Panic disorder with Agoraphobia
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Panic disorder with Agoraphobia



Panic anxieties and panic disorders have become very common in this world today. There are almost 30 to 40 percent of the world populations who face panic disorder with or without agoraphobia PD/PDA. ...

Panic anxieties and panic disorders have become very common in this world today. There are almost 30 to 40 percent of the world populations who face panic disorder with or without agoraphobia PD/PDA. This paper tries to analyze the various factors and symptoms of PDA along with the possible treatments to such problems. The main purpose of this paper is to reconcile the differences between the varied treatments available for PDA and conclude that combination of psychotherapy along with pharmacological treatment is the best solution to this problem.



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Panic disorder with Agoraphobia Panic disorder with Agoraphobia Document Transcript

  • Panic Disorder With AgoraphobiaAbstract: Panic anxieties and panic disorders have become very common in this world today.There are almost 30 to 40 percent of the world populations who face panic disorder with orwithout agoraphobia PD/PDA. This paper tries to analyze the various factors and symptomsof PDA along with the possible treatments to such problems. The main purpose of this paperis to reconcile the differences between the varied treatments available for PDA and concludethat combination of psychotherapy along with pharmacological treatment is the best solutionto this problem.IntroductionAlmost everyone has felt anxious at some point in their life. However, panic attack is a muchmore serious problem that almost grips the person like a heart attack. Panic disorder is arecurrent form of panic attacks that leads the patient to a debilitating state. Sometimes whenpanic attacks recur continuously then it might lead to agoraphobia. Agoraphobia means thephobia (fear) of agora (Greek marketplace), because generally people who visit malls andsuffer from panic attacks find it very difficult to find an exit (Rachman, 1984). PanicDisorder can either occur with agoraphobia (PDA) or without agoraphobia (PD). While panicdisorder and agoraphobia generally occur together, they can also exist in isolation without theinfluence of the other problem. This paper tries to analyze the main causes behind panicdisorder with agoraphobia (PDA) and find possible solutions that range from psychotherapy,cognitive-behavioral treatment to normal medication treatment.What Is Panic Disorder With Agoraphobia?
  • According to the Diagnostic and Statistical Manual of Mental Disorders, (4th ed., TextRevision; DSM-IV-TR; American Psychiatric Association, 2000), a panic attack is acombination of fear and discomfort that is generally characterized by more than fourconditions that affect the person’s well-being. Panic attacks make the heart pound, make theperson feel dizzy and disrupt normal breathing (Smith & Segal, 2012). Recurrent panicattacks make the person weak and leads to a disorder which is often accompanied withagoraphobia. Agoraphobia is often believed as a condtion where people are scared of openplaces. It has been reported that almost one third to one half of patients who suffer from panicdisorder also suffers from agoraphobia (Antony & Swinson, 2000). Panic disorders can bevery difficult to cope with so patients are always advised to seek medical or professional helpat the earliest. Panic disorder is chronic and it may adversely affect normal functioning of anyperson (Antony & Swinson, 2000). Panic disorders lead to agoraphobia which has beendefined by DSM-IV-TR as a condition where people seek escape from a certain situation orplace. In most cases, agoraphobia leads to extreme anxiety and fear which are faced bypeople who are away from home, in a crowd or while traveling in a bus or train. Now, let uslook at the pain factors that lead to panic disorder with agoraphobia (PDA).Factors That Cause Panic Disorder With Agoraphobia (PDA)It has been reported that symptoms and factors leading to panic disorder with agoraphobia(PDA) are almost similar in various parts of the world (Klerman et al., 1991). Today, mostresearchers believe that agoraphobia can be triggered by recurrent panic disorders (Antony &Swinson, 2000). It has been reported that some of the common factors that lead to panicdisorders have been inherited by us since in earlier days, human beings used to live in fear ofwild animals. However, from the point of etiology, though there might be some genetic linksbut PDA is not entirely the reason of genes. It has been reported that in any given year,
