Skip to main content Walden University Library · · · · · · · · · · Fullscreen · Transcript · Details · Clips · Share · Cite Top of Form Search Bottom of Form Transcript 00:00:00TRANSCRIPT OF VIDEO FILE:  00:00:00_____________________________________________________________________  00:00:00BEGIN TRANSCRIPT:  00:00:00[sil.]  00:00:10Panic Disorder and Agoraphobia  00:00:10SHARI SMALL Anxiety disorders. They impact nearly 20 million people in America alone. In fact, they are the most common psychiatric disorders affecting both children and adults. And with the increasing stress of living in the 21st century, both of global and personal level, the subject is getting more attention than ever. There are several anxiety disorders identified in the Diagnostic and Statistical Manual for Mental Disorders, commonly known as the DSM. Though they share a common theme of excessive, irrational fear and worry, each anxiety disorder has its own distinct features and challenges. In this program, we are going to explore panic disorder and agoraphobia. Many people have moments of panic in their lives.  00:01:00UNKNOWN What was wrong?  00:01:00SHARI SMALL But for some these experiences can become quite extreme.  00:01:05UNKNOWN I can't breathe.  00:01:05SHARI SMALL To the point that one might feel as if they are going crazy, suffocating or even dying.  00:01:10UNKNOWN You know, I think I need to go to the hospital.  00:01:15SHARI SMALL These are called panic attacks. One of the central features of panic disorder.  00:01:20Tory Nersasian, Psy.D.  00:01:20Psychologist  00:01:20TORY NERSASIAN People will actually report they feel like they are having a heart attack or that they are dying and the response, the physical response is not in response to any cue in the environment that should cause that type of feeling.  00:01:30SHARI SMALL In general, a panic disorder is diagnosed when a person has experienced at least two unexpected panic attacks and developed persisting concern about having further attacks or changes his or her behavior to minimize such events.  00:01:45UNKNOWN I had another panic attack. It happened out of the blue.  00:01:50UNKNOWN Really?  00:01:50SHARI SMALL Untreated, the disorder can become quite disabling.  00:01:55Sharron Thrasher, Ph.D.  00:01:55Psychologist  00:01:55SHARRON THRASHER They start to narrow and narrow and narrow their lives in order to prevent the situation that they think brought it on in the first place because they often, they don't really understand that it may have nothing to do with the surroundings or the circumstances or anything. It's just their body that has a kind of a faulty panic switch.  00:02:10UNKNOWN Since it happened in the car, I think I've been nervous about driving around town.  00:02:15UNKNOWN Be able to get around.  00:02:15UNKNOWN I know that and if I could control it, I would. It's just… Well I, I've just really been worried about it. That's all.  00:02:25SHARI SMALL Where as the number and.

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00:00:00TRANSCRIPT OF VIDEO FILE:
00:00:00_____________________________________________
________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:10Panic Disorder and Agoraphobia
00:00:10SHARI SMALL Anxiety disorders. They impact nearly
20 million people in America alone. In fact, they are the most

2. common psychiatric disorders affecting both children and
adults. And with the increasing stress of living in the 21st
century, both of global and personal level, the subject is getting
more attention than ever. There are several anxiety disorders
identified in the Diagnostic and Statistical Manual for Mental
Disorders, commonly known as the DSM. Though they share a
common theme of excessive, irrational fear and worry, each
anxiety disorder has its own distinct features and challenges. In
this program, we are going to explore panic disorder and
agoraphobia. Many people have moments of panic in their
lives.
00:01:00UNKNOWN What was wrong?
00:01:00SHARI SMALL But for some these experiences can
become quite extreme.
00:01:05UNKNOWN I can't breathe.
00:01:05SHARI SMALL To the point that one might feel as if
they are going crazy, suffocating or even dying.
00:01:10UNKNOWN You know, I think I need to go to the
hospital.
00:01:15SHARI SMALL These are called panic attacks. One of
the central features of panic disorder.
00:01:20Tory Nersasian, Psy.D.
00:01:20Psychologist
00:01:20TORY NERSASIAN People will actually report they
feel like they are having a heart attack or that they are dying
and the response, the physical response is not in response to any
cue in the environment that should cause that type of feeling.
00:01:30SHARI SMALL In general, a panic disorder is
diagnosed when a person has experienced at least two
unexpected panic attacks and developed persisting concern
about having further attacks or changes his or her behavior to
minimize such events.
00:01:45UNKNOWN I had another panic attack. It happened out
of the blue.
00:01:50UNKNOWN Really?
00:01:50SHARI SMALL Untreated, the disorder can become

