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Agoraphobia Symptoms and Treatments: Must know Information




Agoraphobia Symptoms and Treatment Overview:

The symptoms of agoraphobia may be the most prevalent of all of the anxiety disorders with as many as 5% of the general population or one in 20 people experiencing varying degrees of agoraphobic symptoms. In the United States, the only mental health disorder that experiences a higher level of prevalence may be alcoholism. Therefore, an understanding of agoraphobia symptoms, diagnosis and treatment is imperative to a well rounded understanding of panic and mental health disorders.

Agoraphobia symptoms:

From a practical perspective, agoraphobia is experienced as a fear of having panic attacks although the term actually refers to a fear of open spaces. An individual experiencing agoraphobia usually has an intense fear of having a panic attack and being in a circumstance in which escape is impossible. An individual may avoid such things as driving on highways for fear of having a panic attack, and being unable to escape the circumstances. Most people experiencing agoraphobia symptoms fear not only the panic attack , but being observed by others while having panic symptoms. Some of the more common circumstances avoided by agoraphobics are:

• Being trapped home alone.
• Being in areas where they feel enclosed such as while getting an MRI, tunnels etc.
• Being on public transportation and unable to leave if necessary such as on a bus or train.
• Being in places such as grocery stores or restaurants and other crowded places.

Agoraphobics frequently feel comforted when a “safe person” is present, which seems to help alleviate the agoraphobia symptoms. One of the more common features of this panic related disorder is a fear of being away from home and/or away from this “safe person”. A “safe person” may be a spouse, parent or anyone whom you have a significant relationship with who provides some comfort in these anxiety provoking situations. You may have an intense fear of driving or walking alone or experiencing any other circumstance without this “safe person”.




Most people who are agoraphobic have a relatively high level of anxiety most of the time. Much of this anxiety seems to be anticipatory, fearing future circumstances and situations which may provoke a panic attack, such as a fear of being left alone at home in the future. The severe restrictions on your life related to future panic attacks may also result in depression. Some people experience depression when they are in adverse circumstances that they have no control over which seem unescapable.

Agoraphobia Symptoms and Panic Disorder:

Agoraphobia develops as a result of having panic attacks or panic disorder. At the very beginning you may have panic attacks that occur for no reason, eventually resulting in a panic disorder. Later you begin to recognize that these panic attacks are occurring in specific situations and you begin to avoid those circumstances for fear of having continued panic attacks. These panic symptoms may be mild at the beginning resulting in uncomfortable feelings but not necessarily avoiding these specific circumstances. When experienced at a more moderate level the panic symptoms begin to result in avoidance of these panic inducing circumstances such as avoiding public transportation or shopping on your own. In these moderate anxiety circumstances, you may avoid some panic inducing situations but still continue on without serious restrictions on other aspects of your life. The restriction is usually only partial. When experiencing severe agoraphobic symptoms, you may experience restrictions which seem to affect every aspect of your life, resulting in being unable to leave home unaccompanied.

It is not really known why some people develop agoraphobia from their panic attacks and why others do not, or why agoraphobia is more severe for some rather than others. Some clinicians and researchers believe that the development of agoraphobia may have some environmental and hereditary components. It has been observed to run in families and twin studies have found that identical twins have a higher risk for both to develop agoraphobia. When looking at environmental factors, there may be some childhood experiences that predispose a child to agoraphobia. Some of these experiences may include growing up with parents who (1) are overprotective and/or (2) are overly anxious and communicate that the world is a “dangerous place” and/or (3) overly critical and perfectionistic.

People experience agoraphobia symptoms from all walks of life and all socioeconomic levels, At the present time, approximately 80% of agoraphobics are women. It is unclear what environmental issues factor into the gender difference, although it has been noticed recently that the level of agoraphobic women relative to men with the disorder seems to be leveling off somewhat. That would probably indicate more of a environmental than a genetic influence.

Agoraphobia Symptoms and Treatment:

There are various treatments available to help alleviate the symptoms of agoraphobia. Since agoraphobia is basically a disorder developed in relation to panic disorder and panic attacks, the same treatments are utilized for both including psychosocial treatments and the management of panic attack symptoms utilizing anxiety medications and antidepressant medications. An overall analysis of the medication management of panic disorder and panic attacks as well as an overview of the psychosocial treatments of panic disorder follow on separate pages.

