Effective Management Strategies For Panic Disorder: Psychotherapy, Medication, And Cognitive Behavioral Therapy

What is Panic Disorder and its symptoms?

Discuss about the CBT Model of Panic Attack Treatment.

A panic disorder can be defined as the sudden episode that accompanies intense fear, which is mainly responsible for triggering a range of physical reactions in situations that do not contain a real cause or danger for becoming tensed. When panic attacks occur, the events make patients feel loss of control or experiencing a heart attack or they are dying (Meichenbaum 2017, p.121). Panic attacks are seen to develop almost suddenly without any form of warning. Some of the most common signs and symptoms of that include premonitions of impending danger, increased heart rate, and loss of control, tremors, sweating, death as well as shaking. Chest tightness, shortness of breath, nausea, abdominal cramping, cheat pain, headache, dizziness, lightheadedness and others are some of the common symptoms of the disorder. Panic attacks are intensely uncomfortable but they are not dangerous (Huffman et al. 2014, p.929). However, panic attacks are difficult to manage and these situations worsen without any form of the treatment. Panic attacks can give rise to symptoms that might look like heart attack and therefore it is very important for the healthcare professionals to take interventions that help in the management of the disorders.  Every professional should be well aware of the different management techniques and should follow evidence-based studies so that they can care for the patients and help them to lead better quality lives.

Education is considered one of the most important factors that help in the psychotherapy treatment for the disorder. The therapists can teach the patients about the flight and fight response of the body as well as the associated physiological sensations. Researchers are of the opinion that learning to recognize as well as identify the different sensations is one of the most important steps towards the effective treatment of the panic disorder. Emphasis is provided on the education as well as teaching of effective coping strategies. These are mainly the primary objectives of the aforementioned therapy (Nathan and Gorman 2015, p.221). However, family therapy is considered by researchers to be unnecessary as well as inappropriate. Psychotherapy is also helpful in teaching relaxation as well as imagery techniques. It is also found that discussion of the irrational fear of the clients during the attack is not only appropriate but also beneficial in the context of different types of supportive therapeutic relationship. On the other hand, group therapy is also stated to be as effective as that of the teaching of relaxation as well as related skills. Researchers are also of the idea that psycho-educational groups in this area are also beneficial. One of the psychotherapeutic interventions that had also been proposed by many of the studies is the biofeedback (Joyce et al. 2016, p.689). This is one of the specific techniques that mainly helps in allowing the patient in receiving either the audio as well as the visual feedback mainly about their body’s physiological response during the time of the learning of the relaxation skills. However, there is another aspect that remains intricately associated with this technique.  All the important relaxation skills as well as assignments that are discussed in therapy sessions should be reinforced in the form of daily exercises by the patient. When the client become unable or remains unwilling for completing daily exercises or homework in the practicing of the relaxation as well as the imagery skills, then the therapies that are proposed by the therapists become unsuccessful or less successful (ER 2015, p. 621). The therapist has the responsibility to undertake a proactive approach for changing the behaviors need be clarified at the onset of the therapy. It is important for the therapist to discuss the expectations clearly in order to bring success to the techniques in a much greater way.

