Panic Disorder Research Paper
Theoretical Approaches to Treating Panic Disorder
Michael Figel
Psy 6310
Dr. Wilmshurst
22 May 2011
Trembling limbs, pounding heart so frantic that a heart attack is certain to commence, sweat dripping from the forehead as fate seems lurking around the corner. Panic Disorder is so traumatic that the intense fear one suffers can make them feel they are going to die, or their experience of other physical distress result in not being able to cope with living. Those that suffer from panic disorder experience anxiety that affects its victims emotionally, physically as well as mentally. While many people are affected by it in one way or another, anxiety and panic disorder is far more serious and detrimental to the well-being and ability to …show more content…
function in the lives of those affected by the disorder. There is a great deal of research on the subject of panic disorder, and in order for panic disorder to be effectively treated, a number of variables must be considered and put into practice. As the research presented in this written work will support, it is the education opinion of this writer that empirical research supports that when there is a positive, productive relationship between patient and therapist, and research is conducted under standardized criteria, that naturalistic psychotherapy is advantageous in treating symptoms and sources of panic disorder. Beyond Brand Names of Psychotherapy (Ablon,2006) illustrates the anxiety a patient experiences to an inconvenient distraction that should be disregarded.
Anxiety is not the “signal” that provides clues to a world of personal meaning and significance; it is a kind of “white noise” accompanying a dysfunctional nervous system. And just as it makes no sense to listen to white noise, this literature indicates that seeking to understand the personal significance of anxiety per se is inherently contradictory. Treatment, therefore, focuses not on the meaning of the patient’s anxiety but on the maladaptive habits involved to avoid the anxiety (2006).
Therefore, as Ablon et al clarifies in this statement, clinicians should not aim to cure, over analyze, or explain. The ability to function and create a therapeutic solution to the presented disorder should keep the patient honed in on the ultimate goal of their treatment. As the therapists focus is on the psychodynamic process and a positive therapeutic relationship, likewise the patient will gradually gain a solid foundation for effective therapy to begin. Panic Disorders can also occur in other anxiety disorders, despite whether or not a person is classified as suffering from an anxiety disorder (Roth, Wilhelm & Pettit, 2005). The National Institute of Mental Health’s Committee on Standardized Assessment for Panic Disorder Research is a nationwide assembly of mental health experts and other professionals that are dedicated to the research, experiment, and treatment of those that suffer from panic disorder. The existence of such a committee speaks to the need for professional, objective research that can service the population of panic disorder patients. Roth et al (2005) clinically analyze and describe panic as, “anxiety without an obvious immediate triggering stimulus, an anxiety which over time can lead to avoidance of situations that are difficult to leave quickly, and whose somatic symptoms lead to concerns about heart disease or physical illness (2005).” Many researchers such as Roth focus on only explaining the panic and analyzing the effects that can take place. While this is valid in one’s research, it is the role of the psychotherapist to go deeper and explore the source. As (Teachman, 2010) describes, “According to the cognitive model of panic, change is attained through a shift in the way one interprets feared bodily and mental events”. Anxiety is the product of an underlying emotion that should be further explored in order for effective psychotherapy to take place. Ablon et al (2006) is referenced regarding his concept of emotion in the perspective of panic disorders. He feels that the unexplored underlying emotions, particularly anger, can actually bring on anxiety if not properly dealt with. Expression of anger can propel a patient in their anxiety by their realization of their feelings toward a person or a situation, while in other instances the inability to express anger can stunt one’s progress. The latter is more common as several who suffer from panic disorder wish to escape from their emotions; therefore they are either unwilling or fearful to emit such strong underlying emotions. Ablon et al (2006) state that, “empirical connection between alexithymia (characterized by difficulty recognizing and verbalizing feeling, a paucity of fantasy life, concrete speech and thought closely tied to external events) and panic disorder supports this assertion”. If a patient is consistently hesitant to show their true desires and emotions when examining stressful attacks and underlying fears can prove to be paralyzing to one’s therapeutic growth. In the present study below, valuable empirical research was conducted to evaluate the effects of naturalistic treatment in a controlled setting to document the improvements in patients. It is vital to ones research to note the variables that affect the outcome of one’s research. McNally (2006), states the importance of proper, standardized testing is strongly advocated for. In the National Institute of Mental Health’s Committee on Standardized Assessment for Panic Disorder, such meticulous standards are mandatory to be met for all of the research and experiments done. The reason for such high standards is simple and understandable. Without such criteria that are established prior to one’s research and testing, it becomes more difficult to analyze the outcomes post-treatment. In conducting this research, their goal was to change the perspective of medicated venues to focus on how a natural approach would be effective in an appropriate therapeutic setting:
Assuming that experienced clinicians might help their patients achieve symptomatic improvement, we used empirical methods to identify the change processes present in a naturalistic treatment so that we could learn how and why patients improved. If empirically validated change processes could be identified, we would have an empirical basis from which to develop or amend clinically relevant treatment (2006).
