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False Alarms and “Safe” Harbors: Panic Disorder and Agoraphobia

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Presentation on theme: "False Alarms and “Safe” Harbors: Panic Disorder and Agoraphobia"— Presentation transcript:

1 False Alarms and “Safe” Harbors: Panic Disorder and Agoraphobia
John D. McKellar, PhD Clinical Psychologist Department of Veteran Affairs, Clinical Educator Stanford University

2 Panic Attack Panic Attack Abrupt episode of intense fear
Sweating Trembling/shaking SOB Choking Dizziness Chills/hot flushes Paresthesias Palpitations Fear of dying Fear of loss of control Nausea/abdominal distress Derealization/ depersonalization Chest pain/discomfort Panic Attack Abrupt episode of intense fear Cue induced and non cue induced Associated cognitive and physical symptoms Short duration

3 Panic Disorder Panic disorder Agoraphobia
Recurrent panic attacks Unexpected, spontaneous attacks At least one month of persistent concern about the attacks Agoraphobia Anxiety about being in a place where escape is difficult if a panic attack occurs Situations are avoided or endured with marked distress Occurs with and without panic d/o Imperfect diagnostic categories- lot’s of variability in severity

4 Interventions for Panic Disorder
Panic Control Therapy The “Gold Standard” intervention May work with medication therapy but not with benzodiazepine medications. Antidepressants - Some evidence of benefit Benzodiazepines (Xanax, Valium, etc.) - Poor evidence of longterm benefit

5 Panic Control Therapy Education
Relaxation and Challenging Negative Thoughts Exposure exercises (interoceptive) Exposure to feared situation (for agoraphobia)

6 Panic Control Therapy Education
Fear responses can be adaptive to react to emergency situations When fear responses “misfire” we look for the source of threat In the absence of the threat we look to the physical symptoms as a threat (e.g., I am having a heart attack, Something is seriously wrong with me

7 Panic (and Generalized Anxiety Disorder)
Catastrophic Thinking- negative interpretations about the outcome of physical sensations Shortness of breath, hyperventilation, pounding heart, dizziness, (physical symptoms) Increased Anxiety

8 Challenging Thoughts in Panic
De-catastrophizing worksheet for panic attack: Catastrophizing Thoughts (What if…) De-catastrophizing (Is this possible/likely? So what!!!) What if I am having a heart attack? What has happened in the past? How likely is this? Have I ever had a heart attack? What is the probability I am having a heart attack?

9 Exposure Exercises Beginning Examples: Breathing in and out of a straw
Holding one’s breathe for 30 seconds Breathing into a paper bag Holding full body tension Shaking one’s head back and forth Spinning around in a chair The point is to trigger “interoceptive” anxiety

10 ESCAPE Anxiety TIME

11 Exposure Exercises Next step:
Panic Disorder: Trigger full blown panic attack Agoraphobia: Trigger full blown panic attack and then “expose” slowly to feared situations

12 ESCAPE Anxiety TIME

13 Self-help Resources Mastery of your Anxiety and Panic: Workbook (4th Edition)David Barlow and Michelle Craske


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