Some of the main psychosocial treatments include relaxation training, panic control therapy and interoceptive desensitization. Once again, the same treatments that are utilized for panic disorder and panic attacks are also used for patients with agoraphobia. Also, additional assistance or treatment for agoraphobia symptoms may also include assertiveness training since agoraphobics frequently have difficulty standing up for themselves. Finally, as mentioned previously, some of the main treatments for agoraphobia include medication, graded exposure, cognitive therapy and group therapy.

Agoraphobia Treatments with Medication:

Some of the main treatments for agoraphobia as well as panic attacks and panic disorder include treatment with medication such as selective serotonin reuptake inhibitors (SSRI’s) such as, Zoloft and Paxil and tranquilizers such as Xanax, Ativan or Klonopin. The SSRI’s are more likely to be used in very severe cases where a person is homebound and otherwise very restricted in their activities of daily living. Low doses of tranquilizers such as Xanax may also be used to assist people who are going through the early stages of exposure treatment as well as being used by many doctors as a mainline treatment for anxiety and panic.

Graded exposure treatment for Agoraphobia:

When the treatment or intervention is referred to as “exposure” therapy it usually means that the person is exposed to the stimuli that seems to provoke the anxiety or panic reaction. Situations or circumstances that have been feared and/or avoided are exposed to the individual in incremental steps to gradually increase the amount of time and exposure without having a full-blown panic attack. A good example of graded exposure may be if a person has a severe fear of driving long distances or on the highway. They may initially drive short distances or at slower speeds and build up to greater distances or greater speeds. Sometimes a support person is used to accompany the agoraphobic. Finally, they may then eventually be able to drive alone. If a person is fearful of staying home alone, they may be at home by themselves for short periods of time building up to longer times alone.

Cognitive Treatment to Alleviate Agoraphobia Symptoms:

The goal of cognitive therapy is to help the individual recognize and eliminate exaggerated, fearful thinking which result in phobias and panic attacks in a more realistic way. You will then learn to identify, challenge and ultimately replace counterproductive thoughts with ones that are more helpful and realistic to the stimuli or environment.

Group therapy:

Agoraphobia symptoms can be effectively treated in a group setting with other individuals experiencing similar symptoms and disorders. Group therapy provides an opportunity for an individual to share their experiences with others and recognize that they are not alone and that there are many others who experience agoraphobic related panic attacks.

Agoraphobia Symptoms and Treatment: Some Final Words

Agoraphobia symptoms are successfully treated through the use of several psychosocial interventions and medications to alleviate the symptoms. Additional information is also available on this website related to panic disorder, psychosocial interventions and medication management. Do not allow yourself to continue to suffer agoraphobia symptoms when treatment is so readily available.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from The Anxiety and Phobia Workbook by Edmund J. Bourne Ph.D.



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Panic Disorder Treatment: The Best Long-term Solution




Panic Disorder Treatment: An Overview

The treatment of panic disorder is usually approached very differently from the way it probably should be in that the first line of treatment is almost always to “throw a medication at it”. When given the fact that the medications usually used for panic disorder treatment have serious side effects, a more reasonable approach would probably be to consider possible psychological interventions prior to using medications that have serious side effects. These medications may be necessary in place of psychological interventions or in addition to, but they should not always be the first line of defense in the treatment of panic disorder. In fact, efficacy studies related to the treatment of panic disorder with cognitive behavioral therapy, have found that it performs as well as pharmacological interventions in the short-term and may possibly be more durable in the long-term.

Panic Disorder Treatment: The Psychological Approach

The core feature in the treatment of panic disorder from a psychological treatment perspective, is that panic disorder is frequently caused by and maintained by heightened fears associated with anxiety symptoms. The main psychological treatment modality in current practice by psychologists and other mental health practitioners is cognitive behavioral therapy (CBT) which seeks to reduce those fears. The belief which has also been confirmed by research is that it is this “fear of fear” that is the main culprit and the focus of intervention. This fear can be reduced, resulting in the clinical improvement of panic disorder. Cognitive behavioral therapists utilize various cognitive techniques including psychoeducation about panic along with cognitive restructuring, as well as behavioral methods such as interoceptive exposure to assist in the reduction of the symptoms of panic disorder.




