Dr. Lisa Elrom, Ph.D.

Anxiety Disorders are very common. Almost twenty percent of the United State’s adult population suffers from some form of Anxiety Disorder within any given year. The Diagnostic and Statistical Manual (currently DSM-IV and IV-TR), the mental health code book, defines various types of Anxiety Disorders. They include Generalized Anxiety Disorder, Panic Disorder (with and without agoraphobia), Social Phobia (Social Anxiety Disorder), Post Traumatic Stress Disorder, Obsessive-Compulsive Disorder, and Specific Phobia.

This article addresses one particular Anxiety Disorder: Panic Disorder.  Many individuals have experienced some form of a panic attack in their lifetime.  You may be considered to have a Panic “Disorder” when you have had a series of ongoing panic attacks. The symptoms I hear most individuals complain about are shortness or constriction of breath, rapid heartbeat, faintness or dizziness, tightness in chest. However, individuals, especially at extreme levels of panic, may also experience nausea, numbness or tingling in the hands and/or feet, a feeling of “unreality” or disconnect a fear of loss of control. When someone experiences a panic attack, they often see their doctor or may even go to the emergency room because they think they are having a heart attack.

The majority of individuals can live with panic attacks. However, there are many that find them highly debilitating. Panic attacks come on suddenly and unexpectedly. They can show up either during the day or during sleep. It is not atypical for someone to start avoiding places or situations where they think they will have a panic attack. The tendency to avoid situations where escape may be difficult is called Agoraphobia.  Individuals commonly avoid places where there are crowds. They may also avoid driving on a freeway and/or in rush hour traffic, because they are afraid they will have a panic attack during that time. At the extreme range individuals become homebound.

Treatment

If you are experiencing panic attacks, it is likely you will seek out the assistance of a skilled therapist, such as a psychologist, social worker, or licensed professional counselor. You may even need to be on medication to help manage the symptom. There are a variety of medications that your primary care physician or a psychiatrist can administer. If one does not work there is usually another that will.
The decision to take medication is between you and your doctor. However, medication is not the primary choice in the management of any Anxiety Disorder. Research has shown that Anxiety Disorders, and that includes Panic Disorder, must be managed through therapeutic techniques described below. First of all, it is important to understand that although panic attacks are scary, you will not die from them. Secondly, avoiding situations you fear having an attack will only reinforce having them in those situations and sustain the disorder. Therefore, it is vital that you work on learning to confront those situations.

A skilled therapist should work with you on the following:

1. Relaxation techniques to help you learn to calm your body.
2. Breath retraining—rapid breathing happens during panic attacks and it can lead to hyperventilation when panic attacks are intense. By learning deep breathing or training your breath to be more from the diaphragm or “belly” region (as opposed to the chest region during a panic attack) you might learn to slow your breathing down.
3. Something called “interoceptive feedback” will help you learn to get used to your panic symptoms. This involves doing certain exercises that mimic the symptoms; e.g. spinning around to recreate the experience of dizziness.
4. Cognitive behavior therapy (CBT) is key to managing anxiety disorders in general. It is important that you develop and maintain a realistic perspective of your anxiety and the situation you may fear. Anxiety has an uncanny way of telling us to worry!
5. In vivo exposure, which is part of CBT, will help you learn to confront those avoided situations. Your therapist will help you identify a “hierarchy” of situations that you avoid. Not every situation will elicit the same level of anxiety or panic. By exposing yourself to each situation you avoid in a gradual manner, you will have better success than starting with situations that are highly anxiety producing.

While these techniques are the basis for managing panic attacks, there are others that a creative therapist can offer as well.

We welcome questions in the comment area about panic disorder, and  a professional will respond.