panic disorder ; It can be defined as the fear developed for the feelings created by the physical changes in the person’s body, accompanied by panic attacks . In other words, we can say that panic disorder is a kind of bodily symptom phobia. Agoraphobia, on the other hand, is defined as the person’s avoidance of entering certain situations, with the thought that it will be difficult to escape or seek help if physical symptoms occur that will put the person in trouble.
What is a panic attack?
One day, suddenly, for no reason, I fell into extreme fear. My heart was beating fast as if it was going to jump out of my chest, even though I was breathing, I felt that there was no air in my lungs. I was sweaty, dizzy, and my stomach turned upside down like I was going to vomit. At that moment, my mind went blank and I thought that I was at the end of my life, that I was going to die. After a few minutes that seemed like an eternity, my breathing improved and my heart rate slowed. I felt exhausted even though I had recovered and recovered. Over time, I began to experience these seizures unexpectedly frequently, and I thought I was going crazy. I almost couldn’t go out for fear of having a seizure.
panic attack ; As seen in the example above, it is an intense distressing fear attack that occurs with physical and mental symptoms. 1 The following symptoms are seen during panic attacks 2 but how they appear varies from person to person.
- Palpitations, rapid heartbeat
- Sweating
- Shake
- feeling of being out of breath
- choking feeling
- Chest pain or tightness in the chest
- Nausea or abdominal distress
- Dizziness, drowsiness, feeling faint
- chills or hot flashes
- tingling, numbness, numbness
- Feeling that the environment is unrealistic (e.g. distorted, unrecognizable) or feeling detached from one’s body, like a dream
- Fear of going crazy or losing control
- Fear of death
The most important feature of panic attacks is that they occur suddenly and unexpectedly, are short-lived and continue repeatedly. 1 Panic attacks occur unexpectedly for the person, when there is no obvious situation to trigger them, and the person thinks that it is not possible to stop them. Symptoms quickly escalate to a peak and then subside. However, recurrent panic attacks can occur repeatedly for hours. That’s why some people say that the attacks last all day.
Most symptoms that occur during a panic attack are the fight-flight response that occurs when people perceive danger. However, during panic attacks, these symptoms are triggered spontaneously and cause the person to perceive threats such as death, loss of control, insanity, and disgrace to people.
Panic Disorder and Its Characteristics
panic disorder ; An anxiety disorder (or anxiety disorder) characterized by recurrent and unexpected panic attacks . Panic attacks can be experienced by anyone from time to time. Therefore, the defining feature of panic disorder is not the presence of panic attacks, but the feeling of anxiety about the expectation of having a panic attack again, excessively negative thoughts about the negative consequences of panic attacks such as death, loss of control, insanity, and disgrace, and avoidance behaviors developed due to the fear of having a panic attack.is. The anxiety of the person who begins to fear his bodily symptoms is the panic attacks that may reoccur. This increases one’s sensitivity to normal bodily symptoms. Therefore, in order not to experience these physical symptoms, the person begins to avoid situations and activities that may trigger them . For example,
- does not climb stairs, does not walk fast, as it will cause an acceleration in the heartbeat,
- does not enter hot places because it will sweat,
- does not consume caffeinated beverages as they may shiver,
- does not run because he will be out of breath,
- He does not eat foods that he finds heavy because he will feel nauseous.
In addition to these avoidance behaviors, if panic attacks occur, the person may develop safety-providing behaviors such as carrying sedatives, water, chewing gum, cologne, sitting near exits, regularly measuring blood pressure or pulse, in order to alleviate physical symptoms.
Panic disorder cases have strong beliefs that the somatic symptoms associated with panic attacks are either physical or mental harm, and they view their somatic symptoms as disasters. 3 Examples of such thoughts, called catastrophizing , include:
- ‘ My heart palpitations and chest pain could be indications that I’ve had a fatal heart attack. ‘
- ‘ Being short of breath can cause me to suffocate and die. ‘
- ‘This nausea can cause me to become violently ill and vomit uncontrollably.’
- ‘I might lose control of my emotions and go crazy.’
- ‘Feeling tense can cause me to lose control and have a severe panic.’