Psychoeducation for Panic Disorder:

Psychotherapists using the cognitive behavioral method, usually first begin by providing patients with information about panic disorder. Information and education about panic and how it is maintained is seen as the most basic aspect of this program, allowing the patient and therapist to collaborate on future treatment and intervention. It has been found that there is an enormous amount of misinformation about panic symptoms as well as how they will affect the individual patient. Many patients present to emergency rooms mistaking intercoastal muscle tension in the chest as an indication that they are having a heart attack. Cardiac arrest is much more than pain in the chest. It most often involves a crushing pain in the chest usually accompanied by pain shooting downward through the arm. Also, many patients mistake hyperventilation-related dizzy feelings for fainting, without realizing that ultimately dizziness may be the result of blood pressure and the heart rate suddenly dropping. In actuality, an elevated heart rate during panic will actually protect against fainting in spite of dizziness.

There are certain physiological reactions that protect us from various threats including what has been referred to as the “fight or flight” reaction to stress or danger. The “fight or flight” syndrome is actually believed to help protect us against danger but is not in itself threatening or dangerous. It is a heightened level of physiological arousal that allows us to respond to threatening or dangerous circumstances, but does not specifically pose a threat to our well-being.

Some patients also fear that the physiological symptoms of panic disorder will lead them to more serious mental health concerns. These additional mental health worries also exacerbate the underlying mistaken beliefs that bodily sensations and a fearful response to dizziness and heart palpitations for example, will lead to a full-blown panic attack or result in some other type of mental illness.

Panic Disorder Treatment and Basic Beliefs:

Cognitive behavioral therapy focuses on catastrophic beliefs and misconceptions about our bodily sensations and the prevention of testing these misconceptions and refuting these beliefs. In order to assist with alleviating these catastrophizing beliefs, the therapist may ask the patient what has kept them from experiencing the actual catastrophe that they had envisioned. In most circumstances, patients will indicate that they have taken various safety measures to short-circuit the catastrophe from actually occurring. For example, a patient may state that they are afraid that the panic disorder related dizziness will result in them becoming weak and falling down. The therapist may then ask what has kept them from falling down in the past? The patient will usually state that they were able to sit down prior to falling down. They were able to rely upon these safety measures to keep the catastrophe from actually occurring. So, in effect, specific catastrophic thinking can be addressed along with safety measures that maintain the related fears that seem to drive the panic process.

Panic Disorder Treatment: Using Cognitive Restructuring

Another important aspect of panic disorder treatment using the cognitive behavioral approach involves using the cognitive restructuring of catastrophic beliefs. An important part of cognitive restructuring of these beliefs is that behavioral experiments are also used along with psychoeducation to alleviate the panic symptoms. The behavioral experiments are used to provide direct, experimental evidence that catastrophic consequences are not the inevitable result of catastrophic thoughts and the experience of heightened physiological sensations. A behavioral experiment may involve something as simple as when an individual believes that they will faint when dizzy and immediately sits down to avoid falling down. The behavioral experiment might involve having the patient hyperventilate while sitting down and experiencing the related sensations of dizziness and lightheadedness. The patient’s catastrophic thinking might involve the thought that they will faint if they stand up. The therapist may then encourage the alternative prediction that only a slight sense of unsteadiness will actually occur. Having the patient experience the physical sensations without having them engage in the customary safety behavior is one of the most powerful ways to help an individual change the catastrophic thinking that maintains the panic disorder. The goal of the therapist is to have the patient experience behavioral experiments that allow them to refute the beliefs associated with the usual bodily symptoms. Cognitive restructuring is actually a combination of psychoeducation and the creation of behavioral experiments that allow the individual to refute the catastrophic beliefs.

