Panic disorder + OCD case studies

disorders outlines, answered assessment questions

agoraphobia (5 pts)

1)pronounced, disproportionate & repeated fear about being in at least 2 of the following situations: public transpotation, parking lots/bridges/open spaces, shops/threatres/other confined spaces, lines/crowds, away from home unaccompanied

ex. Joe unable to leave home without Florence

2)fear of these agoraphobic situation come from a fear that it would be hard to escape or get help if panic, embarassment, or disabling symptoms were to occur

3)avoidance of these agoraphobic situations

4)symptoms usually continue for at least 6 months

5)signifigant distress or impairment (ex. interfering with ability to live the life you want to live)

panic disorder (~4 pts)

1)unforeseen panic attacks occur repeatedly

2)one or more of the attacks come befreo either of the following symptoms:

a. at least a month of continual concern about having additional attacks

b. at least a month of dysfunctional behaviour changes associated with having the attacks

*panic disorder is similar to a phobia: but instead of fearing an object, ppl who have it fear/distrust the arousal of their own autonomic nervous system (both sympathetic* nor parasympathetic)

agoraphobia (5 pts)

1)pronounced, disproportionate & repeated fear about being in at least 2 of the following situations: public transpotation, parking lots/bridges/open spaces, shops/threatres/other confined spaces, lines/crowds, away from home unaccompanied

ex. Joe unable to leave home without Florence

2)fear of these agoraphobic situation come from a fear that it would be hard to escape or get help if panic, embarassment, or disabling symptoms were to occur

3)avoidance of these agoraphobic situations

4)symptoms usually continue for at least 6 months

5)signifigant distress or impairment (ex. interfering with ability to live the life you want to live)

panic disorder (~4 pts)

1)unforeseen panic attacks occur repeatedly

2)one or more of the attacks come befreo either of the following symptoms:

a. at least a month of continual concern about having additional attacks

b. at least a month of dysfunctional behaviour changes associated with having the attacks

*panic disorder is similar to a phobia: but instead of fearing an object, ppl who have it fear/distrust the arousal of their own autonomic nervous system (both sympathetic* nor parasympathetic)

panic attack

1)persons experience a sudden outburst of profound fear or discomfot that rises & peaks within minutes

2)the panic attack includes at least 4 of the following symptoms:

increases heart rate/palpitations, perspiration, trembling, shortness of breath, choking sensations, discomfort or pain in chest, nausea or abdominal upset, dizziness/lightheadedness, feeling significantly chilled or hot, sensations of tingling or numbness, sense of unreality or seperation from self or others, dread of losing control, dread of dying

h p s c p n d n u d — Hungry Penguins Slide Carefully Past Narrow Doors, Never Underestimating Danger.

ex. *symptoms of panic attack may mimic those of heart attack (liek for Joe)

in the case of “Joe”, what event caused his panic attack?

the Florida incident — flying home in a plane (public transportation) leaving from Florida, Joe started to feel like it was getting difficult to breathe (shortness of breath), heart palpitations, feeling like he was going to die or lose his mind (dread of losing control and dying)

his panic attacks that came after (during the night, etc.) followed this event

why is Joe’s case different from most panic attacks?

unlike Joe’s case panic disorder usually begins btwn late adolesence and the mid-30s, with the medain age of onset being 20 to 24 yrs old (Joe’s panic disorder started when he was 76 yrs)

Joe was not only diagnosed with a panic disorder, but he was diagnosed with agoraphobia too — bc he was beginning to avoid leavng the house except for in Florence’s company

why do individuals first suspect a general medical condition? (instead of a panic attack)

bc the symptoms for a panic attack are similar to/mimic that of a heart atack or another general medical problem (ex. heart palpitations, chest ache, shortness of breath, etc.)

as soon as physicians rule out cardiac or other medical conditions, they consider possibility of a panic attack

*but physicians also have to consider that certain medical problems (ex. seizure disorder, thyroid disease, etc.) can can CAUSE panic attcks, but medical tests can rule out these such cases

Why was Dr. Geller convinced that panic disorders are “best explained by a combination of biological and cogntive factors”?

1)bc fo biological factors panic attacks (PAs) are similar to the fight or flight response — normal physiological arousal of humans & other animals in response to danger

But difference is that w/ PAs there’s no external triggering event — so it is ‘false alarm’: body produces it reaction to danger in the absence of any objectively dangerous event

2)cognitive factors: a PA disorder affects ppl who repetedly interpret their physiological reactions as a real source of danger (ex. feel like the’regoing crazy or having a heart attack) — instead of a false alarm

for ppl w/ panic disorder, their panic is aggravated by hyperventilation — the more they breath fast/deep (sympathetic system), the l more their sense of alarm increases, which creates vicious cycle of anxious thougths and the sympathetic nervous system feeding of each other

*even if these ppl can recgonize theirPAs as false alarm, they may like in heightedned state of ansiety over what their sympathetic NS might do — may develop anxiety about situations in which they feel a PA would be espeicalluy unwecome (ex. airplane, closed space), & this anticipatory ansiety arouses theri sympathetic NS, so when these situation are appraoched the liklehood of a PA increases

Describe the 4 steps Dr. Geller decided to take to help Joe overcome his panic attacks.

*Dr. Geller asked Joe to track his panic attacks to see progress

1)training in relaxation & breathing techniques

2)changing his cognitive misinterpretations of panic sensations (explained bio and cog reasons behind PAs)

3)repeated exposure to sensation of panic under controlled conditions

4) repeated practice in situations that Joe was avoiding or apprehensive about

*specific steps Joe took (5 — sumarry of sessions 1-12)

1)progressive muscle relaxation exercise—alternately tensed & relaxed various muscle groups with goal of ascheing compelte relaxation in all muscle groups by the end of a 20 min session

2)breathing control exercise to train client to prevetn hyperventilation & cope effectivley when hyperventillation happens — patient practices slow breathing using diaphragm (instead of chest) to promote slow/unpressured braing that counteracts hyperventillation

3)Joe was to venture out 3 times on his own — if he had panic sensations, he was to hangle them using slow brathing with his diaphragm, appraise sensations rationally, & behave normally

4)interoceptive exposure exercises — repeated exposured to panic sensations under controlled conditions

doing these exercises would produce similar panic sensations to give Joe more chances to partice more accurate cogntive appraisal of such sensation, allowin ghim to devlop better coping skills

5)once interoceptive exercises no longer evoked any reaction from him (bored him), Dr. Geller provided Jow with program of pressive exposure to scenes involving airplanes (movies & trips to airport)

List each of the intereceptive exercises that were part of Joe’s treatment (8)

see image

How did Joe’s avoidance of going outside by himself contribute to his panic disorder?

Bc Joe was beginning to avoid leaving the house (except ih his wife Florence’s company — away from home unaccompanied) he was diagnosed with agoraphobia ON TOP of his panic disorder

*panic disorder frequently precedes the onset of agoraphobia (according to the DSM-5, agoraphobia is diagnoses separately from panic disorder)

What was the outcome for Joe?

after immersing himeself in the airplane exposure, Joe was able to go to the aiport and watch the videos wihtout emotional reaction

before his airplane trip Joe was panic free, and then he retuned from his trip without having had any issues with panic attacks on the plane or anywhere else

Dr. Geller reviewed a treatment program with Joe, including strategies he would follow, should he have any panic attack symptoms in the future