Treatment for Panic Attacks and Panic Disorder

Treatment for Panic Attacks and panic Disorder. Introduction

Panic Attacks is a type of anxiety disorders describing a state of intense fear combined with variety of symptoms like chest pain, flashing vision, nausea, numbness and very frequent a subjective feeling of an immediate death. They feel like an inexplicable and unthinkable traumatic event.

Panic attacks can occur as isolated incidents or repeatedly. A pattern of recurrent, panic attacks is referred to as panic disorder.

“The panic episode is like a repetitive micro-delusion exposing the patient to a concrete experience of dying, suddenly facing him with a ‘nameless’ dread and provoking in him that fear of annihilation, biological as well as psychological, that has the power of destructing the mind and damaging any sense of existential continuity and integrity” (Francesco De Massi).

The fear of the next panic attack triggers a “vicious cycle of anxiety” leading to expectation of fear, known as “fear of fear.” Many individuals with panic disorder consequently avoid places and situations that might trigger a panic attack. As a result, people with panic disorder withdraw from life more and more, causing increasingly more problems in their private and professional lives.

However, treatment for panic attacks can stop and unwind the vicious circle.

In this article we describe how to recognize, treat and prevent the panic disorder.

Panic Disorder vs. Panic Attack: What’s the Difference?

A panic attack is a brief period during which an individual experiences intense discomfort, fear, or anxiety, accompanied by various physical, psychological, and general symptoms. Experiencing isolated panic attacks throughout one’s life does not constitute a diagnosis of panic disorder. It’s only when multiple panic attacks occur within a month, accompanied by an increasing fear of experiencing panic, that doctors refer to it as panic disorder. This fear is also known as anticipatory anxiety, which persists for an extended period, typically at least a month, and significantly impacts daily life. The fear of suddenly experiencing a panic attack, especially in situations where escape is difficult or help is unavailable, often leads individuals to avoid confined spaces, crowds, or even long journeys. In severe cases, they may become housebound.

Approximately four percent of people develop panic disorder at some point in their lives. The disorder typically emerges between the ages of 15 and 24 but can onset, particularly in women, in the third or fourth decade of life. Overall, women are more commonly affected by panic disorder than men.

How To Recognize a Panic Attack?

No panic attack is exactly like another. Because the symptoms are often nonspecific, some sufferers may not realize they are having a panic attack. Typical symptoms of a panic attack can include:

• Shortness of breath
• Rapid heartbeat
• Dizziness
• Sweating
• Trembling
• Tightness in the chest
• Tightness in the throat
• Visual disturbances
• Tingling or numbness in the arms or legs
• Weak knees
• Dizziness
• Nausea

In addition, those experiencing a panic attack often feel a sense of loss of control. They may feel like they are beside themselves or even “going crazy”, especially when a panic attack comes out of nowhere. During a panic attack some people can experience the fear of dying on a heart attack on chocking.

Risk Factors of Panic Attacks

Biological or Genetic Factors

Genetics and neurophysiological changes in the brain pathways, play a significant role in predisposing individuals to panic disorder. Environmental factors like stress and significant life changes also contribute to its development. Psychological theories point to recent life events, childhood trauma, and attachment issues as potential root causes.

Childhood Trauma

Childhood trauma with a tumultuous, unpredictable environment increases the susceptibility to mood and anxiety disorders later in life. For instance, a child raised by an abusive or volatile parent might develop hyper-vigilance, constantly monitoring their parent’s moods to stay safe. This habit can carry into adulthood, leading them to overanalyse others’ reactions increasing the vulnerability for panic disorder.

Life Events

“Critical life events” are considered potential influences on the development of a mental illnesses. The life events are considered as “critical” when they involve significant, life-altering, and extraordinarily stressful experiences. Such events often include sudden or prolonged changes or restrictions in one’s life circumstances, perceived as significant stressors. Not only the absolute number of experienced life events but also the nature of these events and their emotional processing play a crucial role in the genesis of the illness.

Major Life Changes

Life changes also can trigger the onset of panic disorder. They often lead to feelings of being out of control, especially in unexpected situations. Unhealthy coping mechanisms and negative mindsets can make it seem impossible to adapt to changes. Pepale’s perspective on life also plays a crucial role in how they handle new situations. Negative outlooks can exacerbate feelings of stress, making major changes even more challenging to navigate. Additionally, even positive changes can be unsettling because they disrupt familiar routines and comfort zones. Therefore, it’s important to find healthy ways to cope and maintain a positive outlook during times of transition.

