Course of treatment and cognitive behavioral psychotherapy for panic attacks, phobias, anxiety disorders, anxiety

In the conditions of modern Russian reality, no more than 5% of patients receive qualified help for panic attacks . This is due to the low level of development of psychiatry, which deals with anxiety disorders. In a city clinic or in a mental hospital, a neurologist (or psychiatrist) diagnoses a person who complains of symptoms of a panic attack as “vegetative vascular dystonia” and prescribes tranquilizers: phenazepam, sibazon, relium, etc. These drugs only provide a narcotic dulling of the feeling of fear, but do not in any way affect the causes of its occurrence. Moreover, tranquilizers cause drug addiction (similar in strength to alcohol addiction) - an unpleasant addition to existing problems. And thus, panic disorder, which can be easily cured in several sessions of psychotherapy, becomes a chronic disabling disease for most patients.

What distinguishes normal fears from panic attacks?

Stress-based fear is a common situation that occurs when we are faced with something unknown or something that makes us feel uncomfortable. It is part of our nervous system response to a real or potential threat, and it prepares us for the need to “fight or flight.” Panic is an acute wave of fear, which is characterized by surprise and exhaustion, acute immobilization. Panic attacks often strike suddenly “out of nowhere”, without any warning. There may be no clear reason for the attacks. They even happen when you are relaxed or asleep.

A panic attack sometimes occurs as a one-time occurrence, but many people experience recurring episodes. Recurrent panic attacks are often triggered by specific situations, such as crossing a bridge or speaking in public—especially if that situation has previously triggered a panic attack. Typically, a situation that causes panic is characterized by you feeling in danger and unable to get out of it.

You may experience one or more panic attacks but otherwise be happy and healthy. In other cases, panic attacks are part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are coping strategies you can use to manage your symptoms. There are also effective treatments.

Paulina's story

Paulina experienced her first panic attack six months ago. She was sitting at work, preparing for an important work presentation, when - suddenly - she felt a sharp wave of fear. Then the room started spinning and she felt like she was going to throw up. She was shaking all over, she couldn’t catch her breath, and her heart was pounding. She held onto the table until the episode passed, but was left deeply shaken by the incident.

Paulina had her next panic attack three weeks later, and from that point on she had them more and more often. She never knew when or where she would suffer because of these attacks, but she was always afraid that it would happen in public. Therefore, she stayed home after work and did not go out to spend time with friends. She also refused to use the elevator to go up to the 12th floor where she worked, out of fear that she would be trapped if she had another panic attack.

Recognize the problem

For the first time “this” happened to my friend Zhenya during an ordinary trip on the subway and it was completely incomprehensible, embarrassing and frightening. When the train got stuck in the tunnel, Zhenya suddenly felt that she was going to die or at least faint in front of her insensitive and unpleasantly surprised fellow passengers.

My heart was pounding unbearably, and like a fish on the shore, there was not enough air. But the soul did not go into the heels, but somewhere up, under the right shoulder. A few minutes later the train started moving and “it” suddenly stopped. It must be said that attempts to share the problem with older relatives did not evoke much sympathy.

Mom asked if Zhenya was pregnant, and father reproachfully remarked that hysterics on public transport are unacceptable. Therefore, when “this” happened again, Zhenya made an appointment with a therapist. After a brief examination, the doctor found her absolutely healthy and advised her to get outside more often.

The advice hit the nail on the head, since Evgenia was already trying to avoid traveling on the subway by any means necessary. The trouble is that panic disorder is excellently disguised as diseases that have little to do with psychology.

Judge for yourself, what can doctors say if, for example, you complain of a sharp increase in heart rate? Or sweating and lack of air? What if it’s nausea and trembling? Most likely, they will offer to do a cardiogram or see an endocrinologist.

At best, a neurologist, who is also unlikely to be able to help. Simply because magic pills have not yet been invented for deep and very personal discomfort in our inner world.

Signs and symptoms of a panic attack

A panic attack often starts when you leave the house, but it can happen in any other place and at any other time. It can happen while you're at the grocery store, walking down the street, driving a car, or sitting on the couch at home.

Signs and symptoms of a panic attack occur suddenly and usually peak within 10 minutes. Most panic attacks are over within 20-30 minutes, and they rarely last more than an hour. A full-blown panic attack includes a combination of the following signs and symptoms:

Shortness of breath and hyperventilation
Cardiopalmus
Chest pain; chest discomfort
Trembling in the body
Feeling like you're suffocating
Feeling of unrealism of what is happening and isolation from the environment
Sweating
Nausea or upset stomach
Dizziness, emptiness in the head, fainting
Numbness or tingling sensations
Sudden feeling of being very hot or very cold
Fear of dying, losing control or going crazy

Is it a heart attack or a panic attack?