3. quite disabling.
00:01:55Sharron Thrasher, Ph.D.
00:01:55Psychologist
00:01:55SHARRON THRASHER They start to narrow and
narrow and narrow their lives in order to prevent the situation
that they think brought it on in the first place because they
often, they don't really understand that it may have nothing to
do with the surroundings or the circumstances or anything. It's
just their body that has a kind of a faulty panic switch.
00:02:10UNKNOWN Since it happened in the car, I think I've
been nervous about driving around town.
00:02:15UNKNOWN Be able to get around.
00:02:15UNKNOWN I know that and if I could control it, I
would. It's just… Well I, I've just really been worried about it.
That's all.
00:02:25SHARI SMALL Where as the number and severity of
the attack varies widely, the concern and avoidance behavior
are essential features of panic disorder. To understand panic
disorder, one must first understand what constitutes a panic
attack. The DSM describes a panic attack as a discreet period of
intense fear or discomfort in which 4 or more of the following
symptoms developed abruptly and reached a peak within 10
minutes. Palpitations, pounding heart or accelerated heart
rate. Sweating, trembling or shaking. Sensations of shortness of
breath or smothering. Feeling of choking. Chest pain or
discomfort. Nausea or abdominal distress. Feeling dizzy,
unsteady, lighthearted, or faint. Derealization involving feelings
of unreality or depersonalization of being detached from
oneself. Fear of losing control or going crazy. Fear of dying.
Paresthesias, a numbness or tingling sensations. Chills or hot
flushes. About 10% of the population will at one time in their
lives have a panic attack. A panic attack is distinguished from
other forms of anxiety by its intensity and sudden episodic
nature.
00:03:40UNKNOWN Are you all right?
00:03:40UNKNOWN I feel as if I can't breathe right.

4. 00:03:45SHARI SMALL They may be further characterized by
the relationship between the onset of the attack and the presence
or absence of situational factors. In other words, there are three
types of panic attacks. Unexpected where the attack comes out
of the blue without warning and for no discernible reason.
Situational. Situations in which an individual always has an
attack, for example, walking in a stairwell and situationally
predisposed. Situations in which an individual is likely to have
a panic attack but does not always have one. Panic attacks can
provoke a strong urge to escape or flee the place where the
attack begins.
00:04:25UNKNOWN You know, I need to get out of here.
00:04:25UNKNOWN Do you want me to call someone?
00:04:25SHARI SMALL And when associated with chest pain
or shortness of breath can result in seeking aid from a hospital
emergency room or other urgent assistance. While an average
person may go to a doctor a few times a year, those with panic
disorder average over 30 visits with about 40% of those being
emergency situations.
00:04:45TORY NERSASIAN Usually what happens is they'll go
into the ER, they get hooked up to all sorts of measuring
devices and they realize no, this wasn't a heart attack, this was a
panic attack.
00:04:55Joseph Schwartz, M.D.
00:04:55Psychiatrist
00:04:55JOSEPH SCHWARTZ I see people referred from
emergency rooms after multiple visits with uh… these kinds of
symptoms.
00:05:00SHARI SMALL Though an attack generally peaks
within ten minutes, some symptoms may last much longer.
00:05:05UNKNOWN Shouldn't we call a doctor?
00:05:10UNKNOWN Just have to stay still.
00:05:10SHARI SMALL Some research suggests panic attacks
occur when an alarm mechanism in the brain erroneously fires
falsely reporting that death is imminent.
00:05:20SHARRON THRASHER When we think about the

