Perspectives on panic Disorder - causes and treatment

1. Biological Perspectives

The exact cause of panic disorder isn't fully understood. However, most experts think a
combination of biological and psychological factors may be involved. There are a number of
theories about the type of biological factors that may be involved with panic disorders. These
are as follows:

1. 'Fight or flight' reflex

One theory is panic disorder is closely associated with your body's natural "fight or
flight" reflex – its way of protecting you from stressful and dangerous situations.
Anxiety and fear cause your body to release hormones, such as adrenaline, and your
breathing and heart rate are increased. This is your body's natural way of preparing
itself for a dangerous or stressful situation. In people with panic disorder, it's thought
the fight or flight reflex may be triggered wrongly, resulting in a panic attack.

2. Neurotransmitters

Another theory is an imbalance in levels of neurotransmitters (serotonin and

Gamma-ammino butyric acid) in the brain. Serotonin affects mood and behavior,
appetite and digestion, impulsivity, sleep, memory and sexual desire and function. It is
considered as a natural stabilizer. Therefore imbalance in this can lead to a heightened
stress response in certain situations, triggering the feelings of panic. It is believed that
gamma-aminobutyric acid—GABA—is a chemical in the brain that modulates
anxiety. It is an inhibitory neurotransmitter. GABA acts like a brake to
the excitatory neurotransmitters that lead to anxiety.. GABA counteracts excitement in
the brain by inducing relaxation and suppressing anxiety. Anti-anxiety medications,
target GABA receptors in the brain. These medications enhance the function of
GABA resulting in a calm and relaxed state. GABA levels in individuals with panic
disorder is low

3. The fear network

 The fear network theory suggests the brains of people with panic disorders may be
wired differently from most people. There may be a malfunction in parts of the brain
known to generate both the emotion of fear and the corresponding physical effect fear
can bring i.e. amygdala. The amygdala is an important part of the circuit that allows
the brain to detect and respond to threats. They may be generating strong emotions of
fear that trigger a panic attack.

4. Spatial awareness

Links have been found between panic disorders and spatial awareness. Spatial
awareness is the ability to judge where you are in relation to other objects and people.
People with panic disorder have a weakened balance system and awareness of space.
This can cause them to feel overwhelmed and disorientated in crowded places,
triggering a panic attack.

Psychodynamic Perspectives
Psychological factors that increase your risk of developing panic disorder include:
● a traumatic childhood experience, such as the death of a parent or being sexually
abused
● experiencing a stressful event, such as bereavement, divorce, or losing your job
● a previous history of mental illnesses, such as depression, anorexia nervosa,
or bulimia
● Substance abuse, such as alcohol misuse or drug misuse
● being in an unhappy relationship, or in a relationship where your partner is very
controlling

Behavioral Perspectives

There are several interrelated mechanisms through which the first panic attack develops into
panic disorder.

1. Anticipatory anxiety

The panic episode generates anticipation anxiety for more panic attacks, thereby
heightening individual vulnerability.

2. Hypervigilance and selective attention

 The anticipation of unpredictable and uncontrollable attacks causes them to be
hypervigilant about bodily changes.

3. Misattribution and distorted belief

The individual tends to misattribute such bodily changes to false catastrophic origins.

4. Interoceptive conditioning

Due to these internal physiological changes the person might learn a fear conditioned
response, due to the panic episodes.

For example, a person failed in an exam in a particular subject. The next time the person is
giving an exam the person experiences panic episode because of the fear of failing again in
that subject. After which the person in vigilant about the changes that happened during the
episode like sweating, chills or hot sensations, tingling heart beating fast. Now the
hypervigilant person might infer that this fast beating of heart is a close call to a heart attack.
Now due to these changes every time the person goes for an exam he would panic, leading to
a conditioned response to the panic episodes. So now any kind of exam will trigger panic
attack.

Treatment

1. Psychotherapy (talk therapy)

Psychotherapy is the form of treatment for emotional and psychological problems that
is based on talking and understanding. The aim is to get better understanding of the
problems and better ways of dealing with them. It is a more skill-based profession,
which uses theoretical concepts to understand human experience and development. In
this therapy there is free association i.e. the client is atalks about their anxiety
provoking thoughts, problems and the therapist facilitates the client with a better way
of dealing with it.
2. CBT (Cognitive Behavioral Therapy)