If left untreated, panic disorder can have significant consequences. First of all, the person’s constant anxiety creates distress and the person may feel weaker emotionally and physically than their peers. Due to the avoidance behaviors developed to reduce anxiety and prevent panic attacks, the person’s normal life is disrupted. The person’s work life may be restricted and therefore he/she experiences economic problems. Similarly, the person’s social relationships may weaken and he becomes withdrawn, with less participation in activities that interest him. This withdrawal can lead to the development of depression over time. Finally, some people may start to use alcohol and drugs to cope with their anxiety and experience related problems.
Agoraphobia and Its Characteristics
agoraphobia ; It is defined as the anxiety that develops with the thought that it is difficult to escape or to get help if physical symptoms occur that will put the person in trouble, and avoiding entering certain situations . 2 These anxiety-inducing physical symptoms may be panic attack symptoms, as well as symptoms that the person sees as embarrassing or incapacitating, such as losing bowel control, vomiting, and falling. Situations that the person typically avoids include:
- go out of the house alone
- public transport (e.g. metro, bus, ferry, etc.)
- open spaces (e.g. bridge, highway, parks)
- closed areas (eg shopping malls, cinemas, stores)
- crowded places (e.g. crowded streets)
- stand in queue
How much a person avoids these situations determines the severity of agoraphobia. For example, in a person who can hardly leave the house alone, the severity of agoraphobia is high and this causes serious limitations in the person’s survival. On the other hand, it can be said that the severity of agoraphobia is low in a person who leaves the house, can go to certain distances in the city by taking the bus, and can enter closed places even though he is close to the exit. Most people with agoraphobia struggle at some level between these two extremes.
Agoraphobia can be a stand-alone problem, or it can be seen together with panic disorder. Not every case of agoraphobia will have a panic attack, they may have never experienced such symptoms in their life. On the other hand, not every case of panic disorder develops agoraphobia. However, it would not be wrong to say that as the severity of panic disorder increases, the probability of developing agoraphobia increases. one
Current Treatments for Panic Disorder and Agoraphobia
Today, international clinical practice guidelines, which are prepared in the light of scientific data and aim to guide clinicians about the treatments they should choose when treating certain psychological problems , state that the first choice treatments for panic disorder and agoraphobia are psychotropic drugs or Cognitive and Behavioral Therapy ( CBT ) . 4,5 Since many clinical studies have revealed scientific findings that these treatments are effective, the guidelines state that these treatments should be preferred in the first place.
CBT used in panic disorder and agoraphobia in general terms ; It aims to (1) weaken or eliminate the link between internal and external stimuli and panic attack symptoms, and (2) create opportunities for the individual to learn and strengthen anxiety-free responses. All CBT protocols emphasize and interfere with the role of avoidance behavior in maintaining these problems. 4 Research shows that behavior change is important, and that even intervention in the faulty thoughts associated with panic disorder and agoraphobia does not lead to any more improvement in treatment than behavior change. 6 In other words, behavioral change is sufficient for recovery.
Antidepressants (SSRI, SNRI, TCA) and benzodiazepines with calming effects are among the psychotropic drugs used in the treatment . It is stated that benzodiazepines are associated with less good results in the long term and are not recommended for use in panic disorder. 5 Antidepressant drugs may take a few weeks to take effect after they start to take effect.
The first question that comes to mind may be which of the psychotropic drugs and CBT is the first choice for the treatment of panic disorder and agoraphobia. There is not enough scientific evidence to show that these treatments are superior to each other in terms of improvement. 4,6 Studies show that CBT is as effective as medication, or even as effective as CBT combined with medication. 6,7 In other words, using drugs and psychotherapy together does not increase the treatment effect. 1,4,6,7 Studies show that the rate of discontinuation of treatment is 15%, and the rate of discontinuation of antidepressant treatment is around 23% in people taking CBT. 6These findings suggest that the side effects of drug therapy are less tolerable than CBT. Perhaps most importantly, many studies have shown that problems return in 50% of cases in the first 6 months after drug therapy. 8 On the other hand, people who take CBT are less likely to relapse. 7,9 These findings suggest that the effect of drug therapy is not permanent, and the effect of psychotherapy is more permanent.
In the light of this information, it is recommended that the clinician and the client take the decision of which of these treatments will be preferred together. 4 Considering the client’s preference when making this decision, informing about risks and benefits for each treatment, evaluating the person’s past treatment history, considering whether the person has medical or other psychiatric problems or other drugs used, evaluating whether the treatment is sustainable for the person . , side effects of the drug and the cost of the treatments need to be considered