  • almost 30 to 40 percent of the general population face panic attacks or PDA that makes themfeel nervous and suffer immense mental problems. According to survey results conducted inU.S., almost 5 to 8 percent of adult population face PD or PDA at some point in their lifewhich implies that 15 to 25 million people undergo this problem, or simply stated one out ofevery 12 person in U.S. are under the threat of PD or PDA (Meca et al., 2010). In Australia,PD affects 1-2 percent of the population each year and the same can be seen in other placestoo (Sanderson & Rego 2000). Through all social cultures, people and races, PDA is a verycommon problem that needs immediate solution.Panic disorder symptoms are generally: shortness of breath or smothering sensations, painand discomfort, heart palpitations, choking and sweating, feeling nervous, feeling dizzy andtrembling, fear of going insane, nausea, numbness, derealization or depersonalization,paresthesias, and fear of dying. Following the first panic attack most people go through amonth of repeated attacks (Sanderson & Rego 2000). Most people who have experiencedpanic attacks do not understand why the problem occurred in their life. Panic disorder withagoraphobia (PDA) is experienced in claustrophobic places such as in theaters, restaurants,malls, busses and trains, basements, auditoriums, elevators and escalators (Sanderson & Rego2000). Sometimes, panic attacks are also caused due to some medical problems. Theseproblems range from hyperthyroidism to pheochromocytoma, extreme use of amphetamines,hypoglycemia, asthma, mitral valve prolapse and gastrointestinal problems. However, mostof these conditions that lead to PDA cannot be controlled with only medication.Though PDA may last for only five to ten minutes but the effects can leave the patientsshocked for hours. It has been also reported that patients who suffer from PD or PDA coupledwith depression are at a higher risk of committing suicides. PD/PDA occurs in conjunctionwith other problems 50 percent of the times and patients need special treatment to get out of
  • this problem (Meca et al., 2010). The following sections discuss the various treatments thatare available to treat patients suffering from PDA.Conventional TreatmentTreatment for panic disorders with agoraphobia (PDA) can be of different types but mostoften they include medication along with psychotherapy. There are two schools of thoughtsbehind treatment of PDA. One school thinks that PDA can be controlled only byneurophysiological or psychopharmacological treatment while the other school thinks thatcognitive-behavioural treatment is the only possible solution for PDA (Busch, 1995). Let usnow discuss the psychopharmacological treatment that is most often used to treat patientssuffering from PDA.According to Saeed and Bruce (1998), most medications that have been found beneficial intreating PD/PDA are tricyclic antidepressants, benzodiazepines, serotonin reuptake inhibitorsand monoamine oxidase inhibitors. Benzodiazepines have been recommended to be the mosteffective out of all these medicines to combat PD/PDA (Watanabe et al., 2007).According to Klein (1993), panic attacks can be controlled with only medication. Treatingpatients with imipramine have revealed good results. According to Klein’s studies, panicdisorder with agoraphobia (PDA) is different from normal panic disorder and both theseconditions require different form of treatment (Busch, 1995). Antidepressants, such asfluoxitene and sertraline can be used to stop panic attacks but to treat PDA one has to educatethe patient as well as the family. He further states that pharmacological intervention may notbe necessary when it comes to treating patients with only panic disorders but for treatingpatients with PDA, structured programs along with medicines is mandatory (Busch, 1995).However, modern research shows that when benzodiazepines are used in combination with
  • psychotherapy then best results can be achieved (Watanabe et al., 2007). The followingsection discusses the importance of behavioral treatment in dealing with PD/PDA.Role of Mental Health In Treating Panic Disorder With AgoraphobiaPanic disorder with or without agoraphobia (PD/PDA) can be a very strenuous condition thatmakes the patient weak and tired. It is believed that the first panic attacks must have beencaused by misfiring of a natural fear system (Busch, 1995). This leads to a vicious cyclewhich finally leads to agoraphobia. Though conventional treatment of PDA is medication butmodern research reveals that Cognitive Behavioral Treatment (CBT) is one of the mosteffective types of treatment for such problems (Galassi, 2007). It has been reported thatpharmacological treatment is effective for PDA but results show that most patients refuse totake medicines or face troublesome side effects so they discontinue medication. Due to thesereasons, psychotherapy and CBT have been recommended by researchers to treat patients(Telch et al., 1993). CBT treatment entails four basic components, of which, cognitiverestructuring is the first basic step. This step