Panic Disorder Treatment: Exposure

Panic disorder is experienced pretty much in the same way that individuals experience phobias. After an individual experiences a high level of anxiety in relation to a certain stimuli they may then attempt to avoid similar experiences. Prolonged exposure to stimuli that is feared causing an extinction of the fear is an important feature of the behavioral treatments associated with anxiety and panic disorders. In individuals with panic disorder, the principle of exposure requires people to expose themselves to the stimuli that they fear and feel the related bodily sensations until they no longer hold the same capacity to provoke fear and discomfort.

Deep Breathing and Additional Treatments for panic disorder:

Some additional panic disorder treatments include applied muscle relaxation and breathing retraining, which is oriented toward counteracting hyperventilation. However, some therapists now wonder if these techniques are such a good idea. These methods were originally designed to help reduce the intensity of the bodily sensations which by implication were bad, which is contrary to the psychoeducational component in which these sensations are essentially taught to be considered harmless. However, teaching the concept that anxiety management techniques are a means of helping an individual to feel some sense of control over their bodies may indeed have some value.

Panic Disorder Treatment and Agoraphobia:

An intense fear of certain circumstances and objects can cause patients to avoid those experiences. This residual agoraphobia can continue even after panic has been successfully treated using cognitive behavioral techniques. Psychologists and mental health clinicians will frequently develop in vivo (real-life) exposure situations where individuals will purposefully enter into feared experiences and circumstances without avoiding the stimuli until the intense discomfort is reduced or goes away.

Some final words on panic disorder treatment:

There have been many studies over time that have identified the efficacy of psychological approaches to the management of panic disorder. Cognitive behavioral therapy delivered on an individual basis or in a group setting has been found to significantly reduce symptoms of panic. Some studies have found as many as 74 4% of cognitive behavioral therapy treated patients are panic free posttreatment. Similar outcomes have also occurred in community mental health settings. Also, cognitive behavioral therapy has significantly outperformed other interventions including the use of some medications such as imipramine, applied relaxation and emotion focused therapy. Finally, panic disorder treatment using psychological methods including cognitive behavioral therapy with or without medication have frequently been found to be the best long-term solution to the treatment of panic disorder.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from Practitioner’s Guide to Evidenced-Based Psychotherapy by Jane E. Fisher and William T. O’Donohue




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Panic Disorder Medications: Side Effects, Pros and Cons






Panic Disorder Medications: An Overview

Researchers and clinicians have found that the most effective panic disorder medications include the tricyclic antidepressants (see depression medications: tricyclic), monoamine oxidase inhibitors (see depression medications: MAOI’s), benzodiazepines (see anxiety medications), and the selective serotonin reuptake inhibitors (see depression medications: SSRI’s). These medications all have similar effects on panic disorder, although some doctors conclude that the SSRI’s tend to be a little more effective over the long-term. These medications do differ in relation to their side effects and also their contraindications, which are other medications and food that they may interact poorly with. Some have anticholinergic effects which include such side effects as dry mouth and blurred vision, which seem to be more common with the tricyclic antidepressants. These medications are also contraindicated for people with comorbid cardiac disorders. There are also significant dietary restrictions when using the MAOI’s in which you may be asked to abstain from any foods containing tyramine. The benzodiazepines may cause sedation and impairment in motor coordination as well as have some addictive qualities and a tendency to develop a tolerance to the medications. Obviously, panic disorder medications include several choices but also include a variety of side effects and negative interactions with other medications and foods and require careful consideration by both patients and doctors.





Panic Disorder Medications: Are the SSRI’s really the best choice?

Many doctors have concluded that when looking at both the efficacy and side effects, selective serotonin reuptake inhibitors (SSRI’s) may be the most promising choice for panic attacks and panic disorder. But like all medications, SSRI’s have side effects also that may make them unappealing, such as you may feel a short-term increase in arousal-related sensations. To assist with this however, SSRI’s may be started at a very low dosage (for e.g. 12.5 mg/d for sertraline; 5-10 mg./d for paroxetine) and then gradually increased (up to 25-200 mg/d for sertraline and up to 10-50 mg/d for paroxetine). The choice of a specific SSRI is based upon a variety of factors including personal preference and an individual’s history of response or nonresponse, and the related side effect profile.

