DSM-IV Diagnoses of Anxiety Disorders.

Panic Disorder: Describes the repeated experience of panic attacks (Panic attacks are described as sudden increase in anxiety accompanied by symptoms such as palpitations, breathlessness and dizziness.) Such symptoms are often experienced as terrifying and are typically mis interpreted as signs of impending or current ill health, like a heart attack or a stroke. Panic disorder can occur with or without agoraphobia. What that means: The sufferer experiences a catastrophic misinterpretation of bodily sensations (particularly those associated with anxiety) as indicating that there will be impending mental or physical harm, such as an imminent stroke or heart attack. Safety behaviours are used to reduce the likelihood of that catastrophe. These include complete avoidance such as not going to certain places or events, and more subtle avoidance such as holding onto someone to avoid collapse or sucking a sweet to avoid vomiting. Sufferers also begin to develop selective attention as they become highly sensitised to dangerous sensations or situations, and their attention becomes focussed towards these events. Thought processes in Panic Attacks: A trigger situation leads to anxiety for the sufferer. This produces physiological symptoms of anxiety; the sufferer misinterprets these as life threatening, which leads to increased anxiety. In order to cope with these feelings the sufferer engages in safety seeking behaviours, which leaves these unhelpful beliefs unchallenged and fees back into the cycle of anxiety. As with other anxiety disorders, thoughts about negative thoughts (e.g. There must be something fundamentally wrong with me for having panic attacks) can heighten anxiety. Emotional reasoning (the assumption that feelings are a reliable source of information about a situation i.e. I feel anxious, therefore this must be a dangerous situation. Is also common amongst sufferers of panic attacks. Case Study: When Julie had a panic attack, her chest tightened, she fought for breath and she trembled. She felt pain in her chest and in her arms and experienced tunnel vision. She thought she was having a heart attack and would die. She avoided any situation where she feared that she might exert herself, as she feared provoking a heart attack. For example she no longer did the weekly supermarket shop, or took her children to the park. She stopped going to the gym, and taking the kids swimming. She knew she was becoming physically unfit, and this heightened her fears.

Therapeutic Treatment of Panic Attacks: Nice Guidelines 2004 State The interventions that have evidence for the longest duration of effect, are in descending order CBT Looking at less catastrophic explanations for the origins of symptoms and less catastrophic predictions of the consequences of them. For example, attributing chest pains or a racing heart to anxiety or exercise, which is normal and not harmful. Setting up behavioural experiments to discover the benign origin of a feared sensation. For example, asking a sufferer to exert herself to trigger the feared sensation such as muscular pains and heart palpitations, to test the validity of her beliefs such as feeling the symptoms of anxiety and feeling them pass. Allowing her to see she can control them and she did not die. Reducing safety behaviours slowly such as shopping with out leaning on a trolley, working up to shopping without a trolley at all.