Panic and Agoraphobia
Introduction

Panic Disorder is defined by the DSM 5 “as recurring, unexpected panic attacks characterized by an abrupt surge of intense fear or discomfort that reaches a peak within minutes.” There are subsequently fears regarding the attack such as preoccupation with additional attacks and worry about the possible meaning or consequences of the attacks. Often, but not always, panic can lead to “agoraphobic” avoidance of situations, activities or reliance on what is commonly referred to as safety-seeking behaviors.

Agoraphobia is defined as anxiety about places, situations or even activities where escape might be difficult or where help might not be available if a panic attack were to occur. Agoraphobia usually develops as a result of panic disorder. People with agoraphobia often avoid a broad range of situations such as large indoor or outdoor places or venues, being alone, doing something alone outside of the home, crowds, bridges, elevators and/or traveling by car, plane, train or airplane. Agoraphobic avoidance is self-reinforcing, often begets avoidance and consequently can spread across many areas of a person's life. Untreated this can lead to serious limitations and disability. Panic can occur alone but often progresses to agoraphobic avoidance as situations and activities become associated with the panic attacks ( associative learning ).

Epidemiology

The estimated lifetime prevalence of panic in the general population is between 1.5 and 3.5 %. Women are twice as likely to experience panic than are men; although the clinical feature of the disorder are similar across the genders.

Treatment - Panic Control Therapy

Panic Control Therapy (PCT), a patchwork of CBT methods, adapted to treat of panic by American psychologist David Barlow in the 1980s is still considered the gold standard for approach panic disorder. The pioneering model developed by Barlow, collaborator, Michelle Craske and UK researcher David Clark targeted key aspects of the cycle of panic for change, particularly fight-or-flight false alarm, the catastrophic misinterpretation of this misdirected biological survival reaction, along with maladaptive "safety behaviors". PCT remains the first-line treatment for panic.

Cognitive and behavioral treatment is most commonly used. David Barlow’s model of panic is still the gold standard today. Barlow’s pioneering model based on extensive research identified key features of panic such as associative learning, biology of species survival and misinterpretation of this physiology. The approach he and colleague Michelle Craske developed, Panic Control Therapy, is still the considered the first line treatment for panic.

Phases of Treatment
  • Education about the fight or flight response and understanding it's evolutionary significance
  • Anxiety management strategies
  • Changing self talk and relevant maladaptive core beliefs • Facing and habituating to what is feared and avoided
Treatment Components
  • Initial assessment
  • Education about the nature and physiology of anxiety and panic
  • Monitoring of panic symptoms
  • Defining the panic symptom profile
  • Defining specific triggers
  • Mapping of avoidance and safety-seeking behaviors
  • Ongoing monitoring of tasks and symptoms
  • Self-soothing techniques such as breathing control strategies and relaxation training
  • Cognitive strategies and interventions (challenging and reframing catastrophic misinterpretations of body sensations, decastrophizing fears)
  • Identifying core beliefs or vulnerable self narratives present in catastrophic interpretations
  • Exposure and desensitization to feared body sensations
  • Symptom induction exposure (“interoceptive exposure”)
  • Progressive situational exposure to avoided activities and places, reversing agoraphobic avoidance
  • Relapse prevention strategies and maintenance goals
  • Stress management strategies
  • Recovery and resetting of life goals.
Image

© 2018 Robert Safion, LMHC

Treatment of Obsessional Spectrum Anxiety

6 Harris Street, Newburyport, MA 01950