What other medications are used in the treatment of panic disorder?

For some individuals who do not respond to SSRI’s or for any other reason, a combination of medications may be used for the treatment of panic disorder. One example may be when SSRI’s are combined with benzodiazepines. The benzodiazepines in this situation may be used to lessen the side effects of the SSRI’s. Despite some preliminary positive effects, this strategy has not been used often and may need to be more properly evaluated. Another alternative strategy may be to simply change the individual’s medication. The newer non-SSRI antidepressants may be considered such as gabapentin, bupropion, nefazodone or venlafaxine. The problem with using some of these newer medications is that there’s not as much clinical experience and research data to back up the use of the strategy. Some clinicians use benzodiazepines for panic disorder and panic attacks.

Panic Disorder and Use of Benzodiazepines:

Some of the primary drugs that have historically been marketed to treat anxiety and panic disorders have been the benzodiazepines. The name benzodiazepine is derived from its chemical structure. This medication changes the way the body handles chemical messengers in the brain. It connects to receptors in the brain that monitor your awareness level, coordination, memory, muscle tone and suppresses the electrochemical transmission of nerve impulses in the brain. The benzodiazepines are very serious medications that are capable of producing anything from mild to very serious sedation of the central nervous system. Sometimes they are referred to as “sedative hypnotics” in that they cause sedation and sometimes may cause the user to feel like even while they are awake, that their routine communication almost has the feel of being somewhat of a “hypnotic command.”

Another problem with benzodiazepines is that psychological and physical dependence can become a real concern for the future, as there is risk of dependence even after a relatively short period of use at their most common dosage levels. That is why these medications are considered to be controlled substances and are dispensed only in limited amounts, ideally for a short duration of time. Stopping these medications suddenly can cause serious withdrawal symptoms due to the feeling of dependency. Tolerance to these medications also is known to occur requiring increased amounts to get the same therapeutic benefit.

Panic Disorder Medications: A Summary

As should be fairly obvious, the use of a specific medication for the treatment of panic attacks and panic disorders, requires significant clinical judgment by a physician well aware of the benefits and side effects of each specific medication. At the present time, antidepressants (especially the SSRI’s) seem to be eclipsing somewhat the use of benzodiazepines for the long-term treatment of panic disorder and generalized anxiety disorder. Another approach to treatment of the drug refractory individual is to use a psychosocial treatment such as cognitive behavioral therapy as an adjunctive or alternative treatment to panic disorder medications.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from DSM/IV/TR Mental Disorders: Diagnosis, Etiology and Treatment by Michael B. First and Allen Tasman and the No-Nonsense Guide to Psychiatric Drugs by Moira Dolan



Having a Panic Disorder? Symptoms, Diagnosis and Treatment




Panic Disorder Overview:

Panic disorders are usually identified by extreme feelings of apprehension or intense fear that may appear suddenly or “out of the blue”. They may or may not have an apparent cause. In most cases, intense panic usually lasts no more than a few minutes but in rarer circumstances it can continue for up to about two hours. If you’re having a panic attack and ultimately have developed a panic disorder you should notice some of the following symptoms:

A fear of dying
Fears of going crazy or losing control
Shortness of breath or a feeling of being smothered
Heart palpitations, pounding heart or accelerated heart rate
Chest discomfort or pain
Dizziness, faintness or unsteadiness
Hot and cold flashes
Shaking and trembling
Numbness or tingling in feet and/or hands
Sweating
Feeling of choking
Abdominal distress or nausea
Feeling of unreality is if you’re not all there

In a full-blown panic attack, at least four of the symptoms will be present. In a limited-symptom attack you may experience possibly two or three of the symptoms.

Panic Attack or Panic Disorder:

If you experience (1) two or more panic attacks and had of at least (2) one of these attacks followed by a month of concern about continuing panic attacks or their consequences, you may be experiencing a panic disorder. In most cases, panic disorder by itself does not usually involve the development of a phobia. The panic itself is usually spontaneous rather than when you’re approaching, thinking about or entering a phobic situation. In many cases, its spontaneity and unexpected nature makes it difficult to recognize any apparent cause. Also, panic attacks are not the result of physiological precipitating factors such as a drug use or withdrawal or a medical condition.