5. panic response as a normal response that everybody has to have,
people who have panic disorder have kind of a response gone
haywire.
00:05:30TORY NERSASIAN It would be normal for a person to
have these kinds of umm… physiological symptoms if they're
let's say being chased by a perpetrator with a bat. Umm… you
would have the fight or flight response that will be a normal
occurrence. In panic disorder people actually have that
response to cues in the environment that are not dangerous.
00:05:50SHARI SMALL Not everyone who has panic attacks
develops panic disorder. A panic attack can occur in the course
of other anxiety disorders such as social phobia and generalized
anxiety disorder or a major depressive disorder. Some are able
to recognize a panic attack as a sign of high stress or anxiety
and can let the experience come and go without any adverse
impact upon their life. Others aren't so fortunate and may
actually develop panic disorder. According to the DSM, in order
to formally diagnose someone with panic disorder both of the
following must be present. One is recurrent unexpected panic
attacks, in other words those that are not situationally bound.
The next is that at least one of the attacks has been followed by
one month or more of at least one of the following. A, persistent
concern about having additional attacks. B, worry about the
implications of the attack or its consequences. C, a significant
change in behavior related to the attacks.
00:06:55UNKNOWN No, no, it's not like I don't get out of the
house or anything. It's.
00:07:00SHARI SMALL When panic disorder is diagnosed,
there is a specifier of with or without agoraphobia, a pattern of
isolation that will be explored later in more depth.
00:07:10UNKNOWN Have you been taking any drugs or
medications in the last several months or had any medical
condition?
00:07:10SHARI SMALL The next of the criteria is that these
panic attacks are not due to the direct physiological effects of a
substance such as stimulants or of a general medical condition.

6. 00:07:25UNKNOWN Have you ever been seen by a counselor or
therapist?
00:07:25SHARI SMALL Or not better accounted for by another
mental disorder like social phobia or obsessive compulsive
disorder. In a given year, 1 to 2% of the US population has
panic disorder with a lifetime rate even twice that number. It
typically begins during late adolescence or early adulthood. In
fact roughly half of all the people who have panic disorder
develop the condition before age 24. Though it can surface at
any age. Panic disorder is twice as common in women as in men
and studies have found a familial and genetic link. Research
shows that panic disorder can coexist with other disorders, most
often depression.
00:08:05UNKNOWN I've been feeling a little down and, I don't
know.
00:08:10SHARI SMALL Substance abuse is also
common. Appropriate diagnosis of these disorders is important
to successively treat panic disorder. One sobering statistic is
that approximately 20% of people with panic disorder will
attempt suicide. Since the sensations of panic disorder often
mimic symptoms of a heart attack or other life threatening
medical conditions, an accurate diagnosis is often not made
until extensive and costly medical procedures fail to provide a
correct diagnosis or relief. Some may go years without learning
that they have a treatable mental illness.
00:08:45TORY NERSASIAN That can be really hard for some
people to take because this is a psychological issue and not a
physical problem and when we go back to all the stigmas about
mental health umm… some people actually go through a period
of denial where they don't believe the doctors or they feel angry
that, that's the diagnosis they receive.
00:09:00SHARI SMALL The frequency and severity of one's
panic attack varies from person to person. An individual might
suffer from repeated attacks for weeks while another will have
short bursts of very severe attacks. Typically an early age of
onset of panic disorder carries greater risk that it will become

7. chronic and cause more impairment.
00:09:20UNKNOWN I'm just worried that it's gonna happen
when I'm alone. Yeah, I mean, I mean what if no one finds
me? What, what… What will happen, I mean, hearing about
people all the time being found in their, it's too late, I mean…
00:09:35SHARI SMALL People with panic disorder can't
predict when or where their panic attacks will occur and many
develop intense anxiety between episodes.
00:09:45UNKNOWN I don't want to risk going there. That's
where it happened last time.
00:09:45TORY NERSASIAN A person leaves their home has a
panic attack. Doesn't know why, doesn't know what the trigger
was but knows that it occurred outside of the home. They may
leave the house the next day and maybe it occurs again or
maybe it doesn't. Maybe it occurs in a few more days. What
happens as the person starts feeling like every time I leave
home, I have no control over my physical body.
00:10:10SHARI SMALL Some people's lives become so
restricted that they may start to avoid normal everyday
activities, just grocery shopping or driving or perhaps only go if
accompanied by a spouse or another trusted person. When
people's lives become this limited which happens in about a
third of those with panic disorder, the condition is called
agoraphobia. The ancient term agoraphobia is translated from
Greek as fear of an open marketplace. Agoraphobia today is
described as severe and pervasive anxiety about being in
situations from which escape might be difficult or avoidance of
situations such as being alone outside of the home, traveling in
a car, bus or airplane or being in a crowded area.
00:10:55JOSEPH SCHWARTZ People become confined to their
homes umm… and uh… some are confined to their bedrooms
and it's hard for them to leave that, that protected space. So
agoraphobia is uh… the expression of an attempt to manage the
panic, to prevent the panic.
00:11:15Nancy Webber, Ph.D.
00:11:15Psychologist

