Treatment For Panic Disorder
Research shows that the most successful treatment for panic disorder is a combination of antidepressant medication and cognitive behavioral therapy . Many clinicians recommend CBT as the first-line treatment, with medication added if necessary to make the patient comfortable enough to participate in CBT.
In treating someone who has panic disorder with CBT, the clinician starts by working with the patient to think more flexibly about his anxiety. Rather than viewing the physical symptoms as dangerous, he practices tolerating them, knowing that they arent harmful.
To help the person disconnect the negative feelings associated with attacks, the therapist induces those physical sensations the patient does jumping jacks or stair climbing to get the heart racing, spinning to get dizzy, breathing through a coffee straw to get shortness of breath. Were exposing you to the actual, physical feelings of a panic attack, one symptom at a time, Dr. Bubrick explains.
Then, instead of simply tolerating the anxiety and waiting for it to subside, the person is taught how to do deep breathing techniques, to calm the physical symptoms down. Some clinicians dont do the deep breathing, on the grounds that the symptoms will pass on their own. But Dr. Bubrick likes to give kids tools to give them a sense of empowerment, to have them feel that they can control the symptoms.
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How To Deal With Panic Attacks
A panic attack is a feeling of sudden and intense anxiety.
Panic attacks can also have physical symptoms, including shaking, feeling disorientated, nausea, rapid, irregular heartbeats, dry mouth, breathlessness, sweating and dizziness.
The symptoms of a panic attack are not dangerous, but can be very frightening.
They can make you feel as though you are having a heart attack, or that you are going to collapse or even die.
Most panic attacks last somewhere from five minutes to half an hour.
Complications Of Panic Disorder
Panic disorder is treatable and you can make a full recovery. But it’s best to get medical help as soon as you can.
If you do not get medical help, panic disorder can escalate and become very difficult to cope with.
You’re more at risk of developing other mental health conditions, such as agoraphobia or other phobias, or an alcohol or drug problem.
Having panic disorder may affect your ability to drive. The law requires you to inform the Driver and Vehicle Licensing Agency about a medical condition that could impact your driving ability.
Visit GOV.UK for further information about driving with a disability or health condition.
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What Are Some Over
December 11, 2014 by Dr. Carlo
Using over-the-counter medications and natural supplements for anxiety is a relatively new development when compared to using OTC medications for physical symptoms. As many people suffer from anxiety, the appeal of OTC medications is understandable. Its the convenience of going to the pharmacy and picking an OTC medication to treat any symptom you may have, be it a headache, muscle pain, fever, or cold. In addition, you dont need a prescription, which requires a doctors visit, and that entails calling the office, waiting a few days for the appointment, and accepting the doctors treatment which you only have a minority voice with regards to the decision for treatment. Why not take control of your own mental health and anxiety? Why should you suffer any longer, waiting for someone elses opinion? We are used to going to the pharmacy to obtain OTC medications for our physical symptomsbut what about for mental symptoms like anxiety? The good news is that there are research studies showing that OTC medications can help for anxiety.
Panic Attack Breathing Training
Once hyperventilation occurs, it is very difficult to stop entirely. You cannot simply hold your breath and have all the symptoms go away, nor can you stop a panic attack by breathing alone. But the right breathing can decrease the severity of the symptoms, and when your symptoms are less severe you start fearing them less, thus decreasing your risk of panic attacks in the future.
It’s best to start this as soon as you even think you might be hyperventilating, and especially if you start to feel panic attacks coming on:
- Breathe in through your nose for at least 5 seconds. Try to breathe in through your stomach if possible first, and fill up your chest second. Don’t try too hard to expand your chest hyperventilation makes it very hard to get a full breath, because your body doesn’t want a full breath.
- Hold for 2 or 3 seconds. Not too much longer. Most doctors advise against holding your breath very long, possibly because if your body regains the Co2 balance too quickly you may experience a change in your blood saturation that could cause other upsetting symptoms.
- Breathe out for 7 seconds by creating a small hole in your lips, almost like you’re about to whistle. Repeat as needed
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Tell Yourself Youre Just Processing Information
When youre suffering from PTSD, panic attacks are so often you cant tell when youre actually having one. Youre in a constant state of fight or flight for months on end. Youre too scared to fall asleep and terrified while being awake. Eventually, when you do finally fall asleep, you wake up from nightmares that scare you awake. Sometimes they come as often as every ten minutes.
A social worker once told me that nightmares are the brains way of processing information. The best way to combat them is to say processing information every time you wake up from one. This little trick has helped desensitize nightmares over the long-term so you feel less panicked after waking up from one.
