Panic Disorder and Agraphobia

Panic Attack/Disorder

Panic attack: A discrete period of intense fear or discomfort, in which four (or more) of the following 13 physical symptoms developed abruptly and reached a peak within 10 minutes: 

• Heart palpitations

• sweating

• trembling

• fear of dying

Panic Disorder

• A. Recurrent unexpected panic attacks

• B. Concern about having additional attacks, worry about implications of attacks, or change in behavior related to attacks – for at least 1 month

The difference between a panic attack and excessive stress or high anxiety

• The timing of peak to end of attack

• The interpretation of normal physical sensations in a catastrophic manner

Saftey Behaviors

• Anti-anxiety medications

• Traveling with someone

• Avoid exercise

Agoraphobia

A marked fear or anxiety about 2 (or more) of the following 5 situations:

• Using public transportation

• Being in open spaces

• Being in enclosed spaces (e.g., shops, theaters, cinemas)

• Standing in line or being in a crowd

• Being outside the home alone

Panic disorder Etiology - misinterpretation of physical cues and repeated attacks

misinterpretation of physical cues

1. anxiety

2. somatic symptoms (like increased heart rate)

3. “something is terribly wrong”

4. more anxiety

5. other panic symptoms

6. this is it. I’m dying.

(3,4,5,6 is a panic attack)

Repeated attacks

1. apprehension about somatic symptoms

2. somatic symptoms, such as increased heart rate

3. “here is another panic attack”

4. panic symptoms

5. (3,4 is panic disorder)

Interoceptive Conditioning

attempts to recreate feared physical sensations through different exercises

CBT for panic disorder

• Interoceptive exposure

• Challenge beliefs about effects of panic symptoms