Panic attacks with and without Agoraphobia

Panic Disorder: written by Ewa Ostoja, Ph.D., Licensed Psychologist (Tel: 970-214-5574)

I have extensive training and experience in the treatment of Panic Disorder and panic attacks. Panic attacks can be terrifying experiences. Panic attacks are also among the most treatable symptoms. Although panic attacks can initially be triggered by a specific event or experience, once they are set in motion, panic attacks usually become autonomous of their original trigger. Therefore, treating the underlying thoughts or circumstances will not interrupt the self-perpetuating nature of panic attacks. If you have repeated panic attacks or if you avoid situations for the fear of a panic attacks, it is very important that you seek help as soon as possible. Most clients with panic disorder can improve dramatically.

If you suffer from panic attacks, the best place to start is to see your Primary Physician to rule out any physical causes, such as thyroid dysfunction or an underlying heart problem. If you have been cleared medically, your best next step is to see a therapist who is trained explicitly to treat panic attacks. Talk therapy will usually not treat Panic Disorder.

When you see an appropriately trained Psychologist or therapist, you will usually first receive instruction in abdominal breathing in your first session. You will want to train as often as possible to become a chronic abdominal breather. This will reduce the likelihood of subsequent panic attacks occurring. You can also use abdominal breathing during a panic attack to lessen its severity.

Once you receive training in abdominal breathing and are given appropriate homework, you should generally receive education about the mechanism of panic attacks and best ways to cope with them (explained briefly below, and in the Resources for Current Clients).

At this point in treatment, I will usually explore the benefits of EMDR treatment. In taking a client’s history, I will have already identified events surrounding the onset of panic attacks, and other important potential targets for reprocessing. Many clients find that adding EMDR to the standard CBT protocol for treating panic can lessen the frequency and intensity of the attacks in the first place, making the CBT techniques easier to implement.

From the CBT perspective, panic attacks are instances of hyperventilation. Panic attacks are usually caused by your breathing patterns, which can be modified with training. Even though you may experience a thought or an event before your panic attack, this usually leads to a change in your breathing pattern, which leads to a hyperventilation episode.

The worst thing you can do during a panic attack is to fight or resist it. This only potentiates your fight or flight response which leads to more hyperventilation and to additional release in adrenaline and other stress hormones.  I teach clients strategies for riding out a panic attack. If there is associated avoidance of places because of fear of another panic attack (e.g., avoiding stores, public places, not leaving your home), I will instruct the client on specific cognitive-behavioral and mindfulness strategies to use. Panic Disorder is one of the most treatable afflictions, and it is best to intervene quickly.