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AAMFT Consumer Update
Panic Disorder
 Case example:
Michael was driving home from work one day and was caught in traffic.
He suddenly noticed that his heart was beginning to race. He then felt
short of breath, and tightness in his chest. When he began to sweat, he
became concerned and drove to the nearest emergency room where they could
find nothing physically wrong with him. Michael had just experienced his
first panic attack. Over the next few weeks, the attacks became worse, and
he started to avoid driving altogether.
Panic disorder is a type of anxiety
disorder in which the key symptom is the experience of unexpected panic
attacks. These panic attacks consist of physical and/or cognitive symptoms
such as racing heart, dizziness, blurred vision, fear of death, trembling,
sweating, and shortness of breath. As shown in the above example, the
experience of panic attacks may lead to the development of avoidance
behavior, known as agoraphobia. In Michael's case, he started to avoid
driving out of concern that he might have another panic attack, so his
agoraphobia was limited to driving. However, it is common for avoidance
behavior to occur in multiple situations. Those with panic disorder with
agoraphobia may stop or reduce activities such as drinking coffee, sexual
encounters, or taking hot showers in an effort to control the sensations
that are associated with panic attacks.
Panic disorder with agoraphobia is
the most common of the panic-related disorders, although individuals may
also report panic disorder without agoraphobia (panic attacks without
avoidance behavior) or agoraphobia without a history of panic (avoidance
behavior related to one or two sensations of panic, but has never had an
actual attack).
The Impact of Panic Disorder on
Individuals and Families
The experience of panic can range
from mild (where the person will have limited interference in their daily
routine) to extremely severe (possibly resulting in being partially or
completely housebound). The experience of panic for most panic sufferers
is frightening and the avoidance can greatly alter one's lifestyle
(e.g., inability to drive to work). As a change in their lifestyle becomes
apparent, there is also a change in their personal relationships. Others
around the person must take on more of the day-to-day routine and
responsibilities (e.g., going to grocery stores or taking the kids to
school). This may cause those around the panic sufferer to feel more
stress from their increased duties. The additional stress experienced by
the family can cause resentment and anger towards the person and then
worsen the panic symptoms. At the same time, she or he may begin to show
signs of depression as a result of their changed family role. The
negativity that comes with depression may then lead the person to believe
that they don't have the capability to improve their condition, and
consequently increase their dependency, depression, and panic symptoms. If
left untreated, this disorder can be consuming.
Knowing When to Seek Help
In general, a person should
consider seeking help when the anxiety occurs too frequently, intensely,
or is becoming disruptive in daily functioning (e.g., going to fewer
parties or social gatherings, going out to stores or movies less than
usual). A good rule to follow is to be conservative and consider seeking
help from a mental health professional when you notice the following:
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Frequently
occurring panic attacks.
If you have noticed that the attacks are increasing in either
frequency or intensity, it may be a sign that they are becoming more
difficult to control. At these times, it is advisable to seek help
before the attacks begin to greatly interfere in your life.
-
The
appearance of avoidance behavior.
If you notice a decrease in the amount of time you spend in activities
you have typically done in the past, you may want to consider seeking
help, especially if the reason for the decrease is related to
experiencing panic attacks. The same can be said for activities that
may bring on some of the sensations of panic (e.g., coffee). If you
are changing your behavior to reduce the number of activities that are
associated with panic symptoms, you may be letting the fear of the
sensations control your behavior at a subtle level, and should
consider seeking help from a qualified mental health professional.
-
Dependency.
If you notice that you are becoming more dependent on others to
accomplish tasks that you would normally do because of the possibility
of experiencing a panic attack, you may want to seek help. While this
behavior is functional in the short-run, in the long-run dependency
may intensify your anxious symptoms.
-
Use
of safety-signals. Safety-signals are
objects or people that you feel comfortable with and signal that you
are less likely to experience a panic attack. As such, it is common
for individuals with panic to seek safe objects or people. If you
notice that you want others (e.g., spouse or partner) to accompany you
more during usual activities, then you may want to seek help.
What Treatments are Available?
Treatment for panic disorder with
agoraphobia usually involves psychotherapy, medication, or a combination
of the two. A qualified family therapist can work with you to determine
which treatment will work best for your circumstances. Psychotherapy
usually involves some form of behavior therapy. This basic approach
consists of in-vivo exposure, which involves repeatedly entering the
feared situations, gradually over time. The exposures can be conducted
with or without the direct assistance of the therapist. A variation of
this approach (cognitive behavioral therapy) involves conducting behavior
therapy exposures in combination with helping you manage the troublesome
thoughts that often accompany periods of intense anxiety. Cognitive
behavioral therapy is a comprehensive treatment designed to influence the
negative thinking (e.g., "I might die") that is common with panic
disorder. It provides accurate information regarding the nature of panic
and teaches specific techniques that allow the patient to correct the
catastrophic thoughts that contribute to panic attacks. In this treatment,
the patient is also taught to utilize breathing techniques to alleviate
some of the physical sensations. This type of therapy has been shown to
greatly reduce the return of panic symptoms in the future. Either of these
treatments can be conducted individually, or in a couples or group format.
Anti-panic medications may be
recommended, including benzodiazepines such as alprazolam, clonazepam, and
lorazepam. These medications work well and are generally considered safe,
quick acting, and have fewer side effects than other types of medications.
While both medications and psychotherapy are effective, some patients have
a preference for one type versus another.
Panic can be very distressing, but
the good news is that it is treatable, and the treatments outlined here
are very successful. The suffering does not have to last for an extended
period of time. A qualified family therapist can help you explore your
treatment options and recommend a treatment plan that is appropriate for
you.
Consumer Resources
Anxiety Disorders Association of
America
8730 Georgia Ave. Suite 600
Silver Spring, MD 20910
(240) 485-1001
www.adaa.org
This mission of ADAA is to promote the prevention, treatment
and cure of anxiety disorders and to improve the lives of all people who
suffer from them.
Anxiety and Its Disorders.
By David H. Barlow, Guilford (2002). This is a comprehensive and technical
textbook that covers all of the recent advances in the nature and
treatment of anxiety disorders.
Life Isn't Just a Panic.
By Anita Pace, Baby Steps Press (1996). This book contains the stories of
how panic patients recovered from the disorder. May provide some
inspiration and instill a sense hope for recovery.
Triumph Over Fear. By
Jerilyn Ross (1995). This book covers many useful strategies and
techniques for managing panic and anxiety-a useful self-help book.
The text for this brochure was
written by
Michele M. Carter, Ph.D.
©
2002 by the AAMFT
Click
here to purchase this or other informative materials from AAMFT.
Marriage and family therapists are mental health professionals who treat a
wide array of disorders, working with individuals, couples, and families.
Marriage and family therapy clients report that they are highly satisfied
with the services they have received, and research shows that marriage and
family therapy is a cost-effective, short-term, and results-oriented form
of treatment.
The American Association for Marriage and Family Therapy (AAMFT), the
professional organization representing marriage and family therapists,
believes that therapists with specific and rigorous training in marriage
and family therapy provide the most effective mental health care to
individuals, couples, and families. This brochure is courtesy of:
the AAMFT.
Visit the AAMFT
TherapistLocator.net, a public service of the
AAMFT. There you will find information about a range of problems facing
today's families, and you can search for a qualified family therapist in
your area.
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