Panic attacks typically begin in young adulthood, but can occur at any time during an adult's life. A panic episode usually begins abruptly, without warning, and peaks in about 10 minutes. It can last anywhere from a few minutes to a half hour or longer. Panic attacks are characterized by a rapid heart beat, sweating, trembling, and a shortness of breath. Other symptoms can include chills, hot flashes, nausea, cramps, chest pain, tightness in the throad, trouble swallowing and diziness.
Women are more likely than men to have panic attacks. Many researchers believe the body's natural fight-or-flight response to danger is involved. For example, if a grizzly bear came after you, your body would react instinctively. Your heart and breathing would speed up as your body readied itself for a life-threatening situation. Many of the same reactions occur in a panic attack. No obvious stressor is present, but something trips the body's alarm system.
Treatment emphasizing a three-pronged approach is most effective in helping people overcome this disorder: education, psychotherapy and medication.
Therapy can also teach relaxation and imagery techniques. These can be used during a panic attack to decrease immediate physiological distress and the accompanying emotional fears. Discussion of the client's irrational fears (usually of dying, passing out, becoming embarrassed) during an attack is appropriate and often beneficial in the context of a supportive therapeutic relationship. A cognitive or rational-emotive approach in this area is best. A behavioral approach emphasizing graduated exposure to panic-inducing situations is most-often associated with related anxiety disorders, such as agoraphobia or social phobia. It may or may not be appropriate as a treatment approach, depending upon the client's specific issues.
Group therapy can often be used just as effectively to teach relaxation and related skills. Psychoeducational groups in this area are often beneficial. Biofeedback, a specific technique which allows the client to receive either audio or visual feedback about their body's physiological responses while learning relaxation skills, is also an appropriate psychotherapeutic intervention.
All relaxation skills and assignments taught in therapy session must be reinforced by daily exercises on the patient's part. This cannot be emphasized enough. If the client is unable or unwilling to complete daily homework assignments in practicing specific relaxation or imagery skills, then therapy emphasizing such skill sets will likely be unsuccessful or less successful. This pro-active approach to change (and the expectations of the therapist that the client will agree to this approach) needs to be clearly explained at the onset of therapy. Discussing these expectations clearly up-front makes the success of such techniques much greater.
Phillip W. Long, M.D. notes that, "Clonazepam (Klonopin, Rivotril) and alprazolam (Xanax), are the treatment of choice in the treatment of Panic Disorder. Clonazepam and alprazolam are preferred to antidepressant drugs because of their less severe side effects." He also states that it is preferred to try the anti-anxiety agents before moving on to the antidepressants because of the increased side-effect profiles. Xanax can be addicting for individuals and should be used with care. Treatment with either clonazepam or alprazolam should be discontinued by tapering it off slowly, because of the possibility of seizures with abrupt discontinuation.
Patients can be encouraged to try out new coping skills and relaxation skills with people they meet within support groups. They can be an important part of expanding the individual's skill set and develop new, healthier social relationships.
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Last reviewed: By John M. Grohol, Psy.D. on 9 Oct 2013
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