helps the patients to understand the problemsand conditions that trigger panic attacks. Self-awareness and sensing the problem is veryimportant to understand PDA (Busch, 1995). The next component of CBT is to understandspecific cognitions that showcase why the person is thinking about panic attacks and tonegate those distortions of thinking. Thirdly, the patients are put through “interoceptiveexposure” whereby patients are put under panic situations and told to cope with the problems.Lastly, the patients are put under situational exposure to panic situations and they arerepeated continuously until the patient understands that there is no fear of such situations(Busch, 1995). All these situations have been found to be very effective in treating patientssuffering from PDA. CBT techniques can be further classified as either (a) Cognitiverestricting treatment or (b) in vivo exposure treatment methods (Galassi, 2007). Some
  • researchers have also used group CBT treatment to find that it is indeed very effective intreating PDA. Panic attacks and agoraphobic behavior can be reduced with such form oftreatment (Galassi, 2007). However, the duration of treatment is a very serious factor whiletreating PDA patients (Sanderson & Rego, 2000). CBT is similar to psychoanalysis thoughthe approach is different. Overall, it can be stated that CBT under group therapy conditions isa very effective means of controlling and treating PDA patients. This form of treatment is lowcost and can be effective under both short-term and long-term conditions (Galassi, 2007).This form of treatment teaches the patient to control the anxiety triggering factors and helpsthem to cope with discomfort by controlling feelings. Breathing techniques, meditation,cognitive therapy and psychoanalysis are other forms of treatment that have been found to beeffective in treating patients with PDA.Reconciling Different Approaches of TreatmentThough the above sections clearly show that pharmacological treatment as well as CognitiveBehavior Treatment (CBT) can be effective in treating panic disorders with agoraphobia(PDA) but modern research shows that when both these forms of treatment are used incombination then the best results can be obtained for patients. According to Silverman, PDand PDA are heterogeneous forms of disorders that require different forms of treatment(Busch, 1995). Psychoanalysis has been reported to decrease the panic fears of patients butwhen combined with pharmacological treatment it can substantially yield the results within amuch shorter time period. Some research has reported that combined therapy can be moreeffective than exposure therapy where benzodiazepines are used (Sanderson & Rego 2000).For patients who have access to behavior therapy, benzodiazepine is not recommended.Exposure therapy is recommended to PDA patients but only if they have access to properresources (Watanabe et al., 2007). Patients suffering from PD with or without agoraphobia
  • can be best treated by combination of interoceptive and non-interoceptive exposure combinedwith breathing training, stress–relieving techniques and CBT (Meca et al., 2010). All in all, itcan be stated that patients suffering from PD/PDA should look for combined treatment ratherthan relying on only one form of treatment.Understanding and ConclusionReferencesAntony, A.A. and Swinson, R.P. (2000). Panic Disorder and Agoraphobia.Busch, F.N. (1995). Agoraphobia and Panic States.Galassi, Ferdinando. (2007). Cognitive-Behavioural Group Treatment For Panic DisorderWith Agoraphobia.Klerman, G., Weissman, M. M., Oullette, R., Johnson, J., & Greenwald, S. (1991). Panicattacks in the community: Social morbidity and health care utilization. Journal of theAmerican Medical Association, 265, 742–746.Meca, Julio Sacnhez., Alcazar, Ana., Martinez, Fulgenico and Conesa, Antonia. (2010).“Psychological Treatment of Panic Disorder with or without Agoraphobia: A Meta Analysis.”Clinical Psychology Review 30: 37–5.
  • Rachman, S. (1984). Agoraphobia—A safety-signal perspective. Behaviour Research andTherapy, 22, 59–70.Saeed, S.A. and Bruce, T.J. (1998). Panic disorder: effective treatment options. AmericanFamily Physician. Volume 57, No. 10:2405-2412.Sanderson,W. C.,&Rego, S. A. (2000). Empirically supported treatment for panic disorder:Research, theory and application of cognitive behavioral therapy. Journal of CognitivePsychotherapy, 14, 219–244.Smith, M.A. and Segal, Jeanne. (2012). Panic Attacks and Panic Disorder. Helpguide.Retrieved 29 Feb. 2012, from, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., LaNae Jaimez, T., & Lucas, R. A.(1993). Group cognitive behavioral treatment of panic disorder. Behavior Research andTherapy, 31,279–287.Watanabe, N., Churchill, Rachel, and Furukawa, Toshi. A. (2007). “Combination ofPsychotherapy and Benzodiazepines Versus Either Therapy Alone For Panic Disorder.”BMC Psychiatry 2007, 7:18.