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Panic Attacks, Counseling Available in Broken Arrow for Tulsa Area Residents

By Alina Morrow, LPC

Disclaimer: The article below is for informational purposes only and should not be considered as direct advice, a personal diagnosis, or as an individual treatment plan. Always consult with a mental health professional or medical doctor if you have concerns.

Introduction and Overview

A panic disorder is an anxiety disorder characterized by the presence of recurrent or unexpected panic attacks accompanied by physical symptoms such as fast heartbeat, chest pain, breathing difficulties, and dizziness. The main two elements that characterize the panic disorder are:

  1. the presence of spontaneous, seemingly out-of-the-blue panic attacks and
  2. the persistent, terrifying fear of having future panic attacks.

However, sometimes, panic attacks are confused with the panic disorder. A panic disorder is a psychiatric condition that requires treatment, while a Panic Attack is one of the symptoms of Panic Disorder.

Panic disorder's evolution and manifestation can vary between individuals. One of the differences consists in the frequency and severity of the panic attacks. Some individuals experience panic attacks that occur regularly (once a week), while others report more frequent attacks (daily for a week) followed by a quiet period (a month or few weeks) without any attack.

Another significant difference is the interpretation associated with the consequences and implications of the panic attacks. Some individuals fear that the panic attacks indicate the presence of an undiagnosed, life-threatening medical condition. Unfortunately, these individuals remain frightened and continue to believe in the existence of a serious, undiagnosed disease even when medical investigations prove the opposite. Others fear that panic attacks are a sign of "getting crazy". In some cases, individuals with panic disorder report constant or intermittent feelings of general anxiety.

Panic disorder affects over 6 million American adults. According to the American Academy of Family Physicians, the onset age of this disorder is in late teen and young adult years. In rare cases, it can develop after the age of 35. Panic disorder is three time more common among women than men. Once the disorder develops, it usually becomes chronic. One in three people that suffer from panic disorder also develop agoraphobia (an anxiety disorder characterized by the fear of experiencing panic attacks in settings where a possible escape is difficult).

Panic disorder can be difficult to recognize or diagnose because the majority of its symptoms are very similar with other medical conditions such as heart disease, thyroid or breathing disorders. Those that suffer from panic disorder have a rich history of visiting doctors' offices or emergency rooms convinced that they suffer from a life threatening medical conditions even if the medical tests prove otherwise. In general, it takes several months up to few years until the proper diagnosis is established. Left untreated, this disorder can be frightening, disruptive and debilitating because the person lives in constant fear of experiencing terrifying panic attacks.

There are several criteria that have to be met in order for a panic disorder diagnosis to be established:

1. Recurrent unexpected panic attacks or Panic attacks followed at least 1 month after one or more of the following:

  • Worry about the possible implication or consequences of the attack.
  • Persistent concern of having additional attacks.
  • A significant change in behavior related to the attacks.

2. The panic attack is not caused by direct psychological effects of a substance (drug abuse or medication), a general medical condition, or other anxiety disorders (such as agoraphobia or obsessive-compulsive disorder)

Symptoms and Types of Panic Attacks

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM- IV), a panic attack is a period of intense fear or discomfort in the absence of a real danger. A panic attack has an abrupt onset, and it usually lasts for 10 to 15 minutes. However, in rare cases it can last for several hours. Those that suffer from panic attacks describe the experience as an intense fear of dying, the sensation of going crazy or losing control over emotions and behavior, or suffering from a heart attack or stroke. During a panic attack, the fear is out of proportion for the situation, which is usually not threatening.

A panic attack is associated with a wide range of cognitive and somatic (bodily) symptoms. Some of the most common cognitive symptoms include:

1. Derealization or depersonalization: Derealization is an alteration in the perception or experience of the external world which seems strange and unreal. Depersonalization is an alteration in the perception or experience of the self where the person feels detached from his or her own mental processes or body. These two symptoms can be triggered by changes in the blood chemicals (usually triggered by episodes of intense fear) which cause an impaired perception of reality.
2. Fear of losing control.
3. Fear of dying.
4. Fear of going crazy.