Education’s role in Psychotherapy for Panic Disorder

Cognitive behavioral therapy can be explained as the combination of the cognitive therapy that is capable of modification as well as elimination of different types of thought patterns that contribute to different symptoms of the patient and behavioral therapy that mainly aims in the helping the patient to alter the behavior successfully. The patients are expected to meet the theorists for about two to three hours in a week (Chen and Tsai 2016, p.223). In the cognitive section of the therapy, the therapist is mainly seen to undertake a careful search mainly to follow the feelings as well as the thoughts of the patient accompanying the panic attacks. These mental events are discussed in terms of the “cognitive model” of panic attacks disorders. Researchers are of the opinion that people who are suffering from panic disorders mainly have distortions in their thinking procedures that they are unaware (Zvolesnsky et al., 2015, p.75). This mainly gives rise to the cycle of fear. Therefore, researchers are of the idea that such with the aid of skilled therapists, people suffering from the panic disorders can learn to be acquainted with their earliest feelings as well as the thoughts in their thinking sequence and thereby learn to take initiatives to modify the responses of such feelings and thoughts. Therapists usually counsel the patients in ways by which tremendous nervousness and stress associated with panic disorders are handled effectively with strategies of self-management of anxiety that ward of panic attacks. This can be explained with the help of the example (Teng et al., 2015, p.6). A patient who was initially feeling “I am having a panic attack” or “I am going to have  a heart attack” or “My breath will stop” and similar others get replaced by “it’s just a period of uneasiness that will pass” or “I know it is a stressful moment that will pass” and similar others. Therefore, therapists play a great role in the application of specific procedures for accomplishing what needs to be taught to the clients. By effectively modifying the thought patterns in this way, the client become more successful in gaining control over the problems. One of the most important feature of this therapy is that it does not focus on the past life of the patient and entirely focuses in the successes as well as the difficulties that the patient is having in the present moment. The behavioral portion of the cognitive behavioral therapy mainly focuses on bringing out changes in the behavior and mainly seen to include systematic training procedures that include different types of relaxation techniques (Tully et al., 2017, p.337). Researchers are of the opinion that by helping the persons to relax, the client will be able to develop the ability that will result in reduction of the generalized anxiety as well as stress that are mainly responsible for setting the stage of the panic attacks. One of the relaxation techniques is the breathing exercises. Here, the professionals help the clients to learn the ways of controlling breathing and thereby avoiding hyperventilation. The later is the pattern of rapid as well as shallow breathing that when experienced by the patients can trigger as well as exacerbate panic attacks. One of the other important aspect of the behavioral therapy is that patients become attuned as well as aware of the internal sensations (Powell and Enright 2015, p.21). The therapists mainly contribute by helping the patient to become more aware of the internal sensations that remain associated with the panic. The therapists asks the patients to exercise the feelings they have during the attacks and then teach them ways about how to cope with their feelings and replace alarmist thoughts.

Cognitive Behavioral Therapy for Panic Disorder

Researchers are of the opinion that most of the cases of panic attack disorders can be successfully treated without resorting to the use of the medication. Still, when medication is required there are mainly two set of medications that are important to treat panic attack disorder.  The most commonly prescribed class of medications is the benzodiazepines like that of clonazepam and alprazolam. There are also SSRI antidepressants. The best of the technique stated by the professional researchers is to never use the medication alone but to use the medication with the effective use of the psychotherapy. This helps in educating as well as changing the behaviors of the patients that are related with the association of certain physiological sensations with that of fear (Livermore et al. 2015, p.39). Different types of log used medications are that are found to be useful in treating panic disorders is the Clonazepam like that of Rivotril and Klonopin. Alprazolam like that of the Xanax is also used for this disorder. Researchers are mainly of the opinion that such medications are much better and safer than the antidepressants because of them have less severe side effects of drugs. However, the medication of Xanax was found to be addictive to many of the participants in the randomized control trials and therefore researchers are of the opinion that they should be used with care. Moreover, another important aspect of the use of clonazepam or that of alprazolam is that these medications should be discontinued by the procedure of tapering very slowly (Knapp et al. 2017, p.11). This is mainly because of the possibility of the occurrences of seizures when the clients are seen to abrupt discontinuation of the medications all of a sudden. It is very important to know the ways by which the medications take the approach for effective treatment of panic disorders. This approach mainly has the prescription medication that can be utilized for the prevention of the panic attacks, reduction in the severity and the frequency of the attacks, decreasing the associated anticipatory anxieties. When the clients become aware that their panic attacks are not much frequent and become increasingly able for venturing in different types of situations that were previously off-limits for them (Imai et al. 2014, p.7). These had been the procedures that benefit the patients from the exposure to situations that were previously feared and even from the different medication. Another set of medication is called the selective serotonin reuptake inhibitors (SSRIs). They are now considered mainstay treatment for panic disorders. The other commonly used different medications are the tricyclic antidepressants, the highly potent benzosiazepines as well as the monoamine oxidase inhibitors that are the MAOIs. Researchers are of the opinion that determination of the correct type of the drug for the patient is mainly decided upon the considerations of the safety, efficacy and the different types of personal needs and preferences of the patient (Farris et al. 2016, p.32). Antidepressant medications have been useful in the reduction of the severity of panic attacks and also helps in elimination of the attacks. They are also seen to be useful because they help in improving the overall quality of life of the different people who are suffering from the panic attacks. It has been proved through different analysis that tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRIs) are highly effective in reduction of the panic severity as well as the number of attacks. It had been found from the randomize control trials that about 615 of the patients had stated that they were panic free after about 6 to around 12 weeks for treatments when comparison was made from the 41% of the control patients (Pateraki and Morris 2018, p.539). Again there had been arguments about which of the antidepressants are more effective – SSRIs or that of TCAs.  Most of the meta-analysis has found that SSRIs are usually more superior to that of the TCAs. However, it can be stated that the benefits of the SSRIs had been overstated in the latter study as it had failed to explain publication bias that means that the greater likelihood that small bodies finding negligible differences between the treatments will not be allowed for publishing. Benzodiazepines are also found to be as effective as antidepressants in the reduction of the panic attacks and the reduction in the frequency of the attacks. However, there had been studies that had stated that the medication could cause depression in the individuals (Cruz et al. 2015, p.178). They are also seen to be associated with unfavorable effects during the use as well as after discontinuation of the therapy. Many of the researchers are also of the opinion that they have less positive effects than the antidepressants such as in the case of global functioning. When patients with panic attacks and co morbid conditions like that of pervious depression, they had seen poorer outcomes when Benzodiazepines compared with the use of antidepressant in the same patients.

