PANIC DISORDER

PANIC ATTACKS.

Panic attacks are characterised by sudden episodes of fear. During a panic attack the person experiences an overwhelming dread of impending disaster. This is accompanied with intense feelings of fear. During this phase of the attack the patient also experiences distressing body sensations. One the most common of these is the sensation of breathlessness, choking, chest pains and racing heartbeat. dizziness, sweating and faintness are also present. First time sufferers of this condition usually end up in A and E.

Acceptance and Commitment Therapy describes panic attack as 'anxiety about anxiety'. This is explained by research literature where the fear of having and feeling this intense anxiety is actually what the person is afraid of in the first place. Patients will do anything to avoid these feelings. This usually starts with the first place that got the attack. From now on, the person will avoid this place, which may be school, workplace or shopping centre, because they associate their attack with that place. This association is then continued on to the other sensation which the person felt on their first attack. Perhaps the person is rushing for a bus or train, they suddenly notice their heart is beating fast and they notice their are a little breathless, this enough to start off the whole sequence of thoughts, feelings, body sensations that will lead to a panic attack. The result of all this is more avoidance. As this condition progresses the person is forced into an ever decreasing circle of 'safe' places.

TREATMENT.

Treatment of panic attack starts when the client presents for CBT or ACT. The Acceptance and Commitment model starts with a thorough assessment. This will include a history of events leading up to and including the first attack. A very brief history of the client's past is taken. In my practice, I have found some evidence of past trauma in this category of clients. This could be anything from a sudden or tragic death of a family member to separation of the parents or some serious health problems. At this point it is vitally important to validate the clients story. Thoughts, memories, images, body sensations, feelings and behaviours are recorded so that a picture can be painted for the client. I use this information to draw a sketch of how we function. How our unhelpful thoughts when believed will give us distressing feelings leading to avoidant behaviours.

The whole process of ACT is then commenced, where we learn to live in the present moment. This process is achieved as we learn mindfulness and awareness. This will help to anchor the client in the present. The importance of this anchoring is a first step in helping the patient come to terms with where they find themselves. Mindfulness is used throughout the process of treatment. Acceptance and acknowledgement that we humans will always have thoughts, feelings and body sensations, so the process of changing our relationship with these internal experiences is worked through. During this stage of therapy various metaphors are used to help the client let go of the fight with their thoughts and feelings.

Life values are a powerful method of concentrating the focus of therapy. Using the life values exercise sheet a person can very quickly identify the thoughts, feelings and behaviours that take away from what is really important to them.

Between session work is a hugely important segment of treatment. Evidence suggests that clients who give full commitment to this 'between session' work will achieve a very good outcome.

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