Understanding Panic Disorder: Causes, Symptoms & Treatment

Cognitive behavioural therapy (previously known as cognitive therapy) is a theoretical framework of psychotherapy, which originated in the 1950s. It continues to grow globally, with application in diverse cultures. As the name suggests, CBT identifies the relationship between cognition or thinking and behaviour or action. It is firmly based on a “meditational approach”, whereby our patterns of thinking and perceiving are considered an important influencer (mediator) for behaviour.

Various eminent proponents of CBT during the early 1960s include Aaron T. Beck, Albert Ellis, Michael J Mahoney, and Donald Meichenbaum. These individuals are credited with devising the basic principles and methods of CBT.

The framework of modern CBT:

CBT emphasizes that an individual’s emotions, behaviour and physiological processes come under the strong influence of their perception of events. As different treatment modalities exist under the umbrella of CBT, the importance placed on each of these elements alters according to the goals of the modality being adopted. A common link between them is the fact that they use the same indices to evaluate change- behaviour and cognition.

As explained by the pioneers of CBT, it is not the situation at hand that determines an individual’s response directly, but the way it is interpreted that determines it5. Hence, in any situation, an individual can have different streams of thought. One of these streams is of keen interest to a cognitive behavioural therapist. And that is of the “automatic thoughts”; the rapid, brief, stream of thoughts that are not the result of deliberate efforts. It is this “automatic” flow that an individual is essentially unaware of and hence, might hold certain “hidden” tendencies affecting choices and responses. However, it is not intended to oversimplify the complexities of human response processes (emotional, behavioural, etc.). Especially since automatic thoughts are based on beliefs that one forms over their lifetime. But, at the fundamental level, automatic thoughts represent the final product that emerges from various factors. It is this cognitive conceptualization that is an essential principle common to all modalities of CBT. It is the blueprint of CBT that a trained Online Psychologist must build upon.

Modalities of CBT:
The techniques of CBT can be divided into the following:

• Cognitive restructuring methods
• Coping skills
• Problem-solving skills

Each of these therapies follows the tenets of the cognitive framework with individual goals. To elucidate further, cognitive restructuring methods are brought to use when maladaptive thinking patterns or styles are considered as the harbinger of distress. It focuses on altering these maladaptive thinking patterns to bring about change. Coping skills can assist a client in more general ways, for example, by using humour, and creative expressions to deal constructively with stressful events. And lastly, problem-solving skills focus on developing a set of strategies, such as level-headedness, logical thinking, etc., that come into use when dealing with difficult events.

Evidence Base:
CBT as psychotherapy is one of the most widely used treatments for adults. There are numerous research studies to bolster its efficacy as a treatment for various psychological conditions (with or without medication) with the following conditions (amongst others):

• Mood Disorder: Unipolar depression, Severe depression, bipolar disorder.

   

  Panic disorder involves the recurrence of unexpected panic attacks . Thus, the clinical picture of this disorder consists of more than one such attack that occurs without obvious triggers or cues. Panic attacks are quite common but having one attack does not qualify one for a diagnosis of panic disorder.

  Panic attacks are discrete, unexpected events characterized by excessive, abrupt, and intense fear which peaks within a few minutes of onset.

  During this period an individual may feel four or more symptoms from the following list:

  • Sweating profusely
  • Trembling
  • Palpitations
  • Shortness of breath
  • Cold or heat sensations
  • Feeling of choking
  • Nausea
  • Numbness or tingling
  • Feeling dizzy, light-headed
  • Feeling detached from your body
  • Stiffness in neck
  • Chest pains
  • Fear dying
  • Fear of losing control

  An individual may feel like one is “going crazy” accompanied by cognitive and physical changes. Panic attacks can occur to anyone who may or may not have any pre-existing anxiety disorder. Panic attacks are often followed by an excessive worry about experiencing another panic attack or suffering consequences due to the panic attack. For example, an individual may worry about being judged by others, or the presence of a physical ailment, etc. The worry causes the person to avoid certain situations or activities. Thus, panic disorder is associated with considerable distress in physical and mental functioning3. Females are twice as likely to develop panic disorder as males. The median onset for panic disorder ranges from 20-24 years. However, onset after 45 years of age is a low probability.

  Assessment and Diagnosis
  The assessment and diagnosis of panic disorder is done by trained professionals such as psychiatrists and clinical psychologists . Assessing the symptoms of panic disorder requires thorough medical and psychiatric evaluation4. Medical assessments become necessary to rule out the presence of other physical ailments that may mimic signs of panic attacks. Diagnostic symptoms are further assessed by the use of rating scales or self-report inventories.

  Agoraphobia is often found to be co-morbid with panic disorder. It is characterized by intense and marked anxiety about being in situations such as being in open spaces, being in enclosed areas (like a cinema), standing in a queue or crowd, using public transport, and being alone and outside one’s home.  Individuals can present with varying degrees of agoraphobia or panic disorder. Thus, clinical judgment is key in identifying this condition

  Treatment of Panic Disorder
  Psychosocial Approaches:
  Cognitive Behavioral Therapy (CBT): Under the cognitive-behavioral model, the panic attack and associated distress are considered a manifestation of the “fight-or-flight” response that gets activated unexpectedly. Thus, misinterpretations of bodily sensations become a primary focus under this therapeutic treatment3.  For example, consider palpitations as a signal of an impending heart attack. Such maladaptive interpretations are identified and then worked upon in CBT sessions.

  Other psychosocial approaches: Psychodynamic psychotherapy is used for the treatment of panic disorder by focusing on the effect of traumatic experiences, childhood experiences, exploring feelings, etc. Eye movement desensitization and reprocessing (EMDR) is also used by targeting the negative effect of life events and experiences associated with panic attacks .

  Pharmacological treatments: Anti-panic medications used as a line of treatment in panic disorder, which include the use of tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake Inhibitors (SNRI)4. Pharmacological and CBT are often applied in combination for better outcomes of treatment.

  Panic disorder is often considered a disabling condition due its pervasive effects on daily life and activities. However, timely and effective management not only helps with controlling panic symptoms, but also bolster the process of dealing with anticipatory anxiety issues

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• Anxiety Disorder: Obsessive Compulsive Disorder, Panic Disorder , Generalized Anxiety Disorder
• Eating disorders: Bulimia Nervosa, Binge Eating Disorder
• Others: Marital Distress, Anger Management .

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