Psychological Factors

Overall, while there is strong evidence supporting the role of biological and environmental factors in vulnerability to panic attacks, psychological factors also play a significant role in understanding the onset and treatment of panic disorder.

When Should You Seek Help?

Seeking therapy can provide a confidential space to explore your thoughts and feelings, learn coping strategies, and regain control over your life.

If you’re wondering whether you should see a therapist for your panic disorder, here are some signs it might be time to seek professional help:

• Feeling constantly overwhelmed, with worries seeming out of proportion.   
• Experiencing physical health issues like nausea, headaches, or muscle pain, which can be linked to chronic stress and anxiety.      
• Struggling to build or maintain relationships due to anxiety affecting communication and conflict resolution.       
• Feeling like your emotions are out of control, with anxiety making negative feelings more intense and harder to cope with.
• Experiencing a decline in academic or work performance due to difficulty focusing caused by anxiety.    
• Turning to unhealthy coping mechanisms such as alcohol abuse to manage anxiety. 
•   Having a history of trauma or abuse, which can benefit from talk therapy with a trained professional.    
• Losing interest in activities you used to enjoy, feeling disconnected from life.                                                                                                         –

How to Treat Panic Attacks?

Panic disorder is well treatable condition. In this article we describe different methods of treatment for panic attacks. In case of relatively rare panic attacks the method of choice is psychotherapy. However, in severe cases of panic attacks, the pharmacological approach to panic attack treatment “opens the door” for psychotherapy. Patients “paralyzed” by severe panic attacks are too fragile and not accessible for psychotherapy. The medication works quickly reducing the symptoms within days and suppressing the symptoms completely within few weeks.

Treatment with Medication for Panic Attacks

Medication effectively treats panic attacks. The treatment should be implemented gradually combining different classes of medication. Benzodiazepines are used for emergency treatment of a panic attack. However, in long term the antidepressants are the most effective group of medication for treatment of panic attacks.

Benzodiazepines

The anti-anxiety medication, such as benzodiazepines are widely used due to their rapid effects. When taken during a panic attack, these drugs can provide relief within just ten or fifteen minutes. Despite their fast-acting nature, benzodiazepines do not suppress the anxiety for longer than few hours. Therefore, benzodiazepines should only be used for a short period during the initial stage of treatment.

Antidepressants

This group of medication is used in treatment of depression, but they are also highly effective in panic attack treatment. They do not work straightaway. It takes few weeks before their effect builds up and may take up to 8-12 weeks to fully work. There are several types of antidepressants. The proper choice of the medication and psychotherapy technique is crucial for the effectiveness of the treatment.

Treatment with Medication Alone?

Despite its effectiveness this method of panic attack treatment will not resolve the problem. The state-of-the-art treatment of panic disorder is the combination of medication (highly effective in a short amount of time) and psychotherapy that addresses the underlying causes of the panic disorder. According to author’s own 30 years of clinical experience, medication can fully suppress the symptoms of panic attacks. However, suppressing the symptoms with medication doesn’t constitute a holistic approach to panic attack treatment. This does not “cure” the patient. The medication will facilitate a stable mental condition and protect the patient from the terror of panic attacks. The patient will be able maintain his private and professional performance and will be able to address underlying causes of his disorder with psychotherapy. Psychotherapy is more effective in the long term (more than one year) than pharmacological treatment.

Psychotherapy in Treatment for Panic Attacks

A body of research compared behavioral, cognitive, and Cognitive Behavioral Therapy (CBT) in the treatment of panic attacks and concluded that CBT had the best long-term effect, which makes it an evidence-based treatment approach.

Recent studies proved that psychodynamic psychotherapy is equally effective in relieving panic attacks as behavioral approaches but has fewer relapses.

Behavioral Therapy

In exposure therapy for panic disorder treatment the patient will be exposed to the physical sensations of panic in a safe and controlled environment, giving him the opportunity to learn healthier ways of coping. The psychotherapist may evoke sensations like the symptoms of panic. With each exposure, the patient can become less afraid of these internal bodily sensations feeling a greater sense of control. Through this experience the patient learns that the situation isn’t harmful. Behavioral therapy aims to identify and change harmful patterns of behaviour.

