Panic disorder is common. It affects millions of people of all ages and is twice as common in women. There is a difference between someone who experiences a panic attack and someone who develops panic disorder. A single panic attack is unlikely to require treatment whereas panic disorder does.
Panic disorder is characterized by recurrent unexpected panic attacks. At least one of the panic attacks will be followed by a persistent concern about having further attacks, or a significant change in behavior, or worry about the possible implications (e.g. insanity, death, public embarrassment).
When a panic event occurs it is one of the most terrifying sensations a person can experience. The heart pounds, chest pains, weakness, dizziness and a sense of unreality are frequently described. Panic can even occur during non-dream sleep. After the panic event, which can last anywhere from minutes to one or more hours, the person is left with a nagging worry about when and where it will happen again.
With such a background it is hardly surprising that the lives of people with panic disorder become more and more restricted. Home becomes a place of sanctuary and security. Shopping, driving, social functions and sometimes just leaving the house become things to avoid. The sense of vulnerability and helplessness in the event of an attack can be reduced if the person is accompanied by a trusted friend or relative.
When it comes to treating panic disorder the emphasis is generally placed on some form of psychotherapy with or without medication. Self-help is something that may be acknowledged during therapy, but it tends not to be addressed in any particular depth, perhaps because the therapist has little contact with self-help situations. In my view self help is best considered as something that supports more formal treatment. The individual can tailor it to suit their own needs, local arrangements and personal circumstances. It is also something that can be tremendously valuable in helping to reinforce the principles of therapy that have been acquired during more formal sessions.
Education is the cornerstone of therapy for panic disorder. Typically the therapist will introduce the patient to the concept of the fight-or-flight mechanism to explain why and how the body reacts to the perception of threat. This is the first step in learning that panic can be controlled. As the formal sessions progress (usually less than 12 in total) additional techniques such as imagery and relaxation are taught. Cognitive strategies, designed to change the way the person thinks about panic are also taught.
Within the therapeutic context different therapists will prefer different techniques. For example, some may like to use biofeedback, some may prefer small group to individual sessions. So although one therapist may differ from the next in terms of technique, the central principles tend to be the same.
Medication is not an essential ingredient to therapy but many people finds that it helps to take the edge off the worst sensations. Medication alone will not address the underlying problems that cause panic disorder so it is best viewed as something that supports psychotherapy, if the patient feels it is necessary.
Self help is about keeping hold of the knowledge and skills you have gained via therapy and applying them to your own life and circumstances. Perhaps the most important thing is to maintain a daily routine of relaxation, imagery and other techniques previously taught. Relaxation is a skill and like all skills it gets better with practice and dwindles without. Be consistent and build it into your daily life.
Perhaps you are also part of a self-help group? If you are, great Sometimes no group exists in your area and even if it does it may not be for you. What you choose to do in terms of self-help is really your choice but these need to be anchored around some very simple activities:
- Learn to control your breathing and practice this regularly.
- Build relaxation into your daily routine.
- Avoid smoking and drinking caffeine.
- Practice the techniques that allow you to cope with stressful situations.
- Eat balanced healthy meals.
- Do a little daily exercise.
- From time to time re-educate yourself about what you are doing and why.
Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.