Most of us have felt anxious at times. A panic attack however 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, and a feeling of choking, chest pain, sweating and heart pounding. Panic attacks can produce the same physical symptoms as some medical conditions. Once your GP has ruled out the medical conditions, you can have treatment for the panic disorder.
Many patients who have panic disorder also experience agoraphobia. Agoraphobia is a fear of places or situations where a panic attack may occur or from which escape might be difficult. People with agoraphobia avoid being out alone, going to supermarkets, travelling in trains and planes, being at heights, in elevators or tunnels or crossing open fields, Many patients even experience panic when they are asleep.
What are the causes of panic disorder and agoraphobia ?
In early human evolution, many situations that can trigger a panic attack were truly dangerous. For example, public places might have brought our ancestors in contact with hostile strangers. In any given year, 30% to 40% of the general population will have a panic attack. Some of these people will not interpret their panic as a signal of danger or illness, and thus will not go on to develop panic disorder and agoraphobia.
Panic attacks are usually activated by stressful situations such as leaving home, relationship conflicts, surgery, new responsibilities or physical illness. The sensations of physical arousal (pounding heart etc) may be misinterpreted as signals of being in the throws of a heart attack. The person therefore starts developing "hyper vigilance" (they focus excessively on physical sensations), which can result in an increase in the sensations and worry. This, in turn, may result in a full blown panic attack. The person may then develop anticipatory anxiety (fear that panic attacks will continue to occur) and begins to avoid situations that give rise to such anxiety. Once avoidance becomes wide spread the person has developed agoraphobia. The person's world may become smaller and smaller as they increase their avoidance behaviours and although they may not be experiencing a panic attack, they often live in constant fear of the next occasion when they have such an attack.
What are the common misconceptions about panic disorder and agoraphobia ?
Panic disorder and agoraphobia are not related to deeper psychological problems. You may become depressed and self critical because you have panic disorder but panic in itself can be treated effectively without long term therapy which explores your childhood experiences. Cognitive Behaviour Therapy (CBT) with or with out medication is often effective in the treatment of panic disorder and agoraphobia.
How effective is CBT for panic disorder and agoraphobia ?
There have been a number of studies which examined the effects of CBT on panic disorder and agoraphobia. Over a course of 12-20 sessions, 85-90% of people have significantly improved. Once a person has learnt to understand and manage their panic disorder, they tend to maintain their improvement. General counselling, i.e. just discussing one's symptoms repeatedly, is not at all effective for panic disorder or agoraphobia.
Medications for panic disorders and agoraphobia.
A number of anti-depressants and other medications such as beta-blockers have been found to help for the symptoms of panic disorder and agoraphobia. Once you stop using the medication however, your panic symptoms may return if you do not also have CBT.
In the CBT treatment of panic disorder and agoraphobia, you will first be helped to understand the nature of anxiety, panic and agoraphobia, secondly, determine the situations that you avoid or fear, and thirdly, evaluate the nature of your symptoms and their severity and frequency. Finally, therapists would also like to understand whether there are other problems which co-exist with your panic.
Your therapy may include some or all of the following treatments: muscle relaxation training, breathing relaxation training, gradual exposure to situations that cause you to panic, stress reduction, understanding your interpretation of physical stress symptoms and training in general cognitive therapy principles. This means that you will be helped to understand how your thoughts can lead to feeling such fear and how, by examining your thoughts and beliefs you can feel better.
What is expected of you as a patient ?
CBT requires regular attendance and active involvement from you. You will be asked to do self help homework that you and your therapist plan and design. Most patients experience improvement in their panic disorder and agoraphobia, some of them rapidly. Even if you experience rapid improvement however, you should complete the full treatment package.