8. 00:11:15NANCY WEBBER That prevents people from going
out in the world, going out into their communities, to perform
some of those tasks that are necessary to have productive lives.
00:11:25SHARI SMALL Agoraphobia occurs in the context of
two disorders. A diagnosis called panic disorder with
agoraphobia and agoraphobia without history of panic
disorder. In both disorders, however agoraphobia is described as
occurring in response to panic attacks or panic-like symptoms.
Though there are debates on this subject, the prevailing view in
psychiatry is that agoraphobia is more often a complication of
panic disorder.
00:11:50JOSEPH SCHWARTZ You can have panic with
agoraphobia and panic without agoraphobia though again I think
that if you leave panic untreated, you, you long enough, you,
you often get agoraphobia.
00:12:05SHARI SMALL The DSM categorizes agoraphobia as
A, anxiety about being in places or situations from which
escape might be difficult or embarrassing or in which help may
not be available in the event of having an unexpected or
situationally predisposed panic attack or panic-like symptoms”
00:12:20UNKNOWN No, I think, I'm just gonna stay here.
00:12:25SHARI SMALL B, the situations are avoided for
example travel is restricted or else are endured with marked
distress or with anxiety about having a panic attack or panic
like symptoms or require the presence of a companion.
00:12:40UNKNOWN I just don't know what I'd do if I got out
there all alone and had a panic attack and…
00:12:45UNKNOWN C, the anxiety or phobic avoidance is not
better accounted for by another mental disorder such as social
phobia or obsessive compulsive disorder.
00:12:55UNKNOWN So for you, it's not really about the social
contact.
00:13:00UNKNOWN No, no, not at all. It's more about being
out some place where I might have one of my panic attacks. I
just wouldn't know what to do in the situation.
00:13:05SHARI SMALL Among the general population

9. approximately 2 to 5% report symptoms of agoraphobia without
a history of panic disorder. However in most anxiety disorder
clinics, the majority of people presenting for treatment for
agoraphobia also have panic disorder. Agoraphobia is found to
be twice as common among women. Some of these gender
difference however maybe attributed to social or cultural factors
that encourage or permit the greater expression of avoidant
coping strategies by women. Obviously, those with Agoraphobia
can experience significant interference in their lives. Some are
unable to travel, work, keep house or attend appointments.
00:13:45SHARRON THRASHER I worked with a few students
who are Agoraphobic and umm… as you can imagine it really
affected them because they were just too uncomfortable even
throughout the classes and try to live the life of a student
without going to classes is pretty difficult.
00:14:00TORY NERSASIAN That becomes of course incredibly
debilitating. The more you avoid that which makes you panic,
the smaller your world becomes.
00:14:10SHARI SMALL Fortunately, there are several effective
treatments that have been developed for panic disorder and
Agoraphobia.
00:14:15UNKNOWN I'm glad that you came in today.
00:14:20UNKNOWN My neighbor was kind enough to bring me
here.
00:14:20SHARI SMALL Panic disorder is actually one of the
most treatable of the anxiety disorders responding in most cases
to carefully targeted psychotherapy and medications.
00:14:30UNKNOWN At work, everything going okay? Any
changes.
00:14:30SHARI SMALL It's also been found that early
treatment of panic disorder can often prevent Agoraphobia. But
careful initial assessment is necessary. There are times when
medical and psychiatric disorders can coexist.
00:14:45SHARRON THRASHER It does happen that sometimes
people who have panic symptoms really do have a medical
condition that has to be checked and maybe they have an

10. arrhythmia, maybe they have some, something going on umm…
in some part of their body that is causing them to have a
physical sensations that are, that mimic the ones of panic. So
umm… usually, if somebody comes in to see me and they have
those symptoms, I almost always recommend that they go have
a physical.
00:15:10SHARI SMALL Cognitive and behavioral approaches
teach patients how to view the panic situations differently and
demonstrate practical ways to reduce anxiety.
00:15:20UNKNOWN That's, that's when my heart starts
pounding.
00:15:20SHARI SMALL In the cognitive portion of the
therapy, the therapist usually conducts a careful search for the
thoughts and feelings that accompany the panic attacks.
00:15:30UNKNOWN What are you thinking right before it
starts to pound?
00:15:30UNKNOWN What if I, I can't escape this situation or
what if I lose control? What if I'm in a public situation with
people around and I do something to embarrass myself or…
00:15:45SHARI SMALL These mental events are discussed in
terms of the cognitive model of panic attacks which supposes
that those with panic disorder often have distortions in their
thinking of which they maybe unaware.
00:15:55UNKNOWN What I would like you to try to do is to
stop and pay attention to your, your thought process. Where
your mind is, what you're thinking of the minute, these attack
start.
00:16:00SHARRON THRASHER Try to get them to gain more
and more insight about the thoughts that snowball into the cycle
of fear and so we try to do when we're breaking that cycle with
somebody in terms of their cognition is teach them to stop at
that first step.
00:16:20UNKNOWN I'd like to try some breathing exercises
with you now. Are you willing to try them?
00:16:25UNKNOWN Yeah, yeah, I guess.
00:16:25SHARI SMALL The behavioral portion of the cognitive