Some of the most common somatic symptoms include:

1. Palpitations.
2. Sweating, chills or hot flashes.
3. Trembling or shaking.
4. Sensation of shortness of breath.
5. Sensation of choking.
6. Chest pain/discomfort.
7. Nausea or abdominal discomfort.
8. Dizziness or lightheadedness.
9. Tingling sensations.

Panic attacks can be classified in three major categories according to the existent relationship between the attack onset and the presence or absence of situational triggers with internal or external clues.

There are three distinctive panic attack types:

1. Unexpected Panic Attack: This type of panic attack cannot be associated with an internal or external trigger.

2. Situationally bound panic attack: This type of panic attack occurs almost invariably after the exposure to or in anticipation of a situational cue or trigger.

3. Situationally predisposed panic attack: This type of panic attack is triggered by a situational cue, but it is not invariably associated with the trigger or occurs immediately after the exposure to a trigger.

The most common type of panic attacks of panic disorder are situationally bound and situationally predisposed panic attacks, numbers 2 and 3 above. However, the presence of panic attacks is not always indicative of a panic disorder. Panic attacks can occur in the context of any anxiety disorder or other mental disorders (such as mood disorders or substance-abuse disorders, social phobia, generalized anxiety disorder, and major depressive disorder) or in healthy individuals (up to 10 percent of healthy people experience an insolated panic attack per year).

Panic Disorder Causes and Risk Factors

The precise factors that cause panic disorder are not fully understood and identified, but researchers have proven that there is a combination of several factors (environmental, genetical, and biological) involved.

Genetic Factors: First-degree relatives of those that suffer from panic disorder are up to 8 times more likely to develop the disorder than the normal population. A study conducted in 2001 by a Yale geneticist team discovered two genetic loci (on the human chromosome 1 and 11q), that govern a persons risk of developing panic disorder.

Environmental factors, include:

  • Drinking large amounts of alcohol or suddenly stopping the consumption of alcohol.
  • Drinking large amounts of caffeine beverages.
  • Using illegal drugs (such as cocaine and marijuana).
  • Taking medication that treats asthma and heart conditions.
  • Abruptly stopping the treatment for anxiety and sleep disorder.
  • The presence of a major stressor in the person's life.

Medical Conditions: Panic attacks can be caused or associated with several medical conditions such as:

  • Hyperthyroidism, a medical condition caused by an overactive thyroid.
  • Heart problems, such as mitral valve prolapse - a heart condition where the valve between the heart's left upper chamber and the left lower chamber does not close properly.
    Seizure disorder, such as epilepsy - a chronic neurological disorder characterized by recurrent unprovoked seizures (abnormal, excessive or synchronous neuronal activity in the brain).
  • Asthma, a chronic disorder that affects the airways.
  • Anxiety disorders, such as post traumatic stress disorder or obsessive compulsive disorder.

Biochemical Factors: A study conducted in 2004 by the National Institute of Mental Health (NIMH) discovered that three brain areas of panic disorder patients are lacking a type of serotonin receptor (called serotonin 5-HT1A receptor) which is involved in the process that regulates emotion. The serotonin 5-HT1A receptor is reduced by nearly a third in three structures straddling the center of the brain (anterior cingulate in the front middle part of the brain, the posterior cingulate in the rear middle part of the brain, and the raphe in the midbrain).

Panic Disorder Treatment

Panic disorder patients have several treatment options available. These treatment options can be classified in two major categories: 1) psychotherapy approaches and 2) medication. Clinical experience has shown that a combination of both these two treatment methods is the most effective.

Psychotherapy, as a treatment approach, includes two options: (1) cognitive-behavioral therapy, and (2) cognitive therapy.

