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Erstellt / Aktualisiert 02.02.2020 / 02.02.2020
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Fenster schliessen

Suffocation false alarm theory

Person is hypersensitive to carbon dioxide levels ⇒ Minor drops in Oxygen result in false alarm "person is suffocating" ⇒ Panic Attack

Fenster schliessen

Pharmacological treatment for panic disorder

First line treatments

• SSRI (Selective Serotonin Reuptake Inhibitors)

effective in many controlled studies ( e.g. Wade et al. 1997; Michelson et al 1998, 2000)

anxiolytic effect latency of 2-4 weeks

• Serotonin Norepinephrine Reuptake Inhibitors

effective in double blind placebo controlled studies (Bradwejn et al. 2005; Pollack et al. 1996)

Second line treatments

• Tricyclic antidepressants

frequency of adverse events is higher than for SSRI (Amore et al. 1999)

Third line treatments

• Benzodiazepines

anxiolytic effects immediately after oral intake, risk of dependency (Bradwejn 1993)

Fenster schliessen

Psychological treatment for panic disorder

Cognitive behavioral therapy

“Panic control treatment”

(PCT, Craske et al., 2000, Hofmann & Spiegel, 1999)

Elements

• Education about anxiety and panic development

• Cognitive restructuration: identification and correction of thoughts /

false cognitions about anxiety and its consequences

• Training (reduction arousal, hyperventilation)

• Exposition, controlled hyperventilation

11-12 sessions, 3-4 months

Fenster schliessen

Psychological treatment for panic disorder

 

Classical CBT Methods

• Hyperventilation

• Triggering bodily symptoms

• Deep breathing

• External focus

• mindfulness

Fenster schliessen

Learning safety in panic

Interoceptive exposure

Feared sensations become safe sensations:

• in the office with the therapist

• at home

• independent of the treatment context

Fenster schliessen

Dizziness

Panic Cycle

Uh oh!

What if:

• This gets worse?

• I lose control?

• This is a stroke?

I have to control

this!

Relative Comfort

• Notice the sensation

• Do nothing to control it.

• Relax WITH

the sensation

Fenster schliessen

Exposure procedures

Head rolling – 30 seconds - dizziness, disorientation

Hyperventilation – 1 minute - produces dizziness

lightheadedness, numbness, tingling, hot flushes, visual

distortion

Stair running – a few flights – produces breathlessness, a

pounding heart, heavy legs, trembling

Full body tension – 1 minute – produces trembling, heavy

muscles, numbness

Chair spinning – several times around – produces strong

dizziness, disorientation

Mirror (or hand) staring – 1 minute – produces derealization

Fenster schliessen

Psychological treatment for panic disorder

Cognitive behavioral therapy

• Efficacy between 87% and 75%

• Greater efficacy than relaxation therapy or control groups

• Greater efficacy than certain medicaments (e.g. alprazolam) and

similar to imipramine

• Long-term treatment with PCT is more effective than pharmacological

treatment

• Evidence of superiority from combined approach towards single treatment

not conclusive

• New developments: combination with self-help modules, therapy via

internet, electronic auto-observation