Almost everyone experiences anxiety at some point, but panic attacks are intense anxiety that causes you to mistake it for a heart attack, a medical condition, insanity, and a loss of control. During a panic attack, you may experience shortness of breath, grumbling, upset stomach, ringing in the ears, a sense of impending doom, tremors, light-headedness, choking, chest pain, sweating, and palpitations. Considering that a panic attack can cause symptoms similar to some medical diseases, you should first see a doctor when you experience these symptoms to make sure that your symptoms are not caused by hyperthyroidism, caffeine addiction, mitral valve prolapse or other medical reasons. After medical reasons have been ruled out, a mental health professional should evaluate you for possible panic disorder.
Panic disorder is commonly called "fear of fear" because people who suffer from this disorder actually fear the symptoms of fear (or a panic attack) and misinterpret these symptoms as a warning of an impending catastrophic event. Fear naturally occurs when we are in a really dangerous situation, then a message is sent to the brain that there is danger, and finally we perceive the danger. So in this way we can defend ourselves against danger. Fear symptoms (heart palpitations, gasping for breath, etc.) act as stimuli, forcing us to flee or fight a dangerous situation (this reaction is called the fight-or-flight response). For example, an increased heart rate when faced with danger causes more blood to flow through the body's vessels, thereby transporting more oxygen. Oxygen provides us with energy to fight or flee when faced with danger. This is a natural reaction to real danger or "true warning" and this system has been ingrained in human nature for millions of years.
In panic disorder, your body thinks you are in danger, even though there really isn't. When fear occurs in the absence of danger, we call it a "false alarm." This situation is like if there is no fire, the sound of the fire alarm is activated. Over time, this false alarm becomes a learned alarm. It means that you are afraid of any sign of fear that appears to protect you from danger, because you do not know the reason for the appearance of these signs. You think that experiencing a panic attack is dangerous or that you are in trouble. In fact, by interpreting panic attacks as a risk factor, you will start a cycle of fear or more panic attacks in the future, so you try to deal with what you think is dangerous. The interesting thing about panic disorder is that you fear the symptoms that appear to protect you from danger factors. When you are sure that you are in danger, your brain perceives more fear (more panic attack), while what you are afraid of are the symptoms of fear itself and there is no real danger.
When a person believes that panic attacks are dangerous, he is worried about the recurrence of these attacks in the future. These people fear and avoid things and sensations similar to panic symptoms (heat, exercise, sunlight, pleasure or excitement, sexual arousal, anger, etc.). People with panic disorder focus on these internal feelings: "My heart starts racing, so I'm having a heart attack," or "I feel weak and dizzy, so I pass out." Most of the people who suffer from panic disorder also experience it while sleeping.
Many patients with panic disorder also experience agoraphobia. Agoraphobia is the fear of places or situations in which a panic attack may occur and it is difficult to escape from them. For example, "I might have an anxiety attack at the subway station and pass out in front of others." People with agoraphobia avoid being alone at home, going out alone, going to the supermarket alone, traveling by train or plane, crossing bridges, high places, tunnels, crossing open places, driving, riding in elevators, and moving by subway and bus, and similar things. These people are very afraid of having a panic attack in such situations; As a result, they try harder to avoid those situations. (For example, "I have to get out of this situation".) In fact, avoidance becomes the main defense mechanism of these people to control anxiety. Usually, when a person cannot avoid such situations, he uses different methods to feel safe. (For example, he carries a water bottle with him.) Most people with panic disorder and agoraphobia usually ask for help and companionship from a "safe person" to accompany them in anxiety-provoking situations.
Although these avoidances are likely to stop or reduce anxiety attacks, people with panic disorder and agoraphobia are constantly worried about future attacks. Avoidance makes the world of these people smaller and smaller. Limitation of life provides conditions for these people to experience depression and chronic anxiety. The depression and anxiety of some of them become so severe that to reduce these unpleasant feelings, they arbitrarily turn to alcohol and Valium and Xanax drugs.
Although these efforts are successful in the short term, in the long term they reinforce people's beliefs that they are at risk and need protection. The treatment of this disorder is that people with panic disorder and agoraphobia come to the conclusion that fearful situations are not dangerous and that panic attacks are harmless symptoms of fear and they do not need to perform protective behaviors.
What are the causes of panic disorder and agoraphobia?
Although about 30 to 40 percent of the population of the entire society experiences a panic attack every year, most of them do not interpret this panic as a warning of an impending disaster, so they are not among the people with panic disorder and agoraphobia. This disorder occurs in people who are vulnerable to it.
Research results show that panic disorder and agoraphobia are caused by the combination of genetic, nature, biological and psychological vulnerability factors. Anxious people may be more vulnerable to panic disorder by nature. In addition, research shows that anxiety can be caused by genetic factors, biological factors or early learned experiences. Some early experiences are linked to the emergence of panic disorder, which teach a person that the world is dangerous and that they should consider their inner bodily sensations as traumatic. People with panic disorder tend to focus too much on their own bodily sensations and interpret them as catastrophic. For example, these patients may focus on their heart rate and quickly conclude that they are about to have a heart attack.