Using Medication as an Effective Treatment for Panic Disorder

There had been various arguments regarding the success of the combination use of the antidepressants and cognitive behavioral therapy but it has still remained unclear whether one treatment is superior to the other or not. Many of the studies suggest anti-depressants to be less effective than the CBT in the reduction of the panic symptoms. However, major methodological issues have been found and therefore the reports are controversial. Again, some of the meta-analysis have shown that the combination use of both the interventions have brought out some of the best benefits or outcomes in the short term studies (Farris et al., 2014, p.37). Many of the studies have revealed that the t combination use of both the interventions brought out best effects in the initial phase of the therapies but after they were discontinued, participants who used CBT alone and CBT plus placebo brought better outcomes than the cases with the use of combination interventions.  There had been also arguments that had provided conflicting results over the tenure needed to continue for the antidepressant therapy with or without CBT (Schwartze et al. 2017, p.77). Different studies have suggested of low relapse rates after six months of the antidepressant therapy. Moreover, when the antidepressant therapy was continued beyond six months, there was no decrease in the relapse rates. Again there had been a recent study that had controlled for the post treatment therapy after the use of the CBT and had found no differences in the relapse rates after continuing as well as discontinuing anti-depressants (Furbish et al. 2017, p.427). However, this study was so small that it could not detect potentially important differences in any of the outcomes.

Conclusions:

From the entre discussion, it is seen that panic disorder is a form of anxiety disorder. Different forms of recurring unexpected panic attacks mainly characterize it. This form of panic attacks mainly sudden periods of intense fear which is mainly seen to include palpitations, sweating, numbness, shortness of breath or a feeling which makes individuals feel that something bad is going to happen. Different types of techniques have been developed over time, which helps in treating individuals with panic disorders. One of them is the psychotherapy that mainly helps to understand the main cause of the panic attacks and thereby help the individuals to learn about the ways that help them to cope with the attacks. One of these types of therapy is the cognitive behavioral therapy where the therapists will recreate the symptoms of panic attack in a safe as well as repetitive manner. When the physical sensations of panic no longer fees threatening, the attacks continue to resolve. Sensitive serotonin reuptake inhibitors called the SSRIs as well as benzodiazepines are some of the medications that are advised by the professionals to be prescribed for the patients with the disorder. Although there are arguments, professionals should try to look for the evidence based practices and consider the level of evidence before they adopt any of the interventions in their care plan.

References:

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