Panic Disorder
What is Panic Disorder?
Panic Disorder occurs when an individual who has had recurrent and unexpected panic attacks worries about having future panic attacks or is afraid of what might happen if he or she has another panic attack.
Panic Disorder affects approximately 2% - 3% of the population. It can occur at any age but usually begins either in late adolescents or early adulthood. Postpartum anxiety and panic attacks are also common. Panic disorder is more commonly diagnosed in women than in men.
What are Panic Attacks?
Panic attacks are discrete periods of intense fear or physical discomfort that are accompanied by a number of physical and/or cognitive symptoms.
Common panic symptoms include:
Panic attacks are the body's natural reaction to feared or dangerous situations. However, sometime an attack occurs in error when there is no real danger. Some panic attacks occur when an individual is exposed to a certain situation or trigger (cued panic attacks), while others occur for no perceivable reason at all (uncued or unexpected panic attacks). While panic attacks are uncomfortable, they are not dangerous. People with panic disorder however, do not believe this and thus react to their panic attacks with fear and anxiety.
What is Agoraphobia?
Agoraphobia is a condition that is often associated with Panic Disorder. It is the fear of places or situations that a person feels would be hard to escape from or get help in if they felt panicky or had a panic attack. Not all people with panic disorder develop agoraphobia. However, those that do are often afraid of leaving their house alone, being in crowded areas, being trapped in a car, train or bus, or simply being in an unknown or "unsafe" area. Individuals with agoraphobia either avoid the situations or feel intense dread and discomfort in these situations. Sometimes, just being in these situations will cause a panic attack.
How is Panic Disorder (with or without Agoraphobia) treated?
The most effective psychological treatment for panic disorder is a combination of different CBT interventions including psychoeducation, cognitive therapy, relaxation training, interoceptive exposure, and graduated exposure.
For patients with agoraphobia, the patient and the therapist build an anxiety hierarchy, in which places and situations are identified and ranked from least to most anxiety provoking. With the therapist's support, and at a pace that is comfortable for the patient, the patient is gradually exposed to each situation on the anxiety hierarchy until that situation no longer provokes anxiety.
Medication may also be used to treat panic disorder. Some medications depress the autonomic nervous system and stop panic attacks from happening. Others help reduce anxiety and curb panic attacks. However, once an individual stops taking medication there is a good chance that the panic symptoms will return. Therefore, medication is best used to help curb symptoms and decrease anxiety so that patients can more easily engage in therapy and successfully learn to combat their symptoms in a more permanent way.
Panic Disorder Links
American Psychologist Association - Panic Disorder website
Anxiety and Depression Association of American - Panic Disorder and Agoraphobia Site
National Institute of Mental Health - "Panic Disorder: When Fear Overwhelms" Website
Panic Disorder occurs when an individual who has had recurrent and unexpected panic attacks worries about having future panic attacks or is afraid of what might happen if he or she has another panic attack.
Panic Disorder affects approximately 2% - 3% of the population. It can occur at any age but usually begins either in late adolescents or early adulthood. Postpartum anxiety and panic attacks are also common. Panic disorder is more commonly diagnosed in women than in men.
What are Panic Attacks?
Panic attacks are discrete periods of intense fear or physical discomfort that are accompanied by a number of physical and/or cognitive symptoms.
Common panic symptoms include:
- racing heartbeat or palpitations
- sweating
- shaking or trembling
- shortness of breath or constricted breathing
- feeling of choking
- chest pain
- nausea or abdominal discomfort (e.g. stomach butterflies)
- dizziness or lightheadedness
- numbness or tingling
- chills or hot flashes
- feelings of unreality or being detached from oneself
- fear of losing control or going crazy
- fear of dying
Panic attacks are the body's natural reaction to feared or dangerous situations. However, sometime an attack occurs in error when there is no real danger. Some panic attacks occur when an individual is exposed to a certain situation or trigger (cued panic attacks), while others occur for no perceivable reason at all (uncued or unexpected panic attacks). While panic attacks are uncomfortable, they are not dangerous. People with panic disorder however, do not believe this and thus react to their panic attacks with fear and anxiety.
What is Agoraphobia?
Agoraphobia is a condition that is often associated with Panic Disorder. It is the fear of places or situations that a person feels would be hard to escape from or get help in if they felt panicky or had a panic attack. Not all people with panic disorder develop agoraphobia. However, those that do are often afraid of leaving their house alone, being in crowded areas, being trapped in a car, train or bus, or simply being in an unknown or "unsafe" area. Individuals with agoraphobia either avoid the situations or feel intense dread and discomfort in these situations. Sometimes, just being in these situations will cause a panic attack.
How is Panic Disorder (with or without Agoraphobia) treated?
The most effective psychological treatment for panic disorder is a combination of different CBT interventions including psychoeducation, cognitive therapy, relaxation training, interoceptive exposure, and graduated exposure.
- Psychoeducation is used to help patients understand their panic reaction and what is happening in their body. This is paired with Cognitive Therapy to help challenge the thoughts of danger that are related to the panic attacks and help patients achieve a more reasonable and rational understanding of their panic attacks and their ability to cope with them.
- Relaxation Training involves teaching the patient breathing, muscle relaxation, and visualization exercises to help them generally manage their baseline higher levels of stress and anxiety that contribute to their panic disorder.
- Interoceptive Exposure involves teaching the patient that the physical sensations that occur during a panic attack are not dangerous and can be tolerated. The patient is exposed to physical sensations that are experienced during a panic attack in a controlled way and taught how to cope with them without setting off a full blown panic attack. For example, this may include spinning in a chair to simulate dizziness or breathing into a bag to simulate hyperventilation. Patients learn both that they can feel these sensations and not have a panic attack, as well as the fact that if they do have a panic attack it is not dangerous and they can successfully cope with it and ride it out.
- Graduated Exposure involves gradually exposing the patient to those feared and/or avoided situations that cause anxiety. By repeatedly exposing oneself to these situations, the patient learns that the situations are not dangerous and that they can freely move about the world.
For patients with agoraphobia, the patient and the therapist build an anxiety hierarchy, in which places and situations are identified and ranked from least to most anxiety provoking. With the therapist's support, and at a pace that is comfortable for the patient, the patient is gradually exposed to each situation on the anxiety hierarchy until that situation no longer provokes anxiety.
Medication may also be used to treat panic disorder. Some medications depress the autonomic nervous system and stop panic attacks from happening. Others help reduce anxiety and curb panic attacks. However, once an individual stops taking medication there is a good chance that the panic symptoms will return. Therefore, medication is best used to help curb symptoms and decrease anxiety so that patients can more easily engage in therapy and successfully learn to combat their symptoms in a more permanent way.
Panic Disorder Links
American Psychologist Association - Panic Disorder website
Anxiety and Depression Association of American - Panic Disorder and Agoraphobia Site
National Institute of Mental Health - "Panic Disorder: When Fear Overwhelms" Website