How Are Panic Attacks Managed Or Treated
Psychotherapy, medications or a combination are very effective at stopping panic attacks. How long youll need treatment depends on the severity of your problem and how well you respond to treatment. Options include:
- Psychotherapy:Cognitive behavioral therapy is a type of psychotherapy, or talk therapy. You discuss your thoughts and emotions with a mental health professional, such as a licensed counselor or psychologist. This specialist helps identify panic attack triggers so you can change your thinking, behaviors and reactions. As you start to respond differently to triggers, the attacks decrease and ultimately stop.
- Antidepressants: Certain antidepressant medications can make panic attacks less frequent or less severe. Providers may prescribe serotonin selective reuptake inhibitors , serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants . SSRIs include fluoxetine and paroxetine . SNRIs include duloxetine and venlafaxine . TCAs include amitriptyline and doxepin .
- Anti-anxiety medications: Benzodiazepines are the most commonly prescribed anti-anxiety medication to treat and prevent panic attacks. They help with anxiety but have risks of addiction or dependence. These medications include alprazolam and lorazepam .
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How Breathing Affects Panic Attacks
Your breathing plays a significant role in panic attacks more so than most people realize. In some ways it causes the majority of panic attack symptoms.
Some examples of the symptoms caused by poor breathing include:
- Chest pains
- Trouble getting a deep breath
- Weak limbs
- Trouble thinking
The main breathing issue is known as hyperventilation. Despite what many people believe from childhood, hyperventilation is caused by too little carbon dioxide rather than too little oxygen. Even though hyperventilation makes you feel like you’re not getting a deep breath, it is actually caused by breathing out too much Co2 before you’re able to produce more.
When you hyperventilate your blood vessels constrict. This causes your body to reduce blood flow to the brain, it causes chest pains, it causes rapid heartbeat and more.
Hyperventilation can be caused by many different scenarios all of which relate to anxiety:
- Breathing too quickly* Breathing more than you need
- Thinking about breathing
The latter is a forgotten reason that hyperventilation occurs, but it’s common with those with anxiety. It causes hyperventilation because when you think about breathing your breathing becomes manual, and most people breathe poorly when they breathe manually.
Coughing and any type of issue with breathing out Co2 too quickly can also lead to hyperventilation.
How Long Does Treatment Take
Much of the success of treatment depends on your willingness to carefully follow the outlined treatment plan. This is often multifaceted, and it won’t work overnight, but if you stick with it, you should start to have noticeable improvement within about 10 to 20 weekly sessions. If you continue to follow the program, within one year you will notice a tremendous improvement.
If you are suffering from panic disorder, you should be able to find help in your area. You need to find a licensed psychologist or other mental health professional who specializes in panic or anxiety disorders. There may even be a clinic nearby that specializes in these disorders.
When you speak with a therapist, specify that you think you have panic disorder, and ask about his or her experience treating this disorder.
Keep in mind, though, that panic disorder, like any other emotional disorder, isn’t something you can either diagnose or cure by yourself. An experience clinical psychologist or psychiatrist is the most qualified person to make this diagnosis, just as he or she is the most qualified to treat this disorder.
This brochure is designed to answer your basic questions about panic disorder a qualified mental health professional will be able to give you more complete information.
Panic disorder does not need to disrupt your life in any way.
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Signs And Symptoms Of Panic Disorder
While many people experience just one or two panic attacks without further episodes or complicationsand theres little reason to worry if thats yousome people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.
You may be suffering from panic disorder if you:
- Experience frequent, unexpected panic attacks that arent tied to a specific situation
- Worry a lot about having another panic attack
- Are behaving differently because of the panic attacks, such as avoiding places where youve previously panicked
While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:
Anticipatory anxiety Instead of feeling relaxed and like your normal self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This fear of fear is present most of the time, and can be extremely disabling.
How Are Panic Attacks Diagnosed
Serious health problems, such as heart disease, thyroid disease and respiratory problems, cause symptoms similar to panic attacks. Your healthcare provider may run tests to rule out a physical problem. If theres no physical cause, your provider may make a diagnosis based on your symptoms and risk factors.
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The Role Of Medication In Anxiety Treatment
When youre overwhelmed by heart-pounding panic, paralyzed by fear, or exhausted from yet another sleepless night spent worrying, youll do just about anything to get relief. And theres no question that when anxiety is disabling, medication may help. But are drugs always the best answer?
Many different types of medications are used in the treatment of anxiety disorders, including traditional anti-anxiety drugs such as benzodiazepines and newer options like SSRI antidepressants . These drugs can provide temporary relief, but they also come with side effects and safety concernssome significant.
