Psychotherapy in the Treatment of Panic Disorder

In the Treatment of Panic Disorder, there is a belief that medication is absolutely necessary for the treatment of panic attacks and panic disorder, or that the first intervention is always done with medication, that there is always a physical disease underlying panic attack and panic disorder, or that psychological origins remain in the background is no longer valid in today’s psychiatric treatments.

Underlying panic disorder are the effects of a series of neurochemical changes on the brain and a catastrophic misinterpretation of bodily sensations are currently accepted theories.

Although medications alleviate panic symptoms and eliminate anticipatory anxiety and avoidance behaviors, they cannot gain the patient’s ability to cope with the existing situation. This is the main role of cognitive-behavioral therapy in the treatment of panic attacks and panic disorder. In fact, when many patients do not receive psychotherapy or medication, they may have new distortions such that this disease cannot be coped with.

Psychotherapy is also inevitable in patients who are hypersensitive to drug side effects, who are pregnant, who cannot use drugs due to a physical illness or any other reason.

The anxious individual sees any situation as a danger or threat to his / her security, with the perception we call “selective processing of information”.

The individual with panic disorder interprets bodily sensations catastrophically, in addition to the above distortion. Heart attack, brain hemorrhage, loss of control, madness, and drowning feelings that occur during panic attacks are the result of catastrophic scenarios.

In the treatment of panic disorder with psychotherapy, we focus on maladaptive behaviors and thoughts and catastrophic beliefs that initiate, sustain or exacerbate panic symptoms.

Explaining the role of rapid breathing, which we call hyperventilation, in panic attacks and discussing with the patient, teaching breathing exercises, redefining bodily sensations, are the basic elements of cognitive-behavioral therapy in the treatment of the panic disorder. Throughout the treatment, the focus will be on the relationship between the somatic sensations of the patients and their panic-anxiety responses, and awareness will be increased. This process is provided by cognitive restructuring and familiarization with internal stimuli.

Generally, 12-15 sessions of psychotherapy are required in the treatment of panic attacks. Cognitive errors related to panic attacks, hyperventilation, conditioned responses to physical sensations, applications for fear and avoidance behaviors will be covered in detail throughout the therapy. The psychotherapist will actively use methods such as cognitive restructuring, breathing exercises, comparison with internal stimuli, real-life exercises and homework while providing mental training and information on the physiology of panic disorder in cognitive-behavioral therapy.

The main interpretation or cognition in anxiety is the perception of physical or psychosocial danger. In addition to negative automatic thoughts, dysfunctional attitudes and rules also play a role here. The main element in the cognitive model of panic is the tendency to interpret bodily situations in a catastrophic way. Misinterpreted bodily sensations will first create normal anxiety responses, gradually catastrophizing will come into play, sensations will be paired with a physical illness, the focus will be on a disease such as a heart attack or a stroke, and the feeling of loss of control will gradually intensify, and the panic attack picture will emerge.

In the cognitive approach to panic disorder and panic attack, the neurobiological and neurochemical processes underlying autonomic symptoms are not denied, but the main goal is to establish the link between the emergence of autonomic symptoms and the misinterpretation of bodily sensations as “catastrophic”. Meanwhile, it tries to show the links between panic symptoms and catastrophic responses to bodily sensations.

The initial symptom of a panic attack is a great guide to psychotherapy. Automatic thoughts here are the greatest help in reaching core belief. Treatment is guided through warm cognitions that are experienced and active at that moment.

In panic attack treatment, the priority is to reduce anxiety and end panic attacks. The psychiatrist should adopt a realistic but hopeful approach and change negative beliefs and distortions about treatment.

When using cognitive-behavioral therapy in the treatment of panic disorder, it is first aimed to reduce the frequency and severity of panic attacks within 2-4 weeks. With the decrease in attacks, anticipation anxiety will decrease, and following this, efforts will be made to eliminate avoidance behaviors.

The general principle in cognitive therapy is that the patient should be able to define his / her own cognitions, be aware of them, and learn to replace them with alternative thoughts.

Panic attack patients have experienced the same situation over and over again, and although they test that nothing has happened, they again succumb to the feelings of having a heart attack, losing control, and being paralyzed. This is because of constantly fighting body sensations, over-concentrating the attention we call hypervigilance on all internal and external stimuli, the tendency to scan the body repetitively, avoiding behaviors and preventing confrontation with negative thoughts.

Cognitive-behavioral treatment of panic disorder consists of structured sessions.

Treatment of Panic Disorder

1) The first step in treatment is to reveal negative automatic thoughts. Followed by;

2) The relationship between thoughts, feelings and behaviors is tried to be shown.

3) What anxiety is, its sources, symptoms, physiology, formation and consequences of autonomic changes are explained in detail.

4) In situations where automatic thoughts cannot be dealt with, the skills of controlling anxiety symptoms are gained.

5) Verbal challenge is made with automatic thoughts.

6) Voluntary hyperventilation and similar experiences create panic attack-like clinical situations and behavioral experiments are performed.

7) Behavioral experimentation can also be in the form of creating panic attacks through imagination.

8) Situations that cause fear and avoidance behavior such as going out alone and exercising are addressed gradually.

9) Dysfunctional beliefs and assumptions are processed with special techniques to gain insight into the patient.

10) Relaxation exercises, which the patient sees that he can control his symptoms himself, are used at every stage of the treatment.

If the skills gained through treatment are not used sufficiently, practice methods are abandoned and reinforcement sessions are neglected, the disorder may recur in many cases. It is important for panic patients to pay particular attention to this situation in terms of the permanence of the treatment. Even if panic symptoms reappear, reminding that the individual is at a different point from his pre-treatment situation and that he now has knowledge, attitude and skills about how to deal with the disorder will stop the panic symptoms in a short time.

Presence of depression or a comorbid psychiatric disorder, inadequate cooperation of the patient, use of alcohol or benzodiazepines may reduce the effectiveness of psychotherapy.

With psychotherapy, which is becoming increasingly important in the world and in our country, you can stop panic attacks and get rid of panic attacks and panic disorder.

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