Panic Disorder Treatment
Panic Disorder Treatment
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.
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.
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 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.
Symptoms
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