Don't Panic

Although your physician and the media may lead you to believe that medication is the best answer, it is not. A meta-analysis (study including several studies) showed that the effect size for cognitive-behavioral therapy is .88; add medication and it reduces the effect to .58. Medication alone has an effect size of only .40.  In fact, benzodiazepines (e.g., Xanax, Ativan) which bring rapid temporary relief to a panic attack, actually negatively reinforces the fear in the long run.  This often increases the frequency of attacks, causes dependency on the drug, and tolerance such that you might need more and more medication to alleviate the anxiety.  They can also cause you to be more resistant to the moreeffective cognitive-behavioral therapies that directly treat the panic.  Benzodiazepenes will help decrease the symptoms of a panic attack, but do nothing to treat the cause of panic attacks.  There are also side effects includingdrowsiness, poor concentration, incoordination, muscle weakness, dizziness, mental confusion, memory impairment, depression.  

For some people panic attacks are a warning signal to motivate you to make a change in your life such as resigning from a job or ending an unhealthy relationship.  Once you make the change, the panic attacks often subside.  However, typically the best treatment for panic disorder is cognitive-behavioral therapy. 

There are two basic cognitive-behavioral strategies that are used to treat panic attacks: catching anxiety early followed by rapid application of a variety of coping strategies and interoceptive exposure.  Interoceptive exposure is the most effective treatment.  It’s based on the fact that the best way to overcome fears is to face them.  Unlike phobias, in which an individual fears situations and things (e.g. crossing bridges, dogs, public speaking) with panic attacks one fears physiological sensations of anxiety such as increased heart rate, difficulty breathing, dizziness, and feelings of unreality, just to name a few.  In interoceptive exposure, the person systematically engages in exercises in order to bring on these sensations.  These exercises are repeated until desensitization occurs (i.e. the person gets used to them).  These exercises include breathing through a small straw, breathing rapidly, shaking ones head from side to side, and staring at something under fluorescent lights (to bring on feelings of derealization/unreality).  The goal is to feel the physical sensations without feeling the fear.  

It is not recommended that you try interoceptive exposure alone.  Work with a therapist who has experience with it, because there is a very systematic way of approaching the exercises.  If you try to do these exercises on your own, there is always the concern that you will stop prematurely, thereby negatively reinforcing your fear, and making your fear worse. A trained therapist will be able to minimize the likelihood of having a panic attack during the exercises and maximize the likelihood that desensitization to the symptoms will occur in the session.   

Tune in soon for more on working past panic attacks!