Ablon et al remind their readers the importance of taking all the variables of a psychiatric experiment into consideration before one can draw conclusions.
Initially, Ablon (2006) hypothesized that their method of naturalistic treatment would be effective if the following variables were considered among the following conditions or a positive outcome:
Specifically, we hypothesized that (1) naturalistic psychotherapy for panic disorder would be a highly effective treatment with gains commensurate with those achieved by prescriptive treatments; (2) that the treatments would be characterized by a high degree of psychodynamic process and significantly less be elements of interpersonal and cognitive-behavioral process; (3) that positive outcome would be predicted by the degree to which psychodynamic (rather than interpersonal and cognitive-behavioral) process was fostered; (4) that the treatments would be chacterized by elements typical of psychodynamic therapy including attention to the therapeutic alliance and relationship, interpretation of defense mechanisms, identification of unconscious feelings and wishes deemed dangerous, and the linking of current symptoms, behaviors, and feelings to past experiences; and (5) that these specific variables along with a focus on facilitating emotional expression would be most predictive of positive outcome …show more content…
(2006).
The participants for this research consisted of 17 patients between the ages of 24-55 (average age 35) diagnosed with the DSM-IV at the Massachusetts General Hospital. Therapists consisted of seven different clinicians who handles anywhere from one to four patients over the allotted time for treatment. Treatment was conducted over six to seven months with an average rate of 21 sessions. The outcome of this study was used through the gathering information from the therapist, patient, and independent raters utilizing numerous means of collection statistical information. The data gathered measured the beginning of treatment to six months after treatment was terminated. As further explained in this article, the comfort of the patient is key in order to have a positive and effective relationship with their therapist. Their studies showed that a positive collaborative relationship between therapist and patient proved to be effective for treatment. An effective therapeutic relationship allows the patient to freely express their fears and insecurities, while also being invested in their treatment and having full trust in their therapist. As reiterated by the research of Ablon (2006) a positive relationship between therapist and patient increases the likelihood of progress. After considering the results of the conducted study, it is easy to see the positive effect a healthy therapeutic relationship can have on the progress of the patient. Clinically, there were statistical improvements in a number of the patient’s moral standards, including self-esteem, while defensive behavior and function still proved to be an issue for participants. It is often said that laughter is the best medicine, and perhaps this statement is not far-fetched. One of the variables that proved to be helpful in the study was humor. After establishing a comfortable working relationship, the expectations of therapy were clarified along with a commitment to one’s progress in therapy (2006). While it is vital to have a clear expectation in therapy, it is usually important for both patient and therapist to commonly understand those expectations, therefore, providing a clear perspective on the process to take place and understanding where they each stand. It is also important to note the specific numerous improvements patients made statistically over the several months of their treatment. With a proper approach to the patient’s emotional stance, progress was statistically made in a number of areas. Patients were able to face their underlying negative emotions, such as shame. As the therapist would focus on such negative feelings they would elaborate on them, focusing on what is and is not acceptable for the patient. Through allowing the therapist to see into the psychoanalytic mind of a patient with panic disorder, the therapist can identify and focus on