Panic Attack


Panic Attack Treatment


Benzodiazepines like diazepam, lorazepam, alprazolam or clonazepam can be prescribed to be taken at the onset of the panic attack or before a particularly challenging situation. Sometimes, the psychological knowledge of knowing that such medication is close at hand may be enough to prevent the panic attack. However, this form of treatment may be considered unfavorable by some doctors, because of the potential for abuse. Furthermore, sometimes when the individual inadvertently forgets his medication at home, he will have a panic attack solely because he realizes he is without that safety net. Additionally, benzodiazepines will not treat the cause of the panic attacks. As such, some doctors may prefer to prescribe an antidepressant, particularly an SSRI (such as paroxetine or sertraline), which after an initial titration period may be effective at reducing anxiety. NaSSAs such as mirtazapine have also been found effective, particularly with individuals whose anxiety and panic causes insomnia.

Cognitive Behavioral Therapy/Interoceptive Desensitization

One particularly helpful and effective form of therapy is Cognitive Behavioral Therapy (CBT). Techniques used may include those based upon the concept that intentional exposure to the symptoms will help decrease the sufferer's fear of panic attacks (Symptom Induction/Interoceptive Desensitization). Intereoceptive Desentization intends to desensitize the afflicted from the symptoms of panic attacks. In a study by Barlow & Craske (1989), 87% of the individuals that participated in the two of four treatments that involved Interoceptive Desensitization were free of panic at the end of treatment and these results were maintained at a 2-year follow up. In controlled studies of interoceptive exposure treatments compared to other treatments, those treatments that included Interoceptive Desensitization were found to be significantly superior to other treatments such as muscle relaxation alone, or education or insight-oriented treatments.

Symptom Inductions generally occur for one minute and may include:

-Intentional Hyperventilation- Creates lightheadeness, derealization, dizziness, -Spinning in a chair- Creates dizziness, disorientation -Straw breathing- Creates dyspnea, airway constriction -Breath holding- sensation of being out of breath -Running in place- Creates increased heart rate, increased respiration, perspiration -Body Tensing- Creates feelings of being tense and vigilante

The key to the induction is that the exercises should mimic the most frightening symptoms of a panic attack. Prior to inducing symptoms (hyperventilation, for example), the therapist asks the patient to rate their level of anxiety. Following the exercise, they rate their resulting level of anxiety. This is repeated at least five times until the anxiety rating is low. The patient's worst symptoms are focused on in this fashion, and the symptom induction cycle is repeated for each symptom. Symptom Inductions should be repeated 3-5 times per day until the patient has little to no anxiety in relation to the symptoms that were induced. Often it will take a period of weeks, or even months for the afflicted to feel no anxiety in relation to the induced symptoms. With repeated trials, a person learns through experience that these internal sensations do not need to be feared - the individual becomes less sensitized or desensitized to the internal sensation. After repeated trials, when nothing catastrophic happens, the brain learns (Hippocampus & Amygdala) to not fear the sensations, and the SNS activation fades.

Many people overcome Panic Disorder and sudden panic attacks on their own. It takes time, but in a sense, they ride out the panic attacks and eventually learn that nothing is going to happen during one. Often, they 'taper off' until they are not noticeable any longer. It is for this reason that some psychologists helping people with panic disorders induce them into an attack, so they can see for themselves that indeed, nothing will happen.

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