Effective Treatment for Panic Attacks (Part 3)
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-photo by Timothy Dykes on Upsplash
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, Klonipin) 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 manage the anxiety. They can also cause you to be more resistant to the MUCH more effective 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 including drowsiness, poor concentration, incoordination, muscle weakness, dizziness, mental confusion, memory impairment, and even feeling depressed.
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 unless you’ve developed a fear of the symptoms. Then, you may still need treatment. But, most people have panic because of the perfect storm of symptoms I described in my last post.
While some people respond very well to SSRI’s (Like Zoloft and Paxil) the best treatment for panic disorder is cognitive-behavioral therapy. The problem is Zoloft and Paxil take 2-4 weeks, sometimes more, before they work and the side-effects may worsen the panic. The great news is that I’ve seen panic attacks cured, that’s right CURED, in a single session. More often it’s a handful of sessions, but still…improvement after one.
There are three cognitive-behavioral strategies that are used to treat panic attacks: 1) interoceptive exposure (IE), 2) mindful acceptance of the symptoms, and catching anxiety early followed by rapid application of a variety of coping strategies. The latter is more effective for the anxiety attacks driven by worry (see my first post in the panic series). For true panic attacks, the best treatment, if it works, is mindful acceptance. But the most likely to work is IE.
Fighting anxiety fuels anxiety. When we truly accept the symptoms of the panic, they lessen. See my post on March 23, 2020 that even includes info on how to get your free recording of this strategy!!!
By far the most consistently effective strategy is IE (interoceptive exposure) 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. IE 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 eventually feel the physical sensations without feeling the fear. The fear is nearly always lessened in less than 30 min.
It is not recommended that you try IE alone. Work with an experienced therapist like myself because there is a very systematic and gradual way of approaching the exercises (kind of like putting your feet on the first step of a pool vs jumping into the deep end). A careful assessment will also determine what the best starting exercise is for you. If you try IE on your own, there is always the concern that you will take on too much, stop prematurely and increase your fear. A trained therapist will be able to ease you into the exercises, know what to do to help you deal with the anxiety if it happens to get too high, and maximize the likelihood that desensitization to the symptoms will occur in the first session. IE is 88-90% effective in curing panic attacks (ZERO panic attacks at 2 yr follow up) and many of the other 10-12% enjoy greatly reducing the frequency and intensity of panic.