Panic Disorder with Agoraphobia...

"When I have a panic attack, I feel like I'm dying. Now I'm scared to drive on the freeway. What if I have a panic attack when I'm driving?"

Panic Disorder occurs when an individual has frequent, overwhelming and scary panic attacks. Panic attacks can occur as often as several times a day to once or twice per month. Some people stop leaving their houses out of fear of having another panic attack, stop driving out of fear of losing control of the car, or stop socializing with friends, out of fear of being embarrassed. More specifically;

1. Panic disorder is characterized by Panic Attacks. Panic is defined as a period of intense fear in which four, or more, of the following symptoms occur:

Heart palpitations, pounding heart, or accelerated heart rate

Sweating

Trembling or shaking

Feeling short of breath or smothering

Feeling of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, lightheaded, or faint

Feelings of unreality, or of being detached from yourself

Fear of losing control or going crazy

Fear of dying

Numbness or tingling feelings

Chills or hot flashes

2. Furthermore, there is a concern about having another panic attack, worry about the implications of the attack (e.g. losing control, having a heart attack, going crazy), and a significant change in behavior related to the attacks.

3. Some people who have Panic Attacks, also experience Agoraphobia, which is defined as:

Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected Panic Attack.

Agoraphobic fears typically involve situations that include being outside the home alone, being in a crowd, standing in line, being on a bridge, or traveling in a bus, train, or car.

The situations are avoided (e.g. travel is restricted or eliminated) or are endured with marked distress. Some will only do these things if a companion comes along.

Cognitive-behavioral model of Panic Disorder with Agoraphobia:

Panic attacks occur when the body's natural fight-or-flight response is triggered out of context (in the absence of a life-threatening situation). When people perceive the bodily sensations of the fight-or-flight response (sensations like increased heart rate, sweating, and lightheadedness) as dangerous, they become frightened of the sensations and avoid places in which they fear experiencing them.

Cognitive-behavior therapy for Panic Disorder with Agoraphobia:

Education: Learn about the symptoms of panic attacks, their causes, and the factors that maintain them.

Monitoring: Learn about the physiological, cognitive, and behavioral components of your panic symptoms and avoidance cycles.

Physical control strategies: Learn breathing control exercises and relaxation training, and mindfulness meditation to manage anxiety

Cognitive strategies: Identify fear thoughts about panic sensations, challenge them, and develop more adaptive ways to think.

Behavioral strategies: Expose yourself to the sensations and situations you are afraid of. To truly learn that the physical sensations of panic are NOT dangerous, it is important to test your beliefs. To do this, you and your therapist will practice exercises in which you purposely bring on the feared sensations (for example, palpitations) and practice tolerating them without escaping them or panicking when you have them. To truly learn that you are NOT in danger and that you can cope in situations that you fear or avoid, you and your therapist will practice approaching feared situations (starting with easy ones and working up to harder ones) and staying in them until your anxiety decreases and your fears are disconfirmed. With repeated practice, your anxiety and panic symptoms will decrease or disappear, and your belief in your ability to cope will increase.