You can possibly have several panic attacks within a month or two and never have another one for years, or may never have a recurrent attack. Or you could have several attacks, followed by a period of time with no attacks, only to have the panic return several months later. Panic attacks can have many different symptom patterns. You could have several within a week or many within the same month. In all of these cases, there is a tendency to develop anticipatory anxiety which is a deep feeling of apprehension and fear about having further attacks. It is usually after several attacks that individuals seek treatment.

Diagnosing Panic Disorder:

People having panic attacks frequently go to the emergency room or otherwise seek a medical or physiological answer to why they are feeling heart palpitations and excessive anxiety. They are often very frightened by the symptoms which often lead to an EKG or other cardiac tests which in most cases turn out to be normal. Occasionally, they may find a mitral valve prolapse (a benign arrhythmia of the heart) which may coexist with the panic attack. However, doctors have become much better at distinguishing between purely physical complaints, anxiety attacks and panic disorders.

A diagnosis of a panic disorder is only made after ruling out all possible medical considerations including hyperthyroidism, reactions to excess caffeine, hypoglycemia or withdrawal from alcohol, tranquilizers or sedatives. The root cause of panic disorder is most often some combination of heredity, personal stress and chemical changes within the body and brain.

The specific criteria for panic disorder can be found on another page of this website but in summary it requires recurrent and unexpected panic attacks of the previously mentioned symptoms. At least one of the attacks must be followed by a month or more of persistent concern, maladaptive change in behavior, and the disturbance cannot be attributable to the physiological effects of a substance or any other medical condition. Also, the disturbance cannot be better explained by any other mental disorder.

Development of panic disorder:

People most often first develop panic disorder in their late teens and early twenties. In some cases, the panic disorder can become complicated by developing into agoraphobia. It is estimated that between 1% and 2% of the population have a pure form of panic disorder while approximately 5% experience panic disorder with agoraphobia.

Panic Disorder Treatment:

Effective treatment for panic disorder usually requires both physiological and/or psychological intervention. Physiological treatments usually involve medications specifically for anxiety referred to as anxiolytics or anti-anxiety drugs, and/or antidepressants to reduce the symptoms of panic attacks. Psychological interventions frequently include lifestyle and personality changes, psychotherapy, and relaxation training.

Some of medications used to treat panic disorder include the benzodiazepine medication such as Xanax, Ativan, Valium or Klonopin. Also, antidepressants may be used such as Paxil, Serzone, Zoloft, or Celexa. These medications are most effectively used in conjunction with psychological interventions however.

A common sense understanding of the psychological dynamics associated with an individual’s experience of anxiety and panic disorders is imperative. Frequently, there are precipitating events or experiences that seem to maintain or exacerbate underlying symptoms of anxiety. Only by recognizing, problem solving and focusing on these precipitating and exacerbating experiences, may you truly have a reduction in your anxiety symptoms. There are various lifestyle and personality changes that can be used to focus on and reduce the symptoms of panic disorder including stress management, eliminating stimulants and sugar from your diet, regular exercise, slowing down your life and creating some “downtime” and even focusing on personality characteristics such as expecting too much of yourself, having excessive need to please others or even an excessive need for control of your life or others.

Relaxation training can be helpful also. Practicing breathing from your abdomen and some type of progressive muscle relaxation on a daily basis has been found to be helpful by many people. This may be helpful in reducing the physical symptoms of panic as well as helping to bring an element of control into your life, and possibly reducing the feeling of anticipatory anxiety that you may have before having a panic attack. Physical exercise is also recommended to assist in reducing underlying symptoms of anxiety.

Psychological interventions also include a form of panic control therapy which focuses on eliminating catastrophic thoughts such as “I’m going to have a heart attack”. Cognitive behavioral therapy is frequently used effectively in assisting people to understand the connections between their thinking and moods as well as physiological reactions. Many times, these catastrophic thoughts are believed to trigger panic attacks.

