Panic Disorder – The Paradox of Effective Treatment

Around 1 in 10 people will experience a panic attack at some time in their life. It may be linked to a phobia but often can be caused by just a build up of anxiety due to the stresses of life. For about 1 in 50 the attacks becoming recurring and this is known as panic disorder.

Sufferers of panic disorder often feel fine one minute, and yet the next minute they may feel totally out of control and in the grips of a panic attack. The physical symptoms range from a rapid increase in heartbeat to a churning stomach sensation. It is a bit like the fear you would get if a lion attacked you but there is no lion. These physical symptoms are naturally unpleasant and the accompanying psychological thoughts of terror can result in a very scary experience. For this reason, sufferers start to dread the next attack, and quickly enter into a cycle of living ‘in fear of fear’.

Much is written about the causes of panic disorder, particularly about the role of serotonin in the brain which is why Selective Serotonin Reuptake Inhibitors (SSRIs) are the medication of choice for many General Practitioners (certainly the case in the UK). However most people working in psychotherapy know that the key to treating panic disorder is to remove the fear of the panic attack because that is what maintains the disorder.

Although there is anecdotal evidence for success using a range of distraction based therapies to help deal with panic, systematic reviews have found Cognitive Behavioural Therapy (CBT) to be the most effective.

CBT does not use distraction. First it teaches the client to challenge their thoughts, behaviours and core beliefs. Then it teaches the client to be able to deal with the panic attack and often will involve some level of exposure therapy. (The client is gradually introduced to situations where they fear they may have a panic attack)

However this creates a paradox. In order to stop the panic attacks the client has to face the very thing they fear. For some clients this is too much and a significant number do not complete the course of therapy. Visit any panic disorder related internet forum and you will see stories from people complaining that the therapist made them or caused them to have a panic attack.

For the people who do complete a sufficient course of therapy, many learn how to deal with the panic attack. As a result the fear of the panic attack diminishes and so does the frequency and intensity of the attacks. For many, panic attacks disappear altogether.

Another key component of CBT is getting the client to drop safety behaviours. Safety behaviours are behaviours that the client has developed because they believe it will reduce the risk of a panic attack or help them ‘escape’ or be rescued in the event of a panic attack. Examples are sitting near exits, never being alone and avoiding busy places. However while these behaviours may give temporary relief they subconsciously tell the brain that there is a danger present so it is more likely to activate the fight or flight response (i.e the panic attack) in the future. This begins a downward spiral that makes the panic disorder more severe and the life of the sufferer becomes increasingly limited by the introduction of more and more safety behaviours and avoidance. In exposure therapy the client is taught to deal with everyday situations without using safety behaviours.

This also can be daunting for the client and some therapists may teach relaxation techniques to help. Therapists (particularly those also trained in Hypnotherapy) may use in vitro exposure before in vivo exposure. This means the client while deeply relaxed will visualise the feared situation in their mind before experiencing the situation for real. When the client then tries it for real they are often surprised what they can actually do without a panic attack.

There is much common ground between the many therapies for treating panic disorder and anyone suffering panic attacks needs to find what suits them best. However there is no easy quick fix or magic pill. Any effective therapy will require a change in behaviours, determination and the willingness to experience some level of discomfort. But like anything in life, the harder you have to work, the greater the reward and many people do experience the enormous reward of freeing themselves from panic attacks.

For those tempted by easy solutions and quick fixes, here is a final word of warning. If an advert for panic disorder treatment looks too good to be true, then it probably is too good to be true.