to avoidance
of any activity or environment which has been associated with feelings
of panic in the past. This can in turn lead to more severe and
disabling disorders such as agoraphobia.
Panic attacks typically begin in young adulthood, but can occur at any
time during an adult's life. A panic episode usually begins abruptly,
without warning, and peaks in about 10 minutes. It can last anywhere
from a few minutes to a half hour or longer. Panic attacks are
characterized by a rapid heart beat, sweating, trembling, and a
shortness of breath. Other symptoms can include chills, hot flashes,
nausea, cramps, chest pain, tightness in the throad, trouble
swallowing and diziness.
Women are more likely than men to have panic attacks. Many researchers
believe the body's natural fight-or-flight response to danger is
involved. For example, if a grizzly bear came after you, your body
would react instinctively. Your heart and breathing would speed up as
your body readied itself for a life-threatening situation. Many of the
same reactions occur in a panic attack. No obvious stressor is
present, but something trips the body's alarm system.
Treatment emphasizing a three-pronged approach is most effective in
helping people overcome this disorder: education, psychotherapy and
medication.
Psychotherapy
Education is usually the first factor in psychotherapy treatment of
this disorder. The patient can be instructed about the body's
"fight-or-flight" response and the associated physiological
sensations. Learning to recognize and identify such sensations is
usually an important initial step toward treatment of panic disorder.
Individual psychotherapy is usually the preferred modality and its
length is generally short-term, under 12 sessions. An emphasis on
education, support, and the teaching of more effective coping
strategies are usually the primary foci of therapy. Family therapy is
usually unnecessary and inappropriate.
Therapy can also teach relaxation and imagery techniques. These can be
used during a panic attack to decrease immediate physiological
distress and the accompanying emotional fears. Discussion of the
client's irrational fears (usually of dying, passing out, becoming
embarrassed) during an attack is appropriate and often beneficial in
the context of a supportive therapeutic relationship. A cognitive or
rational-emotive approach in this area is best. A behavioral approach
emphasizing graduated exposure to panic-inducing situations is
most-often associated with related anxiety disorders, such as
agoraphobia or social phobia. It may or may not be appropriate as a
treatment approach, depending upon the client's specific issues.
Group therapy can often be used just as effectively to teach
relaxation and related skills. Psychoeducational groups in this area
are often beneficial. Biofeedback, a specific technique which allows
the client to receive either audio or visual feedback about their
body's physiological responses while learning relaxation skills, is
also an appropriate psychotherapeutic intervention.
All relaxation skills and assignments taught in therapy session must
be reinforced by daily exercises on the patient's part. This cannot be
emphasized enough. If the client is unable or unwilling to complete
daily homework assignments in practicing specific relaxation or
imagery skills, then therapy emphasizing such skill sets will likely
be unsuccessful or less successful. This pro-active approach to change
(and the expectations of the therapist that the client will agree to
this approach) needs to be clearly explained at the onset of therapy.
Discussing these expectations clearly up-front makes the success of
such techniques much greater.
Medications
A lot of people who suffer from panic disorder can successfully be
treated without resorting to the use of any medication. However, when
medication is needed, the most commonly-prescribed class of drugs for
panic disorders are the benzodiazepines (such as clonazepam and
alprazolam) and the SSRI antidepressants. It is rarely appropriate to
provide medication treatment alone, without the use of psychotherapy
to help educate and change the patient's behaviors related to their
association of certain physiological sensations with fear.
Phillip W. Long, M.D. notes that, "Clonazepam (Klonopin, Rivotril) and
alprazolam (Xanax), are the treatment of choice in the treatment of
Panic Disorder. Clonazepam and alprazolam are preferred to
antidepressant drugs because of their less severe side effects." He
also states that it is preferred to try the anti-anxiety agents before
moving on to the antidepressants because of the increased side-effect
profiles. Xanax can be addicting for individuals and should be used
with care. Treatment with either clonazepam or alprazolam should be
discontinued by tapering it off slowly, because of the possibility of
seizures with abrupt discontinuation.
Self-Help
Self-help methods for the treatment of this disorder are often
overlooked by the medical profession because very few professionals
are involved in them. Many support groups exist within communities
throughout the world which are devoted to helping individuals with
this disorder share their commons experiences and feelings.
Patients can be encouraged to try out new coping skills and relaxation
skills with people they meet within support groups. They can be an
important part of expanding the individual's skill set and develop
new, healthier social relationships.