They are also not a cure. In fact, there are many questions about their long-term effectiveness. According to the American Academy of Family Physicians, benzodiazepines lose their therapeutic anti-anxiety effect after 4 to 6 months of regular use. And a recent analysis reported in JAMA Psychiatry found that the effectiveness of SSRIs in treating anxiety has been overestimated, and in some cases is no better than placebo.
Whats more, it can be very difficult to get off anxiety medications without difficult withdrawals, including rebound anxiety that can be worse than your original problem.
Dont Run Away Youll Only Strengthen Your Fears
I used to avoid places and situations where Id had a panic attack for fear of having another, but I found that actually going to that intimidating concert or overwhelming shopping mall, or whatever the case may be, has helped me regain freedom over the fear. Dr. Misti Nicholson, a psychologist and the director of clinical services at Austin Anxiety and Behavioral Health Services, calls this using paradox.
She explains: Logic and intuition tell us to run away or fight when we are in danger however, when we avoid panic or treat it like an enemy, we make it stronger. Instead, it is important to take a paradoxical and counter intuitive approach to panic. I often encourage my patients to do the opposite of what anxiety is expecting them to do. This often means moving toward what they are afraid of when anxiety is telling them to back away.
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What Can Clients Do During An Attack
The exercises described above are essential tools for reducing the likelihood of a panic attack occurring, recovering from the aftermath, and fostering better psychological wellbeing. However, they can also be used during a panic attack to reduce its severity and duration.
As soon as your client feels the onset of a panic attack, they should begin by grounding themselves, affirming that they are experiencing a panic attack, immediately creating some psychological distance, and identifying a panic attack as something that is happening to them. Once they have done this, their focus should be on managing the intense physical pain and anxiety they will be experiencing.
This is a Herculean task, and your client should realize that success is not making the panic attack disappear, but just making it a little more controlled.
They should use their controlled breathing exercises to soothe the brain, soften the alarm signals being sent by the body, and reduce the spiraling sensation of a panic attack. They should affirm that they are safe and that the panic attack will pass, labeling their emotions as calmly as possible to increase the psychological distance they created initially.
E Social Anxieties And Phobias
For those with social anxieties, medications can help to reduce the tensions associated with entering the fearful situation, to bring a racing heart and sweaty palms under control, and to reduce some shyness.
Physicians use several classes of medications that are beneficial, individually or in combination. These include the beta-blockers, benzodiazepines, venlafaxine, the SSRIs and trazodone.
The drugs with the longest history of use with social anxiety are the beta adrenergic blocking agents, also known as beta blockers. The most commonly used are propranolol and atenolol . The patient can take propranolol as needed or in dosages of 10 to 20 mg three to four times a day, or atenolol in dosages of 25 to 100 mg once daily. Surprisingly, controlled research studies have not supported the widespread anecdotal reports of success with beta blockers. Its possible that their best use is for occasional mild social anxieties associated with performance.
The high potency benzodiazepines clonazepam and alprazolam may also be effective. A combination of a beta blocker and low dosages of clonazepam or alprazolam could be best for some individuals.
If the social anxiety is more general, unpredictable and widespread, then patients may need to take venlafaxine, an MAOI such as phenelzine, or an SSRI such as sertraline. Keep in mind that these medications take several weeks to work.
Bupropion does not have enough evidence yet to verify its effectiveness for social anxiety disorder.
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How Are Anxiety And Panic Attacks Diagnosed
Anxiety disorders are usually diagnosed with a psychological evaluation. The Diagnostic and Statistical Manual of Mental Disorders , published by the American Psychiatric Association, provides diagnostic criteria for an anxiety disorder.
Lab studies to help diagnose or exclude medical conditions that may cause anxiety disorders or panic attacks include:
- Complete blood cell count
- Chemistry profile
- Urinalysis
- Urine drug screen
Tests to rule out central nervous system disorders that can cause anxiety or panic attacks to include:
Panic Disorder: When Fear Overwhelms
Do you sometimes have sudden attacks of anxiety and overwhelming fear that last for several minutes? Maybe your heart pounds, you sweat, and you feel like you cant breathe or think clearly. Do these attacks occur at unpredictable times with no apparent trigger, causing you to worry about the possibility of having another one at any time?
An untreated panic disorder can affect your quality of life and lead to difficulties at work or school. The good news is panic disorder is treatable. Learn more about the symptoms of panic disorder and how to find help.
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How Is Panic Disorder Treated
If youre experiencing symptoms of panic disorder, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.
Panic disorder is generally treated with psychotherapy , medication, or both. Speak with a health care provider about the best treatment for you.