Panic and Agoraphobia
For a panic attack, four or more of these symptoms occur abruptly and reach a peak within about 10 minutes:
Trembling or shaking
Shortness of breath
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded or faint
Feeling of unreality or depersonalization
Fear of losing control or going crazy
Fear of dying
Numbness or tingling
Chills or hot flushes
Agoraphobia is simply anxiety about places or situations where escape can be difficult or help unavailable in case of a panic attack. These places or situations are avoided or endured with anxiety. Common examples are being in a crowd or standing in line, being stuck in traffic or on a bridge or in an elevator, traveling far from home or from a hospital.
Up to one out of 28 people will suffer from a panic disorder at some point in their life, with or without agoraphobia.
Changing thoughts: People with panic tend to be hypervigilant about their body (e.g., they scan and detect any change in sensation or appearance). They interpret the physical symptoms of panic as a sign that something is terribly wrong and that they are in danger, or either dying, fainting, or going crazy and/or making a fool of themselves. In the case of a panic disorder, they anticipate future panic attacks and try to avoid them. Part of the treatment is providing and discussing information about panic (its causes and why it is not dangerous) and correcting faulty beliefs.
Changing behaviors: In panic, the physical sensations of panic are associated with fear. With a technique called “interoceptive exposure”, this association is broken, such that one is able to experience physical sensations of panic without fear. In parallel, “systematic desensitization” is used to decrease the anxiety associated with agoraphobic situations or places. The treatment is clearly explained beforehand in therapy and implemented in a gradual baby-steps manner. Panic is one of the disorders most studied and the cognitive behavioral approach, as briefly described, has been found to be highly effective.
Optional additional treatment strategies
Relaxation and Deep Breathing: Reducing one’s overall level of anxiety reduces the likelihood of a panic attack.
Mindfulness and Acceptance: Learning to be in the here and now, and to suspend judgment (i.e., instead of labeling experiences as “good” or “bad”, accepting them the way they are).
Medication: SSRIs (Selective Serotonin Reuptake Inhibitors) are used to treat panic, like Paxil, Celexa, Lexapro, Luvox, Prozac, Zoloft, as are SNRIs (Selective Serotonin Norepinephrine Reuptake Inhibitors) like Effexor. Other antidepressants may also be used. Finally, benzodiazepines (e.g., Xanax, Rivotril, Ativan, Valium) are fast-acting drugs that can be used on an as needed basis.
Selected Book References
10 simple solutions to panic.
Martin Anthony, Ph.D. & Randi McCabe, Ph.D. (2004).
New Harbinger Publications. ISBN 1-57224-325-2
The anxiety and phobia workbook, third edition.
Edmund Bourne, Ph.D. (2000).
New Harbinger Publications. ISBN 1-57224-223-X