the suppressed emotion as therapy takes place (Stoeri, 1987). Such an established goal allows the therapist to clearly see the patient’s perspective and ascertain their needs within the course of their therapy. Upon conclusion of the presented information, it was determined that patients reported statistically significant decreases in both the anticipation and experience of anxiety as well as significant increases in overall functioning Ablon (2006). By the end of this naturalistic study, two patients stopped taking medication due to the improvements mad in coping with panic disorder. The severity of panic attacks was reduced, as well as the ability to function and cope. Some may question the overall scientific ability to measure happiness; however one could surmise that these researchers succeeded in getting their participants closer to a higher level of functioning and perhaps, happier while conducting this study. Emotions, physical health, and the patient’s general satisfaction with their life improved for participants. In closing, the empirical research conducted and documented by Ablon (2006) verify the value of non- prescriptive treatment for panic disorder.
As stated by the author, “This study provides evidence that non-prescriptive treatment, particularly psychodynamic psychotherapy, may hold promise as a stand-alone treatment for panic disorder that could be offered as an alternative to compare to EST’s such as Panic Control Therapy in controlled trials.” The psychodynamic approach that was taken is deemed more acceptable regarding improvements versus an approach the concentrates on combating symptoms alone. Overall, the effective outcomes were credited to the emotion-based approach. This non-prescriptive, naturalistic approach is highly recommended for those that suffer from panic disorder and who are looking for an effective approach to deal with symptoms and source of their
disorder.
Reference
Ablon, J; Levy, R, A; & Katzenstein, T. (2006). Beyond brand names of psychotherapy: Identifying
Empirically supported change processes. Psychotherapy: Theory, Research, Practice, Training 43(2) 216-231
McNally, R. J. (1996). Methodological controversies in the treatment of panic disorder. Journal of
Consulting and Clinical Psychology 64(1) 88-91
Roth, W. T; Wilhelm, F. H; & Pettit, D. (2005). Are current theories of panic falsifiable? Psychological
Bulletin 131(2) 171-192
Stoeri, J. H. (1987). Psychoanalytic psychotherapy with panic states: A case presentation. Psychoanalytic
Psychology 4(2) 101-113
Teachman, B. A; Marker, C. D; & Clerkin, E. M. (2010). Catastrophic misinterpretations as a predictor of
Symptom change during treatment for panic disorder. Journal of Consulting and Clinical
Psychology 78(6) 964-973
Hypothetical Counseling Session
Therapist: How have you been since our last session?
Patient: As if you really care. As if, when I tell you, a person like you could appreciate or experience what I go through day to day.
Therapist: Do you blame others when you feel like you are going to have a panic attack?
Patient: Yes, I do. I’m tired of people telling me to get over it, tired of being given ridiculous advice from family members who say, “just breathe deeply and count to ten” when I feel anxious or upset. Thinking about breathing, concentrating on breathing when I can’t breathe is only going to make me more upset and I can’t breathe!
Therapist: Actually slow deep breathing actually calms the mind and body. Let’s try an exercise, is that okay with you?
Patient: I guess so.
Therapist: What I want you to do is sit back and close your eyes. Think of a warm, gentle place where you used to go when you felt calm and relaxed. As you begin to think of this wonderful place I want you to slowly breathe in your nose and slowly exhale out of your mouth.
Patient: Okay.
Therapist: Now do this for about eight to ten times visualizing where you are and focus on being in the present moment. I know this may feel awkward at first, but it will take a lot of practice. Try to say a soothing word when you breathe as well. When you feel like you are going to have a panic attack in the future trust in yourself to use a cue word and breathe slowly and let the panic attack takes its course.
