During the past 25 years, over 600 people have come to my office with essentially the same story. Often, they remember a specific day when, seemingly out of nowhere, there was a sudden sense of terror, a feeling of impending doom. They were having a panic attack , with symptoms such as the following:
- palpitations, pounding heart, chest pain
- shortness of breath
- sweating, trembling, shaking
- dizziness, lightheadedness, a sense of unreality
Typically, these physical sensations are accompanied by a fear of having a heart attack, another physical crisis, or "going crazy." Terrified, my future patients often go to an emergency room where medical problems are ruled out. Many seek out the opinion of a range of medical specialists. Often, they begin to dread the recurrence of these sensations and start feeling anxious much of the time. Panic attacks often begin to occur in particular situations. These typically are places where the person feels trapped, e.g., highways, elevators, sit-down restaurants, malls, and is at a distance from safety . Avoidance of these situations is a common complication of panic disorder called agoraphobia .
The good news is that as I began seeing more and more people with this problem, it was clear that most got much better. Panic disorder, a condition that effects some four percent of the population during their lifetimes (about 146,000 people in metro Atlanta), is among the most treatable of all emotional disorders.
What form of treatment is most likely to be helpful?
Scientific research has shown Cognitive Behavioral Therapy (CBT) to be the most effective therapy for panic. It is the only so-called "empirically validated" form of therapy. It consists of the following:
- meeting with an understanding person whom you can trust to tell your most upsetting feelings
- an intensive, structured learning program during which you learn about panic attacks, i.e., about your body's emergency (fight or flight) response
- cognitive therapy that helps you identify and change the automatic thoughts about the attacks which have perpetuated the cycle of panic, e.g., that you are having a heart attack
- behavior therapy that involves gradual exposure, or desensitization, to body sensations comprising panic, followed by exposure to the environmental situations that trigger it
- coaching and practice in the skills that physically calm the body, such as muscular relaxation and diaphragmatic breathing, are supplemental
Medication often is used in conjunction with CBT. It can be prescribed either by your own physician or by a psychiatrist in our office.
There is no exact formula for overcoming panic. These guidelines are sensitively adapted to the individual. Often, panic disorder is accompanied by other conditions which must be addressed. For example, it is common for varying degrees of depression to occur as a consequence of panic.
Is in the home or telephone therapy possible?
For individuals who are unable to travel as far as my office, initial treatment can sometimes occur only with a home visit or by phone. Subsequent therapy over the phone is not uncommon in my practice. I sometimes use a structured workbook and audio materials as well.