Assessment and Treatment of Panic Disorder PDF

Assessment and Treatment of Panic Disorder Fran Wymbs, PhD Acute Course Panic Disorder  Recurrent, unexpected and severe attacks of anxiety.  A panic attack is a sudden and overwhelming period of intense fear or discomfort  Accompanied by four or more physical and cognitive symptoms characteristi...

Assessment and Treatment of Panic Disorder Fran Wymbs, PhD Acute Course Panic Disorder  Recurrent, unexpected and severe attacks of anxiety.  A panic attack is a sudden and overwhelming period of intense fear or discomfort  Accompanied by four or more physical and cognitive symptoms characteristic of the fight/ flight response  At least one of the attacks is followed by persistent concern/worry about additional panic attacks (e.g., losing control, “going crazy”)  Or they do things to try to avoid the attacks (like avoiding exercise) Panic Attack Symptoms (1) Heart palpitations or accelerated hear rate (2) Sweating (3) Trembling or shaking (4) Sensations of shortness of breath (5) Feeling of choking (6) Chest pain or discomfort (7) Nausea or abdominal distress (8) Feeling dizzy, unsteady, lightheaded, or faint (9) Derealization / depersonalization (10)Fear of losing control or going crazy (11)Fear of dying (12)Paresthesias (numbness or tightening sensations) (13)Chills or hot flashes Psychosocial Treatment Aimed at: - Information processing biases - Physiological reactions to perceived threat - Perception of a lack of control - Escape and avoidance behaviors Psychosocial Treatment  Cognitive Behavior Therapy (CBT) o CBT has outperformed all other psychological treatments and anti-anxiety medication for ppl with panic attacks. o Scientific studies have consistently found that CBT is more effective at reducing symptoms o Treatment is briefer in duration in CBT than meds and other therapies o Results are more often maintained compared to other treatments. o Panic Control Treatment Psychosocial Treatment o Combo of CBT and medication is sometimes a starting point if patient is overwhelmed by panic and anxiety. o Medication can de-intensify some symptoms right away, allowing patient more ease starting therapy. o If patient is medicated and engaged in CBT, there are benefits to tapering meds; patient can experience arousal and expose self to physiological symptoms common in panic attacks that become triggers in and of themselves. o In doing so, patient learns that these symptoms are not to be feared. Panic Control Treatment  Full course of panic control treatment is about 12 weeks.  Many patients observe reductions in symptoms within 23 weeks of treatment. Example Format of 12-session Panic Control Treatment  Education  Relaxation Training  Cognitive Restructuring  Mindfulness  Exposure Treament  Stress Reduction Education Education  About 1 session  Our ancestors were biologically wired to detect threat; cues helpfully told person to “fight or flee.”  However, panic attacks for the patient currently come in the absence of immediate danger or threat.  Misinterpretation of cues causes a hard-wired reaction. We have to unlearn this reaction. Relaxation Training  Breathing techniques called “breathing retraining” to stimulate parasympathetic nervous system.  Taught in 1 session and reviewed in 1 session.  Relaxation strategies to help alleviate muscle tension.  Some dismantling studies have found, however, these techniques can be associated with worsening anxiety (Schmidt et al., 2000), so can be left out. Cognitive Restructuring  Changing Thought patterns  About 3 sessions  Involves recognizing unhelpful thought, identifying mood associated with it, developing more helpful thought, and retraining thinking.  Starts with conscious effort and becomes automatic over time. DEP Handout 8 (HW): Cognitive Restructuring Cognitive Restructuring Automatic Thought This thought makes me feel? © Seattle Children’s Hospital 2011 This thought makes me want to? Evidence For Thought Evidence Against Thought Cognitive Error A more helpful thought is? Mindfulness  Newer technique added to CBT Protocols  About 1-2 sessions  Borrowed from eastern traditions of meditation  In treatment for panic disorder, it is used to help teach people to experience unpleasant physical sensations without reacting negatively to them  In doing so, patients short-circuit the vicious cycle of fear and panic. Exposure  The biggest “bang for your buck” in CBT comes in the exposure treatment sessions  About 4-5 sessions  Systematic exposure is an intervention that helps people face what they normally avoid. By purposely putting themselves in challenging situations, they defuse the fear associated with them, and no longer fear the situations in the future.  Also engage in interoceptive exposure in which patients expose selves to feared sensations (e.g., practice spinning in a chair with therapist to simulate dizziness sypmtom) Stress Reduction  Reducing stressors can be an important part of treatment for anxiety.  About 1 session  This involves learning to react to different situations more calmly (using skills already learned, e.g., cognitive restructuring and mindfulness) AND reducing unnecessary stress  Stress Reduction strategies can be helpful in reducing overall anxiety and improving quality of life. Exposure Therapy Session  https://www.youtube.com/watch?v=M2Bou5nBONA  Patient exposes self to fears  E.g., fear of suffocation  This is an interoceptive exposure.  Patient works with a therapist in the therapist’s office (safe space) to simulate the physiological experience of suffocation.  Therapist often does the exercise too (though in this video, therapist does not).  Patient rates level of anxiety before and after exposure. Patient repeats exposure until peak anxiety before and after is about 30% of maximum anxiety. Questions?  Thank you for your time.