Panic Disorder What is Panic Disorder? Up to 4 people in every 100 will experience moments of overwhelming fear and anxiety that reach a peak in less than 10 minutes and appear to come on suddenly and unexpectedly. During these attacks it is not unusual to experience symptoms such as dizziness, a rapid heart beat, sweating, numbness, fear of a heart attack or of dying, shaking, nausea as well as other physical and psychological sensations. Many people with such symptoms are able to report feelings of anxiety dating back to childhood and adolescence. After a person experiences just one or two panic attacks they begin to anxiously anticipate and fear when the next one will come. As the fear of another attack increases, the individuals' day to day life can be affected as they try to avoid situations where panic attacks can or have occurred. In severe cases, some individuals end up developing agoraphobia, which is a fear of going outside. Those who suffer from agoraphobia may become housebound and unable to function day-to-day. Panic attacks can manifest differently in children and adults simply because of lifestyle differences. In children, panic and anxiety often materialize in the form of school phobias, fear of performing (i.e. recitals, oral presentations), at home where they are often afraid of the dark or of going upstairs and downstairs alone, as well as in social situations such as meeting new people. In adults, panic disorders can disrupt the marital relationship as the individual may withdraw socially and from day to day activities as a way of avoiding having another attack. It is also not uncommon for people to turn down business opportunities and to suffer from poor productivity at work as a result of avoiding situations where panic attacks may occur. As well, many children and adults who are suffering from panic disorder are at greater risk of having comorbid depression- whether as a primary or secondary disorder. Depressive symptoms are important to look for and note because a diagnosis of comorbid depression could alter treatment and therapy techniques. A Self Test for Panic Disorder If you think that you may have panic disorder, complete the following questionnaire. Check off any of the symptoms if you have had them in the past month. 1. Shortness of breath or the feeling that you are being smothered   Yes No  2. Dizziness, unsteadiness or faintness   Yes No  3. Palpitations or a rapid heart beat   Yes No  4. Trembling or shaking   Yes No  5. Sweating   Yes No  6. Choking   Yes No  7. Nausea or abdominal upset   Yes No  8. Feelings of unreality or being detached as if watching yourself from afar   Yes No  9. Numbness or tingling   Yes No  10. Flushes or chills   Yes No  11. Chest pain or discomfort   Yes No  12. Fear of dying   Yes No  13. Fear of going crazy or of doing something uncontrolled   Yes No  14. Do these symptoms come together to reach a peak in 10 minutes?   Yes No  15. Do you worry about these symptoms, avoid places that might trigger an attack, or avoid situations and places that you cannot escape from if an attack occurs?   Yes No  If you have answered "yes" to at least 4 of the symptoms and/or "yes" to either of the above questions, you may have panic disorder and you should see your doctor. 1 How Can Counselling Help? Panic disorders and anxiety can be treated with the use of medication, specifically antidepressants (e.g. SSRIs) as well as cognitive-behavioural therapy. In many cases, counselling alone can be sufficient in treating anxiety. With cognitive behavioural therapy, the patient learns to anticipate panic attacks by learning to identify situations and physical cues and symptoms that frequently precede them. The patient is also taught relaxation techniques, such as meditation and a variety of breathing skills that can be used as coping strategies to get through the attack once it has started. Family therapist, Susan Lieberman gives examples of various breathing skills and relaxation techniques which patients can be taught in counselling…. The Calming Breath Take a deep breath, filling first your lower lungs then your upper lungs. Hold to a count of 3 as your heart slows. Slowly exhale, saying "relax" (or a similar word) under your breath. Let go of your worries. Let your muscles go limp and warm; loosen your face and jaw muscles. Remain in this "resting" position physically and mentally for a few seconds, or for a couple of natural breaths. USES: Incorporate this brief experience into your daily life. Use it six to eight times a day to reduce the build up of normal tensions. 2 An example of a relaxation technique is Brief Muscle Relaxation. Brief Muscle Relaxation Close your eyes and sit quietly, letting go if any distracting thoughts. (20 seconds) Bend your arms, then cross them in front of your chest. Tighten your fists, arms, shoulders, chest and back and lift your shoulders up to your ears, while you're breathing. (10 seconds) Now relax. (15-20 seconds) Crunch your face up, wrinkle your nose, squint your eyes, purse your lips and bite down on your teeth. (10 seconds) Now relax. (15-20 seconds) Take a deep breath, pull in your stomach and tense your lower back. Hold your breath while counting to "six". Then exhale SLOWLY. Now relax. (15-20 seconds) Extend your legs and tense them, while pointing your toes toward your head. (10 seconds) Now relax. (15-20 seconds) Repeat steps 2-5 Sit quietly, clearing your mind and focusing on your gentle breathing or on a pleasant scene in your mind as you invite your body to feel relaxed, warm and heavy. (1 minute) Open your eyes, feeling refreshed and at ease. USES: Anytime you want to release muscle tensions and quiet your mind. 3 Often when a person is in the midst of a panic attack, the thoughts that are racing through their mind are negative, self-critical and/or hopeless. Through cognitive-behavioural therapy, the patient learns to recognize their negative thoughts and then make a conscious decision to stop them. Such thoughts are often stopped with the use of "self-talk" and supportive comments. Supportive Comments It's o.k. to take a chance here—this is a place to practice my skills. I can be a little anxious and still perform my task. I don't have to let these feelings stop me. I can handle these symptoms. I am free to come and go according to my comfort. I always have options, no matter what. This is not an emergency; I can think about what I need. I can be relaxed and in control at the same time. It's o.k. to feel safe here. I deserve to feel comfortable here. I can slow down and think. I can trust my body. USES: Whenever you are feeling anxious or panicky. 4 Lastly, a final example of a relaxation technique taught to patients in counselling is meditation. Meditation Find a quiet spot Sit in a comfortable position and focus on a single object. Then close your eyes. Clear your mind of everything but that one object. Begin to breathe in slowly through your nose and mouth. When your lungs are full, hold your breath for a count of 3. Slowly exhale. Repeat at least 5 times. Panic disorder is frequently underdiagnosed in clinical practice. However, when diagnosed correctly, panic disorders are extremely treatable. With the right use of medications and/or therapy, panic attacks and anxiety can be reduced substantially and in a large majority of patients, can be eliminated altogether in just a matter of weeks. For more information and helpful resources on Panic Disorders, check out The Anxiety and Phobia Workbook and our Stress & Anger section in the Family Support Network store. Back to Reports & Articles Back to Family Support Network ----------------------------------------------------------------------------------------------- Susan Lieberman is in private practice in North York as a family therapist and public speaker. For more information, Call: (416) 512-6356. or Email: susanl@familysupport.net