Characteristics and Treatments for Panic Disorder

26 October, 2020
What's a panic disorder? What are its causes and possible treatments?

According to the DSM-5, between two and three percent of the general population in the Western world have had or will have a panic disorder. There are two affected women for every affected man and the average age is between 20 and 24 years old. But what exactly is this disorder? What causes it? Is there a treatment for it?

Let’s shed some light on anxiety disorder. For one, it can be disabling because a person who’s experienced a panic attack is often afraid they’ll have another.

These disorders, along with depressive ones and those pertaining to substance abuse, are quite prevalent. Thus, giving them visibility can raise awareness about their importance and repercussions.

A worried woman.

Definition and symptoms of panic disorder

Panic disorder is a type of anxiety disorder. Its main characteristic, according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), is the recurrent occurrence of sudden and unexpected panic attacks. A person is often calm and enjoying themselves in the moments before an attack. Similarly, as with panic disorders, they’ll fear having another one. This is because it interferes with important parts of their lives.

But what exactly is a panic attack? Also referred to as an existential crisis, it consists of the appearance of sudden and temporary episodes of sensations of anguish, malaise, and intense fear. Although their duration varies, they last approximately 15 minutes. Also, the peak of maximum intensity is a few minutes after it starts.

The symptoms that may appear during a panic attack are diverse and include sweating, hyperventilation, tachycardia, tremors, dizziness, vomiting, and nausea, among others. In addition, there are other psychological symptoms, such as the fear of losing your mind, losing control, having a heart attack, and dying. There can also be dissociative symptoms such as derealization (feeling that what’s happening isn’t real) or depersonalization (detachment from yourself).

Causes of panic disorder

The causes of panic disorder aren’t always clear. For example, the first panic attack may appear due to situational factors. Similarly, the fear of it happening again may be due to the generation of negative and aversive interpretations of bodily sensations (not related to anxiety).

Thus, if you interpret certain bodily sensations as anxiety-related, these may intensify and generate more fear and anxiety which, in turn, can lead to a panic attack.

Genetics may also be related to the etiology of panic disorder. In other words, people with relatives who also experience anxiety disorders are more likely to develop one. Finally, previous experiences and exposure to certain behavior patterns can also influence the beginning of a panic disorder.

Treatments for panic disorder treatments: psychotherapy

Some of the effective psychological therapies for panic disorder are cited in Marino Perez’s Guía de Tratamientos Psicológicos Eficaces (In English: Guide to Effective Psychological Treatments) (2010) and M. A. Vallejo’s Manual de Terapia de Conducta (In English: Behavior Therapy Manual) (2016).

Multi-component cognitive-behavioral programs

There are two highly effective programs in panic disorder:

  • Barlow’s Panic Control Treatment (2007).
  • Cognitive therapy by Clark and Salkovskis (1996).

Barlow’s therapy includes live exposure to interoceptive sensations as a central element of the intervention. Also, it includes the following components: psychoeducation, interoceptive exposure, cognitive restructuring, and breathing/relaxation training.

Likewise, Clark and Salkovskis’ cognitive therapy aims to identify, test, and modify erroneous sensations for more realistic ones. It includes the following components: psychoeducation, cognitive restructuring, behavioral experiments based on the induction of feared sensations, and recommendations for abandoning safe behaviors.

Breathing training

This is Chalkley’s (1983) training in slow breathing for panic attacks. It essentially involves learning slow, diaphragmatic breathing. However, its effectiveness as a stand-alone intervention is currently in question (ideally, it should include such training).

Applied relaxation

Öst’s (1988) applied relaxation is mostly used for panic disorder and it teaches progressive muscular relaxation so that a patient can use it to confront a future attack. It’s a gradual way to confront:

  • Firstly, the corporal sensations that unchain the panic.
  • The activities and situations you can avoid.

Live exposure therapy

One of the most effective treatments is exposure therapy by Williams and Falbo (1996). Such therapy involves systematic exposure to the situations they fear and avoid.

Vagal innervation

Sartory and Olajide’s (1988) vagal innervation for panic seeks to control the patient’s heart rate by learning some massage techniques on the carotid artery. Specifically, it consists of applying pressure to one eye while the person exhales.

Sensation-focused intensive treatment (SFIT)

The authors of this therapy for panic disorder are Morissette, Spiegel, and Heinrichs (2005). It’s an eight-day consecutive intervention that aims to entirely eliminate the fear of physical sensations.

To do so, they use massive exposure without graduation, facing the most feared sensations from the very beginning. They also strengthen the exposure and induce body sensations through physical exercises.

Acceptance and commitment therapy

Within acceptance and commitment therapy (ACT), there’s an increased acceptance of cognitive-behavioral therapy for panic, by Levitt and Karekla (2005).

It consists of a standard cognitive-behavioral procedure that includes psychoeducation, situational and interoceptive exposure, and cognitive restructuring. Also, it adds other components of CT, such as mindfulness and discussion about valuable activities in the face of anxiety.

A person undergoing therapy for panic disorder.

Pharmacotherapy for panic disorder

Marino Pérez (2010) and M. Vallejo (2016), explain that the pharmacotherapy used and validated for panic disorder includes the use of antidepressants and anxiolytics. In this regard, SSRIs are usually prescribed as antidepressants and benzodiazepines or tranquilizers as anxiolytics.

These drugs can help reduce anxiety in a person. However, it’s best for the treatment to combine both psychotherapy and pharmacotherapy. This is because the deep changes in the individual will always be obtained with suitable psychological support (with therapy, that is). Furthermore, pharmacotherapy can calm down an individual and lay the foundations for their recovery. However, psychotherapy is what will allow the individual to modify their beliefs and stop avoiding certain situations and sensations.

  • American Psychiatric Association -APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid. Panamericana.
  • Caballo (2002). Manual para el tratamiento cognitivo-conductual de los trastornos psicológicos. Vol. 1 y 2. Madrid. Siglo XXI (Capítulos 1-8, 16-18).
  • Pérez, M., Fernández, J.R., Fernández, C. y Amigo, I. (2010). Guía de tratamientos psicológicos eficaces I y II:. Madrid: Pirámide.