11. behavioral therapy may involve systematic training and
relaxation techniques.
00:16:30UNKNOWN When you breathe, we're gonna try to
relax and slow your breathing down. So place your hand on your
abdomen.
00:16:40SHARI SMALL Patients may learn to control their
breathing and avoid hyperventilation, a pattern of rapid shallow
breathing that can trigger or exacerbate panic attacks. Overall,
cognitive behavioral therapy has proven to be quite effective.
00:16:55UNKNOWN Now, we'll focus on showing you when
you're panicked, how you hyperventilate. So it's hyperventilate.
00:17:00SHARI SMALL Another behavioral approach is called
exposure therapy.
00:17:00UNKNOWN And that's what happens when you have a
panic attack. You breathe really fast. So I want you to see what
that feels like, so that you can then adjust to slowing your
breath down. So try breathing really fast in and out.
00:17:10SHARI SMALL Here they explore the client's internal
sensations associated with their panic.
00:17:15JOSEPH SCHWARTZ If the story suggest that people's
panic is induced by hyperventilation, sometimes you
demonstrate to that, that to them by getting them to
hyperventilate, reproduce their symptoms and that can, can help
people to manage their behavior.
00:17:30UNKNOWN So in your journal, you indicated that you
went downtown twice to see brother.
00:17:35UNKNOWN Right and umm… I got a little tensed. So
we left. But each time I went a little bit further.
00:17:40UNKNOWN Has that been helping?
00:17:45UNKNOWN I think so. He thinks so.
00:17:45SHARI SMALL With exposure therapy one can learn to
alleviate some of the fears involved with panic disorder and
agarophobia. In this approach people are slowly exposed to the
fearful situation until they become desensitized to it called
systematic desensitization.
00:18:05UNKNOWN How are you feeling?

12. 00:18:05UNKNOWN Okay. Umm… can we turn around soon?
00:18:10UNKNOWN Yeah, we can turn around.
00:18:10SHARI SMALL This step by step approach helps them
gradually master their fears and enter situations that seemed
overwhelming before.
00:18:20JOSEPH SCHWARTZ Though there are many ways to
intervene in panic and agarophobia, once that agarophobia has
developed umm… usually need to get people to confront their
uh… their fears and tolerate their anxiety and really push the
walls back.
00:18:35TORY NERSASIAN Final step is repair it. We start
lower down on hierarchy and repair relaxation with the actual
trigger that makes the person anxious. Over time, we are
essentially deprogramming the brain and the misfiring signals.
We are now programming the brain to relax to those cues in the
environment.
00:18:50SHARI SMALL Certain prescription medications can
provide relief for clients with panic disorder and agoraphobia.
They are used to decrease anticipatory anxiety as a way to
prevent panic attacks or reduce their frequency and severity.
00:19:05UNKNOWN Have the new medications been helping?
00:19:05UNKNOWN They seem to have calm me down a bit.
00:19:10UNKNOWN Uh… any side effects? Have you felt…
00:19:10SHARI SMALL Two types of medications that have
been shown to be effective in the treatment of panic disorder are
antidepressants and benzodiazepines. The research is ongoing.
Many believe that a combination of medication and cognitive
behavioral therapy represents the best alternative for the
treatment of panic disorder and agoraphobia. In fact,
appropriate treatment by experienced professionals can reduce
or prevent panic attacks in over 70% of people with panic
disorder and early treatment can help keep the disease from
progressing to the later stages where agoraphobia
develops. When patients find that their panic attacks are less
frequent and severe, they are increasingly able to venture into
situations that had been off limits to them. With new education,

13. research and treatment on the horizon comes a hope that people
these kinds of anxiety disorders will lead less impaired and
more fulfilling lives.
00:20:10[credits]
Obsessive-Compulsive Disorder
5:39 / 20:15
(Naples, FL: National Educational Video, Inc., 2015), 20
minutes