Cognitive Therapy

Cognitive therapy is based on the idea that certain ways of thinking triggers and maintains panic attacks. This type of panic attack treatment is focused on the understanding of patient’s thought patterns to identify any harmful, unhelpful, and mistaken ideas or thoughts. The aim of cognitive therapy is to change how people think to avoid the pathogenic ideas and create more realistic and helpful thought patterns.

Cognitive Behavioral Therapy (CBT)

CBT is a mixture of the above-described therapies where the patient benefits from changing both thoughts and behaviours. Cognitive behavioral therapy is the most researched and the most effective form of treatment for panic disorder. CBT focuses on the thinking patterns and behaviours that are sustaining or triggering the panic attacks. It helps the patient create insight showing his fears in a more realistic light. Once the patient learns that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.

Psychodynamic Psychotherapy

Psychoanalytic/psychodynamic treatment for panic disorder attempts to uncover unconscious conflicts within the patient’s mind. From the psychoanalytical point of view, the panic attacks are the effect of a fragile self-defence. The clinical experience teaches us that the symptoms of panic are always accompanied by an identity defect and betrays a failure of the self.

The psychodynamic treatment of panic attacks focuses on two goals.

At the beginning the therapist aims to help the patient comprehend the root cause of his anxiety, the internal conflict, he is not aware of. Then the therapist assists the patient in developing an insight into the problem. The awareness of the conflict opens the way for the integration of repressed emotions.

Throughout the analytical treatment, the frequency and intensity of panic attacks decrease, ultimately resulting in complete recovery. By exploring the patient’s inner world, the therapy enables him to make the necessary changes to restore emotional stability.

The second condition is to help the patient build a stable and permanent sense of self. Building a stable “self” is a process of developing individuality with the capacity to formulate autonomous opinions and thoughts to attain emotional experiences. The patient can be freed from inhibitions, self-indulgences, unconditional conformity and make his own ethical decisions. Psychodynamic psychotherapy focuses on the root causes of the disorder and less on the symptoms. This approach is causal in its nature. The psychotherapeutic process lasts for several months and sometimes even up to two years.

What helps during an acute panic attack?

1. Stay calm and breathe: Try to remain calm and focus on your breathing. Remind yourself that the panic attack will pass and your life is not in danger.
2. Stay where you are: If you’re in a car, pull over and stop. If you’re on public transport, remain seated until you feel better, even if your stop is approaching.
3. Focus on something neutral: Concentrate on an object in the room or an item of clothing someone is wearing, something that isn’t triggering your anxiety.
4. Don’t suppress the panic: Instead, acknowledge it and understand that it will pass. Resisting it can make it worse.
5. Seek help if needed: If you’re unable to calm down, reach out to someone nearby, see a doctor, call emergency services, or contact a medical helpline. Sometimes, just speaking to a professional over the phone can provide reassurance and guidance.

How to Prevent Panic Attacks

To prevent panic attacks in long term follow the below advices:

1. Watch your lifestyle: Alcohol, drugs, nicotine, and caffeine can exacerbate panic. If you’re prone to panic attacks, try to avoid these substances.
2. Take care of yourself: Ensure you get enough sleep, eat healthily, and exercise regularly. These habits strengthen your body and help it cope with anxiety.
3. Try meditation and mindfulness: These practices are effective tools for managing panic attacks. They help you focus and calm down faster when needed. Many free apps can guide you through relaxation techniques step by step.

Therapy for Panic Attacks and Panic Disorder. Summary

Panic attacks are episodes of intense fear that usually occur unexpectedly and without warning, lasting from a few seconds to several minutes. In some cases, the overwhelming fear can be so severe that those affected may think they are having a heart attack or another serious life-threatening condition. Recurrent panic attacks are called “panic disorder”.

Untreated panic disorder tends to increase in frequency and severity. restricting more and more the social and professional performance of the individuals affected. In consequence people with panic disorder are more and more restricted in their social and professional performance which can end in a full invalidism. Therefore, an early diagnosis and treatment of panic attacks is essential to reach a full recovery.

Panic disorder is a treatable condition with a good prognosis. The state-of-the-art therapy is a combination of pharmacological treatment (medication) and psychotherapy. Most of the surveys show the high effectiveness of cognitive behavioral therapy (CBT) as well as psychodynamic psychotherapy.