Many of the situations that trigger panic attacks were really dangerous for our ancestors in the distant past. For example, in the distant past, if a person got stuck in a tunnel, he might suffocate or faint and become weak, the height could be dangerous, it was possible that in open places, people would be more exposed to predatory animals (such as lions and wolves), it was possible that our ancestors were exposed to aliens and enemies in public places. Therefore, many fears, including panic disorder and agoraphobia, are the remnants of these instinctive and adaptive fears of our ancestors. Although today these situations are no longer dangerous.
Initial panic attacks for vulnerable people usually occur during a stressful situation such as leaving home, marital and relationship conflicts, surgery, new responsibilities, or physical illness. Most people with panic disorder and agoraphobia also suffer from depression, which is partly due to the limitations created by themselves and partly due to the fact that they feel they have no control over themselves and do not know how to manage their problems.
What are the misconceptions about panic disorder and agoraphobia?
Most people misinterpret their panic symptoms as a sign of a dangerous physical or psychological illness or lack of control. Sometimes they believe that they have been diagnosed with schizophrenia or heart disease, sometimes they believe that they are disconnected from reality, they may faint and become weak at any moment, have a heart attack or stroke, or other scary events are coming. People with panic disorder and agoraphobia may view panic attacks as a sign of weakness or a serious flaw. These types of interpretations expose them to depression, dependency or self-blame.
Some people mistakenly consider panic attacks to be a sign of deeper problems. People with panic disorder often have false and unrealistic beliefs about anxiety. For example, they believe that "any anxiety is bad" and "I need to get rid of this anxiety immediately". Others believe that it is because they have been experiencing panic attacks and panic attacks for years and traditional treatment has not been effective for them. They never recover.
It is very important to teach patients that panic disorder and agoraphobia respond easily to treatment. Cognitive behavioral therapy, with or without medication, is very effective for the treatment of panic disorder and agoraphobia. This type of therapy helps people correct misconceptions, misconceptions, and judgments about these disorders. Therapists help these patients to accept that their illness is treatable by applying psychotherapeutic strategies. It is also possible to assure these patients that there is no need for long-term treatment based on their childhood experiences to receive an effective treatment.
How effective is cognitive behavioral therapy for panic disorder and agoraphobia?
Fortunately, many researches have been conducted in the field of examining the effect of cognitive behavioral therapy on panic disorder and agoraphobia. These researches have been conducted at Oxford University in England, University of Pennsylvania, State University of New York at Albany and other universities and medical centers. The effectiveness of the treatment in a period of 12-15 sessions is from 85% to 90%. In addition, the results of these studies show that most patients continue to improve one year after the end of treatment.
Drug treatment for panic disorder and agoraphobia
Many medications are effective in treating panic disorder, including a wide range of antidepressants (eg, Prozac, Zoloft, Tofrainil) and Xanax and other anti-anxiety medications. These drugs reduce the symptoms of panic disorder and agoraphobia, but these symptoms return after the drugs are stopped. As a result, our recommendation for patients is that even if they take medication for these disorders, they should also undergo cognitive behavioral therapy.
What are some stages of cognitive behavioral therapy?
Cognitive behavioral therapy for panic disorder and agoraphobia has several goals: First, it helps you understand the nature of anxiety, panic, and agoraphobia. Second, it identifies your fearful or avoidant situations. Third, it assesses the nature, severity, and frequency of panic-provoking symptoms and situations, and fourth, it identifies other problems associated with panic. For example: depression, other anxiety disorders, substance abuse, overeating, isolation or communication problems.
In your treatment, all or some of the following methods may be used: Familiarity with panic disorder (de-catastrophizing and normalizing panic attacks), retraining breathing; relaxation training; panic induction (so that the brain understands that panic attacks are not harmful and that you are not in danger); gradual exposure to panic-provoking situations; identifying and correcting your misinterpretations of panic or arousal symptoms (for example, “My heart is pounding, so I'm about to have a heart attack”), assumptions (for example, “physical sensations are dangerous”), and your core beliefs (for example, “I'm vulnerable and weak”); Coping with life's stresses; Courage training (if necessary); Learning to identify panic symptoms and reduce them when they occur. In addition, other problems (such as depression) are also addressed.
What do we expect from you as a patient?
The patient is not passive in cognitive behavioral therapy. You need to be actively involved in treatment. We expect you to attend weekly sessions (or sometimes more than once a week), fill out problem assessment worksheets, and complete self-help assignments assigned by your therapist. As we have already mentioned, most of the patients who participate in this treatment experience recover from their panic disorder and panic disorder, and some recover quickly. Even if you recover quickly, you must complete the treatment plan. Premature termination of treatment increases the possibility of recurrence of symptoms.
This treatment course is designed for 12 sessions. The first few sessions are devoted to the evaluation and familiarization with the disorder and its treatment, and the other sessions are devoted to the implementation of therapeutic techniques and strategies. After completing the prescribed treatment sessions (12 sessions), reinforcement sessions may be scheduled every two weeks, monthly or more to maintain the therapeutic gains and prevent relapse.
Our therapy program is a combination of techniques proposed by the universities of Oxford, Pennsylvania and New York. In our opinion, this therapy is a program where we teach you how to help yourself. This is why doing homework is important in this type of treatment.