Most symptoms of a panic attack are physical. And often these symptoms are so severe that people think they are having a heart attack. In fact, many people who suffer from panic attacks often visit the doctor or call an ambulance in an attempt to get treatment for what they consider to be a life-threatening medical problem. While it is important to rule out medical causes for symptoms such as chest pain, rapid heartbeat, and difficulty breathing, panic itself is often not considered as a potential cause.

Signs and symptoms of panic disorder

Many people experience panic attacks without subsequent episodes or complications. There is little cause for concern if you have had one or two panic attacks. However, some people who experience panic attacks develop panic disorder. Panic disorder is characterized by recurrent panic attacks combined with severe changes in behavior or persistent anxiety about subsequent attacks.

Recognizing Panic Disorder

You may be suffering from panic disorder if:

Frequently and unexpectedly you experience panic attacks that are not related to a specific situation
Worry a lot about a possible panic attack
You behave differently because of panic attacks: you avoid places where you have had panic attacks before.

Although a single panic attack may last only a few minutes, the effects of the experience are imprinted in the memory. If you have panic disorder, repeated panic attacks take their emotional toll. The memory of the intense fear and terror you felt during the attack negatively affects your self-confidence and causes serious disruption in your daily life. Ultimately, this leads to subsequent symptoms of panic disorder.

Anticipation anxiety . Instead of feeling relaxed and happy between attacks, you feel anxious and tense. This anxiety comes from the fear of a future panic attack. This “fear of fear” is present almost all the time and is extremely disruptive.
Phobic avoidance . You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you are avoiding caused a previous panic attack. Or you avoid places where escape would be difficult or where help would be unavailable if you had a panic attack. In its most extreme expression, phobic avoidance becomes agoraphobia.

Deal with fear the right way

Since panic attacks can seriously ruin life, their victims begin to avoid provoking situations at all costs. It seems like a very sound solution, but let's see how feasible it is and where it leads.

Zhenya, whom I have already mentioned, has set a goal to do without traveling on the subway, which is quite problematic in a metropolis. If an attack is provoked by crowded places, cinemas, concert halls, large stores, and airports are automatically blacklisted. As a result, the life of alarmists gradually becomes confined within the walls of a safe house - the way out disappears in the literal sense of the word.

Panic disorder with agoraphobia

Agoraphobia is traditionally understood as a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks. With agoraphobia, you fear that you will have a panic attack in a situation that will be difficult to “get out of.” You're also likely afraid that you'll have a panic attack where you can't get help.

Because of these fears, you begin to avoid more and more situations. For example, you might start avoiding crowded places like shopping malls or sporting events. You may also have avoided cars, planes, subways, and other forms of transportation. In more severe cases, you only feel safe at home.

Although agoraphobia can develop at any time, it usually appears within a year of the first recurrent panic attack.

Situations or activities you may avoid if you have agoraphobia

Being away from home, driving, or being somewhere where you are not accompanied by a person “responsible for safety.”
Physical activity - because of the belief that it can trigger a panic attack.
Visiting places where “getting out” is not so easy: restaurants, theaters, shops and public transport.
Eating or drinking anything that is thought to trigger panic: alcohol, caffeine, or certain foods or medications.

Source: American Academy of Family Physicians

Panic attacks

Anti-panic therapy

Having found no sympathy in the family or at the clinic, Zhenya turned to the all-knowing Internet. Having typed “fear of riding the subway” into a search engine, she, to her amazement, found out that her “it” was nothing more than a psychological problem that thousands of people face every day.

At first, the need to see a psychologist caused our heroine to protest. Firstly, I wanted to quickly get rid of the symptoms, and not delve into the events of distant childhood. Secondly, there were fears that the specialist would certainly prescribe some terrible pills.

Thirdly, Evgenia, being a strong-willed person, is used to dealing with her weaknesses on her own. And at the same time, she understood that this was no longer about weaknesses. And I’m pretty tired of getting to work on transfer roads.

To Zhenya’s great relief, no one prescribed her any pills or forced her to recall childhood conflicts. From the very beginning, the work went directly with the symptoms of panic, or more precisely, with thoughts on the topic of symptoms. “Imagine this sequence,” the psychologist explained to Evgenia, “you experience physical discomfort in a stuffy carriage.

