Panic Disorder

Panic disorder consists of frequent and sudden panic attacks. Panic attack symptoms include rapid/pounding heart rate, chest pain, dizziness, fear of dying or losing control, feelings of nausea, faintness, shortness of breath, and sweating. The perceived consequences of panic attacks, such as a possible illness, embarrassment, or causing an injury or traumatic event, lead clients to avoid activities they used to engage in easily. Clients may be confused by their panic attacks because a specific trigger does not always follow them.

Panic disorder is essentially a fear of having panic attacks. Typically, what happens is a client will have a panic attack and then fear having subsequent panic attacks. They will avoid people, places, or situations that they feel could initiate a panic attack.

We have noticed over the years certain behaviors that those with panic disorder will do. For example, these clients will tend to carry around water with them. They might fear dehydration or becoming too hot. Heat is usually a trigger for them. They will engage in distraction behaviors as soon as they think a panic attack might start, such as scrolling through social media.

Most of these clients will have benzodiazepines (Xanax, Klonopin, Valium, Ativan, to list a few). They usually seek out these medications first from their psychiatrist or primary care physician. The problem with taking benzodiazepines for panic disorder is that the client will begin to think they need these pills. Moreover, the benzodiazepine reduces the client’s threshold for anxiety, so as soon as they think they could become anxious, they will take a pill. Sometimes, they will take a pill preemptively if they think they will be in a situation or environment that could trigger anxiety. Benzodiazepines exist for a reason and are necessary, however, if a client is depending on them as management of panic disorder, therapy is really needed. A client with panic disorder will go so far as to have a last resort pill hidden somewhere, like their wallet. We can’t tell you how many clients we have asked to remove their very expired and powdery pills from their wallets as an exposure! Some people have had the same pill in their wallet for years! This is also the benefit of seeing a provider who specializes in these kinds of disorders. We know all the nuances and what to ask. We see you!

Exposure response prevention treatment is used to treat panic disorder. Interoceptive exercises are included in the ERP treatment. Interoceptive exercises are specific behaviors we have the client do that would produce some symptoms similar to those of a panic attack, such as rapid heart rate, dizziness, trimmers, numbness, tingling, and more. Interoceptive exercises are not usually scary. The purpose of them is to expose clients to their feared symptoms repeatedly so that when they spontaneously develop some panic attack symptoms, they are less threatening. This reduces the chances of having a panic attack. Ultimately, once the client no longer fears having a panic attack, the panic attacks stop. Panic disorder is not difficult to treat and does not take long at all.

To learn more about exposure response prevention treatment (ERP), please click here.