Anxiety: Panic Disorder

Reminder of Scenario #2:
A piano's about to fall on your head (we won't wonder why it's hanging in the air). You panic and get out of
the way just in time. Good job.

Panic can be a great thing! Imagine if your body didn't have a fight/flight response system to immediately react to something potentially adverse. Panic can keep you safe. It can help you keep others safe. It's a great protection mechanism. Most (if not all) of us have panicked sometime in out lives, be it at the sight of a pop quiz or seeing a child run out into the middle of the street. Some of us may have even had a full-blown panic attack. But that doesn't mean that you have panic disorder.

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So when do you have panic disorder?

You have it when that piano's always falling on your head, even if there's no piano in the room. You could be sitting somewhere watching I Love Lucy and start panicking. Thus, in panic disorder, the panic you experience is a false alarm. That's why it's a disorder: If there were a real reason to panic, your reaction wouldn't seem out of the ordinary. People who have OCD and Generalized Anxiety Disorder (GAD) may experience more panic-inducing experiences because of the anxiety they already carry.


What exactly is panic disorder?
It's defined as discrete (separate) periods of intense fear. Remember that that fear is focused on the present. So, it's something that causes an fear reaction now, not in the future.

The requirements are that said fearful experience has to come with at least four of the following:

Those who are diagnosed with it will get recurring attacks followed by at least one month of (1) worrying about future attacks and/or (2) a major change in their behavior as a result of an attack.

Many who have this disorder also develop Agoraphobia, which is a very intense fear of (1) not being able to escape if you need to or (2) being in a place where you can't get the help you need if something negative happens. It stems from the fear of being vulnerable or without control. Those with Agoraphobia may avoid eating out at restaurants or even going shopping due to this fear.

In addition, if you have panic disorder, you may seriously avoid going to the gym or asking that cute guy/girl out on a date. Why? Well...

Exercise is usually accompanied by increased heart rate, sweating, chest pain, and sometimes even shortness of breath. If you exercise too much, you may even get nauseous. Asking someone out on a date very often comes with increased heat rate, shaking, sweating, and for some, a sense of impending doom. Notice a similarity between these symptoms and the symptoms of panic? If you're going to start to experience the symptoms of a panic attack (something you actively try to avoid), why would you even go there?

Medication and CBT
The first rule of treatment is "Do no harm." With both medication and CBT (talked about here), there are advantages and disadvantages.

The most commonly used type of medication for panic is called a beta-blocker. Even though we can't just fix the part of the brain that's causing the panic attacks, a beta-blocker can help to suppress the physical symptoms so that when the person does panic, it's easier to calm down and move on.

Advantage: The person can calm down sooner and thus, lead more of a normal life.

Advantage: It works quickly. No need to spend hours with a therapist. 

Disadvantage: The potential side effects of some beta-blockers (insomnia, dry mouth, memory/learning problems) are either related to the symptoms of the disorder or could trigger another panic experience. 

Disadvantage: The person will always have to continue taking medications because that's the only way he/she has to control it.

Question: In the end, is it more harmful to keep a person on a beta-blocker for the rest of his/her life, or would CBT be better?

Here's the scoop on CBT: As I explained earlier, CBT helps people recognize triggers to their specific condition and develop techniques to control their own reactions and sensations. In panic, CBT would work with the person to pinpoint a few scenarios in which they tend to freak out for no reason. As they experience those same sensations (heart rate, sweating, etc.), the therapist would help them recognize that everything really is okay and nothing catastrophic's going to happen. Over time, the person would learn to "catch themselves in the act," as it were, and either calm down on their own or not panic at all.

Advantage: Over time, you can gain better (and even complete) control of your reactions.

Advantage: No dependency on medication. 

Disadvantage: It takes time. The amount of time depends on the person. Are you willing to spend the time necessary to overcome this?

Disadvantage: You will be exposed to many panic-inducing things, thus causing significant distress in your life, even if it's only for a short time. 

Question: It is more harmful to consistently expose a person to things that cause them to panic, even if it's in the name of helping them, or would medication be a more appropriate alternative? 

Some have tried a combination of CBT and medication with the thought that suppressing the symptoms a little could help the person gain gradual control of the disorder. While that can be beneficial in other disorders, it doesn't really work if you want to use therapy to overcome panic: If you're suppressing the symptoms that therapy is trying to expose you to, not much progress will be made. One can't face a problem that's being suppressed by something else.