Cognitive-behavioral therapy is a psychotherapy approach which considers that our thoughts and not the external situations, people or events, trigger the behavior and feelings. The benefit of this perspective is that a person can change the way he or she thinks and benefit the way he or she feels and acts when the situations, other people, or events do not change. This form of therapy combines methods from behavioral and cognitive therapies for a better outcome such as: applied relaxation, exposure in vivo (reality) and through imagery, panic management, breathing retraining, and cognitive restructuring.

Cognitive-behavioral therapy for panic disorder focuses on re-training the way the person thinks. This is possible by following some essential steps:

1. Education: During this step, the person learns what causes the panic attacks.

2. Physical control strategies: During this step, the person learns to breath differently and relax in order to reduce the anxiety and panic.

3. Psychological control strategies: During this step, the person learns how to handle the panic thoughts by realistically evaluating and modifying thinking patterns that trigger and maintain the panic.

4. Behavioral strategies: During this step, the person is encouraged to face those situations that trigger panic attacks by testing the new coping skills.

Cognitive therapy is a form of psychotherapy that focuses on changing peoples' unproductive and inaccurate beliefs which are the source of the panic attacks. Numerous controlled trials conducted in the United States, Germany, England, Netherlands, and Sweden have shown that cognitive therapy is an effective treatment for panic disorder.

Cognitive therapy is based on the cognitive model of panic disorder, which considers that panic attacks in those that suffer from panic disorder are being caused by a misinterpretation of the body and mental sensations. These sensations are usually perceived more dangerously than they really are, and are seen as sign of an imminent catastrophe.
Cognitive therapy for panic disorder is usually a brief treatment that includes between 8 and 15 sessions which follow several steps:

1. Education: When the patient receives information about panic disorder, and the common myths about the danger of panic attacks are explained. During this step, each symptoms is identified and the panic itself is defined.

2. Cognitive restructuring: During this step, the person learns to identify how cognition provokes panic, explores and evaluates the accuracy of his or her thoughts, and identifies distortions.

3. Decatastrophize step: When the person learns to think in more adaptive ways.

Medication: Those that suffer from panic disorder can benefit from medication to treat panic attacks. There are two types of medication prescribed for those that suffer from panic disorder anti-anxiety medication and antidepressants. In some cases, when necessary, heart medication may also be prescribed.

Tranquilizers: Benzodiazepines are an anti-anxiety medication used for people that suffer from panic disorder for their sedation or tranquilizer effect. They decrease the physical symptoms of a panic attack (such as pounding heart, chest pain, dizziness, trembling, muscle tension, or nervousness) leaving the person calm and relaxed, and reduce the frequencey of panic attacks.

Unfortunately, the use of benzodiazepines is associated with adverse side-effects during use and after stopping the treatment. One of the most predictable side effects when used over the long-term is physical dependence. Used in combination with other central nervous depressants (opiates) or alcohol, benzodiazepines increase the risk of an overdose and death due to collapse of the central nervous system, as well as respiratory and cardiovascular system depression. Benzodiazepines can impair the ability to drive and operate machinery (impairment that can worsen in association with alcohol) or cause behavioral disturbances and cognitive impairment and deficits.

Antidepressants: Antidepressants can be prescribed for those that suffer from chronic panic disorder or panic disorder associated with depression. Studies show that antidepressants reduce the panic severity, control anxiety, and eliminate the attacks. The two most common types of antidepressants prescribed for panic disorder patients are tricyclic antidepressants (which correct the imbalance of norepinephrine and serotonin) and selective serotonin reuptake inhibitors (which corrects the serotonin imbalance).

Heart medication: In some cases, heart medication (such as beta blockers) is prescribed for panic disorder patients because of its beneficial effects over physical symptoms of anxiety (shaking and heart palpitations).

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Do you suffer from panic attacks? Contact Tulsa Therapist Alina Morrow, LPC, today to make an appointment and get the help and relief you deserve. You can reach me by texting or calling 918-403-8873 or by Email.

Page Last Updated: October 30, 2016

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