Another important aspect of behavioral therapy is “in vivo” or real-life exposure. The therapist and the patient determine whether the patient has been avoiding particular places and situations, and which patterns of avoidance are causing the patient problems. They agree to work on the avoidance behaviors that are most seriously interfering with the patient’s life. For example, fear of driving may be of paramount importance for one patient, while inability to go to the grocery store may be most handicapping for another.
Some therapists will go to an agoraphobic patient’s home to conduct the initial sessions. Often therapists take their patients on excursions to shopping malls and other places the patients have been avoiding. Or they may accompany their patients who are trying to overcome fear of driving a car.
The patient approaches a feared situation gradually, attempting to stay in spite of rising levels of anxiety. In this way the patient sees that as frightening as the feelings are, they are not dangerous, and they do pass. On each attempt, the patient faces as much fear as he or she can stand. Patients find that with this step-by-step approach, aided by encouragement and skilled advice from the therapist, they can gradually master their fears and enter situations that had seemed unapproachable.
Many therapists assign the patient “homework” to do between sessions. Sometimes patients spend only a few sessions in one-on-one contact with a therapist and continue to work on their own with the aid of a printed manual.
Cognitive-behavioral therapy generally requires at least twelve (12) weeks to start becoming effective. Some people may need a longer time in treatment to learn and implement the skills. This kind of therapy, which is reported to have a low relapse rate, is effective in eliminating panic attacks or reducing their frequency. It also reduces anticipatory anxiety and the avoidance of feared situations.
Other Therapy Treatments
There are other types of psychotherapy treatments available for panic disorder. Psychodynamic therapy is a form of “talk therapy” in which the therapist and the patient, working together, seek to uncover emotional conflicts that may underlie the patient’s problems.
Although psychodynamic approaches may help to relieve the stress that contributes to panic attacks, they do not seem to stop the attacks directly. In fact, there is no scientific evidence that this form of therapy by itself is effective in helping people to overcome panic disorder or agoraphobia. However, if a patient’s panic disorder occurs along with some broader and pre-existing emotional disturbance, psychodynamic treatment may be a helpful addition to the overall treatment program.
Another treatment option is a psychotherapy group. Such groups meet usually once a week with other people who are also striving to overcome panic disorder or phobias. These weekly meetings are used to discuss progress, exchange encouragement, and receive guidance from a trained therapist who leads the group.
Medications for Panic Disorder
A lot of people who suffer from panic disorder can successfully be treated without resorting to the use of any medication. However, when medication is needed, the most commonly-prescribed class of drugs for panic disorders are the benzodiazepines (such as clonazepam and alprazolam) and the SSRI antidepressants. It is rarely appropriate to provide medication treatment alone, without the use of psychotherapy to help educate and change the patient’s behaviors related to their association of certain physiological sensations with fear.
There are a few long-used medications typically used to treat panic disorder: Clonazepam (Klonopin, Rivotril) and alprazolam (Xanax). Clonazepam and alprazolam are generally preferred by most doctors to antidepressant drugs because of their less severe side effects. 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.
In this treatment approach, a prescription medication is used both to prevent panic attacks or reduce their frequency and severity, and to decrease the associated anticipatory anxiety. When patients find that their panic attacks are less frequent and severe, they are increasingly able to venture into situations that had been off-limits to them. In this way, they benefit from exposure to previously feared situations as well as from the medication.
The selective serotonin reuptake inhibitors (SSRIs) are now the first line of medication treatment for panic disorder. Other commonly used medications are the tricyclic antidepressants, the high-potency benzodiazepines, and the monoamine oxidase inhibitors (MAOIs). Determination of which drug to use is based on considerations of safety, efficacy, and the personal needs and preferences of the patient.
Self-Help for Panic Attacks
Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings. Self-help books may also be helpful for a person to read, as they often provide techniques and coping tips an individual can use in their daily lives to help combat panic feelings.
Patients can be encouraged to try out new coping and relaxation skills with people they meet within support groups. They can be an important part of expanding the individual’s skill set and developing new, healthier social relationships. An online support group for panic disorder is also available.