Panic Disorder with or without Agoraphobia and Panic Attacks: Is your world getting scarier and smaller?
Has COVID-19 brought on panic attacks for you? Or are you having more panic attacks since the onset of the novel coronavirus SARS-CoV-2 pandemic?
If so, are you considering therapy for your panic attacks?
Are you feeling like you have lost control over most things in your life? And nowadays perhaps feeling like you are no longer losing control only when panic attacks, but much of the time, making for more frequent panic attacks?
Does the panic bring on a sense of dread or even impending doom?
Does it all get worse if you know you may need to leave the house for essentials, or when you are at the grocery store?
You could be suffering with Panic Disorder, which may be accompanied by Agoraphobia.
What is a panic attack?
A panic attack is a cluster of physical symptoms, such as a racing heart, chest pain, chest tightness, shortness of breath, dizziness, lightheadedness, weakness, stomach discomfort, nausea, sweating or chills, numbness, tingling, trembling, and shaking, that occur unexpectedly. About 2.7% of the adult U.S. population will experience a panic attack each year.
The panic attack experienced can be centered on physical symptoms. For this reason, it is paramount to ensure that the physical symptoms are indicative of a panic attack and not a medical emergency. This is particularly important the first time a cluster of physical symptoms appears that may be a heart attack or other physical ailment. It is common that someone who is experiencing the physical symptom cluster for the first time go to the Emergency Room. At the ER, the ER physician can run tests and treat the physical symptom cluster as a medical emergency, if appropriate, or the ER physician may rule out a heart attack (or other physical ailments) and diagnose a panic attack or panic disorder instead. Panic attacks are frequently diagnosed in ERs and Urgent Care Clinics. If you have experienced physical symptoms in the cluster and did not seek medical attention yet, it is important that you see your medical provider for a heart checkup as soon as possible.
How is Panic Disorder different from a panic attack?
Panic disorder is diagnosed when a person has had at least two unexpected panic attacks. It is possible to learn with experience the symptoms that are part of Panic Disorder. There are other kinds of symptoms that may accompany a panic attack in addition to those in the physical symptom cluster. The fear of having another panic attack is often preoccupying. Because people who are suffering with Panic Disorder fear the consequences of the symptoms they are experiencing, recurrent panic attacks are often interpreted by the people having them as if they are having a heart attack, beginning fainting, going "crazy," or are going to die. Finally, it is possible to have experiences during a panic attack of looking at oneself from the outside or feeling like what is happening is not real.
What is Agoraphobia?
Agoraphobia may occur on its own, although it accompanies panic disorder more commonly when people who have panic attacks avoid situations they believe will trigger a panic attack because it will be difficult to escape or get help. Common situations that are avoided because immediate escape may be difficult include driving on busy roads, going to the movies or concerts, eating in restaurants, exercise, or traveling outside the bounds of a general "safe zone." In the days of COVID-19, grocery stores, pharmacies, essential workplaces, and other places of business deemed essential to remain open may be avoided to prevent a panic attack.
If avoidance is impossible, a person with Agoraphobia will find themselves going through the situation with severe anxiety. Consequently, the world shrinks around the person suffering with Agoraphobia who is constantly on guard for the next panic attack. A world that has shrunken may include certain routes by car, public transportation, or on foot that are considered safe or safer than other routes. Living in a world shrunken can also involve not moving beyond the borders or perimeter of a safe territory. A safe territory may vary vastly in size from one person suffering with Agoraphobia to the next.
What kind of treatments do you use in therapy for Panic Disorder with or without Agoraphobia?
All therapy sessions are provided in a telehealth format during the ongoing COVID-19 mitigation efforts. At Verdandi Anxiety Clinic & Consulting, Dr. Ellen Jorstad-Stein uses Cognitive Behavioral Therapy as a first line treatment for Panic Disorder that may or may not be accompanied by Agoraphobia. Cognitive Behavioral Therapy addresses the three components of anxiety including physical symptoms, thoughts, and behaviors that were described in the previous sections in this informational piece. Typically, clients learn to recognize their physical panic-related symptoms and approach these through interoceptive exposure until anxiety about the symptoms are minimized. Clients also learn through cognitive therapy to identify and challenge their unhelpful and negative panic-related thoughts. Exposure therapy related to approaching and staying in real world situations that a client avoids because of panic may also be a part of the treatment plan. This part of the treatment often requires “out of the office” sessions with Dr. Ellen.
Is virtual online therapy effective?
There is a growing body of evidence about the effectiveness of Cognitive Behavioral Therapy for Panic Disorder with or without Agoraphobia that is delivered over the internet with a therapist. 1, 2 There is evidence that people who complete Internet Cognitive Behavioral Therapy for Panic Disorder and/or Agoraphobia have better outcomes better than those who only receive information or remain on a waitlist. The evidence also suggests that outcomes for Internet Cognitive Behavioral Therapy related to reducing panic and Agoraphobia symptoms are similar to traditional in person face to face Cognitive Behavioral Therapy in an office setting. 3
Verdandi Anxiety Clinic & Consulting located in Hinsdale in the western suburbs of Chicago is experienced at treating Panic Disorder and Agoraphobia with cognitive behavioral therapy, exposure therapy, and mindfulness-based therapies. There is help available to reduce your symptoms of panic and anxiety, and to increase your life satisfaction. If you are interested in finding out more about specialist anxiety treatment services, you can Contact by calling on (630) 280-8900 or completing the contact form.
References
- Olthuis, J.V., Watt, M.C., Bailey, K., Hayden, J.A., Stewart, S.H. (2015). Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. The Cochrane Database of Systematic Reviews, Mar 5;(3):CD011565. doi: 10.1002/14651858.CD011565.
- Andrews, G., Basu, A., Cuijpers, P., Craske, M.G., McEvoy, P., English, C.L., Newby, J.M. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. Journal of Anxiety Disorders, 55, 70-78. doi: 10.1016/j.janxdis.2018.01.001.
- Stech, E.P., Lim, J., Upton, E.L., Newby, J.M. (2019) Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis. Cognitive Behaviour Therapy, Jul 15, 1-24. doi: 10.1080/16506073.2019.1628808. [Epub ahead of print]