It’s pulsating in your temples, you want to take a breath of fresh air, and then the train stopped as if on purpose. Anxiety arises: something is wrong with me. What if I'm sick? What if it gets worse now? You begin to listen to your bodily sensations with triple attention, which naturally strengthens them. Eventually you become convinced that something terrible is coming. This is the spiral in which a panic attack unfolds.”

The way out of the vicious circle turned out to be logical and understandable: Zhenya had to learn to stop negative thoughts at the moment they appeared. And not just drive away nightmares by force of will, but respond to them sensibly and intelligently (as psychologists say, confront them). That is why, at the initial stage of working with panic, a specialist usually talks about the nature of this disorder, that people do not die from it or go crazy.

In addition, he helps develop and rehearse confrontation techniques, teaches muscle relaxation and proper breathing. And a little later, when the patient begins to feel more confident, the psychologist accompanies him in a situation that provokes panic - and not as a crutch, but as a reliable, competent coach observing the success of his student.

This is exactly how Zhenya’s therapy turned out. Now, after a complete recovery, she says that she not only coped with the symptoms, but also learned to better understand herself and regulate her conditions. Surely the new experience will be useful to her more than once in her life. I hope that after reading this text, if you have a panic attack, you will not self-medicate, but will approach the problem intelligently.

Causes of panic attacks and panic disorder

Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in the family. There also appears to be an association with major life changes such as graduating from university, starting a new job, getting married and having a child. Severe stress, such as the death of a loved one, divorce, or job loss, also triggers a panic attack.

Panic attacks are also caused by medical conditions and other physical causes. If you are suffering from panic symptoms, it is important to visit a doctor and rule out the following possibilities:

Mitral valve prolapse, a minor heart problem that occurs when one of the heart valves does not work properly.
Hyperthyroidism (overactive thyroid gland)
Hypoglycemia (low blood sugar)
Use of stimulants (amphetamines, cocaine, caffeine)
Withdrawal syndrome for certain medications

Treatment

Panic attacks and panic disorder are treatable diseases. They are usually successfully treated with self-help strategies or several psychotherapy sessions.

Cognitive behavioral psychotherapy

Cognitive behavioral therapy is generally considered the most effective form of treatment for panic attacks, panic disorder, and agoraphobia. Cognitive behavioral therapy focuses on the patterns of thinking and behavior that support or trigger panic attacks. It helps you look at your fears from a more realistic perspective.

For example, if you had a panic attack while driving, what's the worst that could happen? Although you might pull over, you are unlikely to crash your car or have a heart attack. Once you learn that nothing really catastrophic will happen, the experience of panic will become less terrifying.

Exposure psychotherapy for panic attacks and panic disorder

In exposure therapy for panic disorder, you are exposed to the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to breathe very quickly, shake your head from side to side, or hold your breath. These various exercises cause sensations similar to panic symptoms. With each experience, you become less and less afraid of these internal sensations and feel more and more in control of the panic.

If you have agoraphobia, exposure to situations that you fear and avoid is also included in treatment. In exposure therapy for specific phobias, you face frightening situations until the panic begins to subside. Through these experiences, you learn that the situation is not harmful and that you are in control of your experiences.

Drug treatment

Medication is used to temporarily control or reduce some of the symptoms of panic disorder. However, they do not cure or solve the problem. Medications will be helpful in severe cases, but they should not be the only treatment option. Medication is most effective when combined with other treatments, such as psychotherapy and lifestyle changes, that address the underlying causes of panic disorder.

Medications that are used for panic attacks and panic disorder include:

Antidepressants . It will take several weeks for them to start working, so you should take them for a long time, not just during a panic attack.
Benzodiazepines . These anti-anxiety pills work very quickly (usually within 30 minutes to an hour). Taking them during a panic attack quickly relieves symptoms. However, benzodiazepines are easily addictive and have serious withdrawal symptoms, so they should be used with caution.

Overcoming panic with the help of psychoanalysis, or the deep method

Sigmund Freud, the founder of the deep method of psychotherapy, considered panic attacks as a response to a conflict situation that the patient not only cannot resolve on his own, but is not even aware of. The root cause is the impossibility of realizing sexual desires. This is caused by parental or religious prohibitions, social norms, which the patient is not able to cross. Moreover, in an effort to conform to the imposed norms, he denies the drives themselves.

The psychoanalyst places the patient on the couch and asks him questions relating to the distant past, starting with childhood. There is a long way to go from the beginning of psychotherapeutic treatment to awareness. Psychotherapy can take months, or even a year or two. However, careful in-depth study helps get rid of panic attacks.