Another psychological intervention is referred to as interoceptive desensitization. This type of desensitization involves voluntarily habituating to the bodily symptoms of panic such as sweaty hands, shortness of breath, dizziness and rapid heartbeat. Often the symptoms are created deliberately in a therapist’s office through such activities as spinning in a chair to create dizziness, or rapid heartbeat by running up and down stairs. Repeatedly being exposed to unpleasant bodily symptoms promotes desensitization which means adjusting to and learning to cope better with the actual symptoms associated with panic attacks and panic disorder.

Summary of Panic Disorder:

Panic attacks and panic disorder can become very uncomfortable and even disabling. If not treated they can become even worse resulting in such comorbid conditions as panic disorder with agoraphobia. Thankfully, psychological and physiological treatments are available to effectively assist with panic disorder.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from The Anxiety and Phobia Workbook Third Edition by Edmund J. Bourne Ph.D.



Panic Disorder 101: What do I really need to know?







Panic Disorder Overview:

Some of the main characteristics of panic disorder are short-term, sudden, intense feelings of fear, terror or sense of losing control and begin without warning during activities that are believed to be nonthreatening. Many individuals experiencing panic disorder go to the emergency room because of the intensity of their physical symptoms which may include a rapid heartbeat, breathing difficulty and sometimes a choking sensation giving the appearance of a possible heart attack. Many patients believe that they are having a heart attack and need to consult a doctor immediately.

Panic attacks usually peak within approximately 10 minutes and they seem to go away over a 20 to 30 minute period of time. Panic attacks are usually characterized by a combination of at least several of the following symptoms:

• hyperventilation or shortness of breath
• discomfort in the chest
• dizziness or feeling faint
• trembling or shaking
• Heart palpitations
• stomach pain, nausea or choking
• cold or hot flashes
• tingling or numbness
• a sense of feeling detached from one’s surroundings
• a fear of dying or losing your mind.

Many individuals with panic disorder also experience other symptoms of anxiety as well as depression. While some patients will have some relief from antidepressant medications from their symptoms of depression and panic attacks, others may need totally different medications for a panic disorder than would usually be given for depression and anxiety.

Prevalence of panic disorder:

Estimates of the prevalence of panic disorder are usually between 1% and 2% among both men and women. The first attacks frequently begin in the late teens or early 20’s and will frequently go for a significant period of time misdiagnosed, undiagnosed and often untreated. Some studies have found that as few as one in four people with a potential diagnosis of panic attacks or panic disorder receive appropriate care.

Panic attacks and Agoraphobia:

Agoraphobia can be one of the most common complications associated with panic disorder. The symptoms of agoraphobia include fear of being in public places alone, and future attempts to avoid situations that are triggered by panic attacks in the past. If untreated, Agoraphobia and panic attacks can tremendously restrict an individual’s activities and lifestyle, since they will tend to avoid situations that may result in another panic attack. Another negative byproduct of panic disorder is that it may frequently increase the risk for depression, alcohol and drug dependency and even possibly suicide.

Treatment for Panic Disorder:

Treatment for panic disorder frequently involves a combination of psychotherapy and psychiatric medications. Successful treatment may necessitate being referred to a therapist that specializes in treatment of panic disorder or anxiety disorders. Many studies have found support for the effectiveness of cognitive and behavioral therapy that involves incremental exposure to situations that provoke symptoms of anxiety or panic.

Tricyclic antidepressants and MAO inhibitors seem to currently be the mainstream psychopharmacological intervention for panic disorder. These medications have been identified to be approximately 80% to 90% effective in blocking panic attacks. However, they’ve also been found to frequently take between 6 to 12 weeks to be effective. Alprazolam (Xanax), a benzodiazepine, has been found to be effective within several days and cause fewer side effects than the antidepressants. Unfortunately, Xanax can be very addictive as with all the other benzodiazepines. Also unfortunately, a relapse of panic symptoms can occur in anywhere from 30% to 60% of patients within 6 to 12 months after medications have been discontinued. Additionally, the SSRI’s such as Zoloft and Paxil have been approved by the FDA for the treatment of symptoms of panic disorder. Beta blockers can also reduce the physical symptoms of panic attacks but do not eliminate the fear or the actual panic itself.

By Paul Susic Ph.D. Licensed Psychologist