Cognitive behavioral treatment for panic attacks and panic disorder usually involves
some combination of the following interventions:

o Relaxation Training: Relaxation training can be helpful in beginning stages of

treatment for panic. Often people have become increasingly anxious over time, so
much so that their bodies are overwrought with muscle tension, making them even
 more susceptible to additional anxiety. Usually relaxation training involves
relaxation breathing or progressive muscle relaxation, ways of decreasing
physiological anxious arousal. This then helps to reduce future vulnerability to
anxiety.
o Cognitive Restructuring: Cognitive Restructuring is a method of becoming more
aware of anxiety-provoking thought patterns, and replacing them with more
balanced, less anxious thinking. By reducing the intensity of your reactions to
panic symptoms and feared situations, you can further reduce your anxiety, and
decrease the frequency, intensity, and duration of panic symptoms.
o Mindfulness: A meditative technique borrowed from eastern traditions of
meditation, mindfulness as a tool for overcoming anxiety is increasingly becoming
the focus of a great deal of scientific research. In treatment for panic disorder, it is
used to help teach people to experience unpleasant physical sensations without
reacting negatively to them, thus short-circuiting the vicious cycle of fear and
panic.
o Exposure treatment: Once people feel less anxious about future panic attacks due
to using relaxation training, mindfulness, and cognitive restructuring, they are more
able to confront anxiety-provoking situations. Systematic exposure is an
intervention that helps people face what they normally avoid. By purposely putting
themselves in challenging situations, they defuse the fear associated with them, and
no longer fear the situations in the future.
o Stress Reduction: For some people, reducing stressors can be an important part of
treatment for anxiety. A combination of 1) learning to react to different situations
more calmly and 2) reducing unnecessary stress, can be helpful in reducing overall
anxiety and improving quality of life.

3. Pharmotherapy

Pharmotherapy means medications.

⮚ Selective serotonin reuptake inhibitor (SSRI) like Zoloft®, Prozac®, Paxil®,

Celexa®, Luvox® and Lexapro®
⮚ Antidepressants, such as Anafranil, Norpramin, and Tofranil.
⮚ Benzodiazepines, such as Ativan, Valium, or Xanax.
⮚ Antidepressants with mixed neurotransmitter effects, such as Effexor.
 ⮚ Monoamine oxidase inhibitors (MAOIs), such as Marplan, Nardil, or Parnate.

Once the person is given anti-anxiety medication the panic attacks can be controlled
in few days.

4. Relaxation techniques

Standard Progressive Muscle Relaxation - Progressive Muscle Relaxation teaches you

how to relax your muscles through a twostep process. First, you systematically tense
particular muscle groups in your body, such as your neck and shoulders. Next, you
release the tension and notice how your muscles feel when you relax them. This
exercise will helps to lower the person’s overall tension and stress levels, and helps
them relax when they are feeling anxious.

Breath focus – It is a relaxation technique that involves deep, rhythmic breathing,

mental detachment, and the use of a word or phrase that helps a person focus. The key
is to focus on allowing the belly to rise easily when inhaling and fall when exhaling.
The objective is to breathe all the time with the belly (diaphragm) and not the chest.

Guided Imagery - Guided imagery is a traditional mind-body technique that is also

considered a form of hypnosis. Visualization and guided imagery offer tools to direct
one’s concentration on images held in the mind’s eye. These therapies take advantage
of the connection between the visual brain and the involuntary nervous system. When
this portion of the brain (the visual cortex at the back of the head) is activated, without
receiving direct input from the eyes, it can influence physical and emotional states.
This, in turn, can help elicit physiologic changes in the body, including therapeutic
goals. Because guided imagery is a mind-body therapy, any stress-related health
concern, including high blood pressure, pain related to muscle tension, insomnia, and
anxiety or depression, may be alleviated via this approach.

Yoga - Yoga is an activity that actually encompasses all three of these common
relaxation techniques. Additionally, yoga has been known to help ease stress, reduce
feelings of nervousness, and enhance mindfulness. For these reasons, yoga has been
considered to be potentially beneficial for people with anxiety disorders, including
panic disorder.
5. Self Help techniques

Exercise, Meditation, Yoga, Deep Breathing, Relaxation ,Visualization

References

o Dattilio, F. M., & Salas-Auvert, J. A. (2000). Panic disorder: assessment and

treatment through a wide-angle lens. Phoenix: Zeig, Tucker.
o Diagnostic and Statistical Manual of Mental Disorders - 5
o http://cogbtherapy.com/cbt-for-panic-attacks/
o https://www.anxietybc.com/sites/default/files/MuscleRelaxation.pdf
o https://www.drweil.com/health-wellness/balanced-living/wellness-therapies/gu
ided-imagery-therapy/