Panic Disorder with Agoraphobia

Therapy that works; a therapist who cares.

Etan Ben-Ami, LCSW

34 Atlantic Ave, ste 202
Lynbrook, NY 11563
(347) 844-0071

Late evening appointments available
Email:  etan.benami@gmail.com

Skype sessions available in New York

Medicare & AARP Supplemental accepted
NYS Empire Plan & ValueOptions accepted

 

What are panic attacks?

Panic attacks are episodes of sudden, intense fear and anxiety that often occur 'out of the blue', without any apparent cause or warning. Panic attacks are different from just feeling anxious or afraid. Panic attacks are much more intense, and physical sensations accompany the disturbing thoughts and feelings.

The physical symptoms of a panic attack often include:

  • rapid heartbeat;
  • chest pain;
  • shortness of breath;
  • sensations of choking;
  • chills or hot flushes;
  • sweating;
  • nausea or intestinal distress;
  • trembling or shaking;
  • numbness or tingling; and
  • dizziness or feeling light-headed.
During a panic attack, people often believe they are actually dying or going crazy, or that they will do something in public that is dangerous or embarrassing. Many people also feel as if they are about to pass out. (This almost never actually happens.)

Despite these intensely disturbing feelings, panic attacks are not dangerous. They are a common reaction to extreme or long-term stress and anxiety. Nearly one in three people will have a panic attack at some point in their lives. Chances are good that you know more than one person who has occasional panic attacks under stress.

What causes panic attacks?

Panic attacks are caused by a combination of physical and emotional reactions to stress and anxiety.

Even when a person is good at managing their outward reactions to stress, their body may react to it with a 'fight or flight' reaction. This includes an increased pulse and more rapid breathing, as well as many other changes that would be helpful in a dangerous situation in the wild. It prepares us for the immediate physical activity we might need to save ourselves.

In our civilized world, we rarely face these physical challenges. When a 'fight or flight' response is triggered, yet we remain at rest, it causes temporary imbalances in the body. This can occur even without our being consciously aware of what our body is doing, and sometimes without our being aware of how stressed or anxious we may be.

Panic attacks begin when these physical reactions occur without our understanding their cause or process. The physical changes can be frightening. This fear can cause an even more intense 'fight or flight' reaction. The result is sometimes a vicious cycle in which fear and physical symptoms temporarily spin out of control.

It's important to remember that these symptoms are temporary. The body knows how to limit its reactions and restore its balance. Panic attacks are not dangerous to a person who otherwise enjoys good health.

Diagnosis of Panic Disorder

Many people respond to their first panic attack by going to a hospital ER. This is actually wise. Unless you have medical training and an EKG machine, you probably shouldn't try to diagnose yourself. And though many people are embarrassed to learn that their problem is an emotional reaction, it should be taken as good news.

For most people, panic attacks occur during a stressful time in their lives, e.g. during a divorce or when there is a serious illness in the family. When the level of stress goes down, the attacks stop, and life returns to normal.

Panic disorder is diagnosed when panic attacks occur repeatedly, when they become their own source of stress, and when they disturb a person's ability to function. Roughly 3.5 % of the population suffers from panic disorder.

In many cases, people with panic disorder cut back on their activities for fear of having a panic attack in public or in a situation where they would be unable to get help. Sometimes people become afraid of driving a car alone or they develop many different phobias. While some people can resist these fears, every day becomes a struggle for them.

This condition is known as panic disorder with agoraphobia. Though it can be disabling, it is very treatable. Using modern treatment methods, most people are back to normal activities in six months or less.

Short-Term Therapy for Panic Disorder

The 1991 National Institute of Health consensus statement on panic disorder recognized two forms of effective treatment for panic disorder. They are medication and cognitive-behavioral therapy.

Medication for panic disorder can include short-term, occasional use of a tranquilizer or long term use of an antidepressant, such as Paxil. Despite the antidepressant label, these drugs are effective at stopping the vicious cycle of panic attacks and fear of panic attacks. Unfortunately, panic attacks often begin again after the medication is stopped.

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is a short-term psychotherapy that has been studied in clinical trials, head-to-head with medications. It is as effective as medication, and unlike medication, for most people it remains effective after treatment has ended.

CBT is an active, short-term therapy based on the patient's thoughts and behavior as they occur currently. It is focused on reducing the frequency and severity of panic attacks, and on eliminating the avoidance that results in agoraphobia. While childhood events and relationship issues are important to a person's general adjustment in life, discussing them isn't very useful in overcoming panic disorder with agoraphobia. Instead, CBT focuses on developing a patient's skills for dealing with panic attacks and avoidance.

To do this, the therapist provides education, exercises, homework assignments, and coaching. Patients are responsible for actively working with their therapist to examine and change their mental and behavioral reactions to panic attacks and phobias. CBT teaches people that they do not need to fear panic attacks, and it helps them gain confidence that they can deal with a panic attack if one occurs.

CBT for panic disorder usually takes less than six months to be effective. Patients should expect weekly therapy sessions, plus two to six hours of homework assignments between sessions. In clinical trials, 70% to 80% of patients are successfully treated.

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