Patient: What do I do when I feel like feeling?
Therapist: I know it will be difficult, but try your best to stay where you are and continue to with the deep breathing exercises. What’s happening to you is you are hyperventilating which means your body is getting too much carbon monoxide and not enough oxygen. Now for our next visit I want to talk about some of your emotions that you might be suppressing that I believe is causing your anxiety.
Patient: Okay. I have a lot of anger and frustration. And I don’t know where it comes from.
Therapist: I believe together we can bring some of those feelings into your conscious awareness so your anxiety won’t have such a hold on you. I will see you next week. Keep up with the breathing exercises meanwhile.
Patient: I will. Thank you.
Michael Figel
Psy 6310
Dr. Wilmshurst
22 May 2011
Trembling limbs, pounding heart so frantic that a heart attack is certain to commence, sweat dripping from the forehead as fate seems lurking around the corner. Panic Disorder is so traumatic that the intense fear one suffers can make them feel they are going to die, or their experience of other physical distress result in not being able to cope with living. Those that suffer from panic disorder experience anxiety that affects its victims emotionally, physically as well as mentally. While many people are affected by it in one way or another, anxiety and panic disorder is far more serious and detrimental to the well-being and ability to …show more content…
function in the lives of those affected by the disorder. There is a great deal of research on the subject of panic disorder, and in order for panic disorder to be effectively treated, a number of variables must be considered and put into practice. As the research presented in this written work will support, it is the education opinion of this writer that empirical research supports that when there is a positive, productive relationship between patient and therapist, and research is conducted under standardized criteria, that naturalistic psychotherapy is advantageous in treating symptoms and sources of panic disorder. Beyond Brand Names of Psychotherapy (Ablon,2006) illustrates the anxiety a patient experiences to an inconvenient distraction that should be disregarded.
Anxiety is not the “signal” that provides clues to a world of personal meaning and significance; it is a kind of “white noise” accompanying a dysfunctional nervous system. And just as it makes no sense to listen to white noise, this literature indicates that seeking to understand the personal significance of anxiety per se is inherently contradictory. Treatment, therefore, focuses not on the meaning of the patient’s anxiety but on the maladaptive habits involved to avoid the anxiety (2006).
Therefore, as Ablon et al clarifies in this statement, clinicians should not aim to cure, over analyze, or explain. The ability to function and create a therapeutic solution to the presented disorder should keep the patient honed in on the ultimate goal of their treatment. As the therapists focus is on the psychodynamic process and a positive therapeutic relationship, likewise the patient will gradually gain a solid foundation for effective therapy to begin. Panic Disorders can also occur in other anxiety disorders, despite whether or not a person is classified as suffering from an anxiety disorder (Roth, Wilhelm & Pettit, 2005). The National Institute of Mental Health’s Committee on Standardized Assessment for Panic Disorder Research is a nationwide assembly of mental health experts and other professionals that are dedicated to the research, experiment, and treatment of those that suffer from panic disorder. The existence of such a committee speaks to the need for professional, objective research that can service the population of panic disorder patients. Roth et al (2005) clinically analyze and describe panic as, “anxiety without an obvious immediate triggering stimulus, an anxiety which over time can lead to avoidance of situations that are difficult to leave quickly, and whose somatic symptoms lead to concerns about heart disease or physical illness (2005).” Many researchers such as Roth focus on only explaining the panic and analyzing the effects that can take place. While this is valid in one’s research, it is the role of the psychotherapist to go deeper and explore the source. As (Teachman, 2010) describes, “According to the cognitive model of panic, change is attained through a shift in the way one interprets feared bodily and mental events”. Anxiety is the product of an underlying emotion that should be further explored in order for effective psychotherapy to take place. Ablon et al (2006) is referenced regarding his concept of emotion in the perspective of panic disorders. He feels that the unexplored underlying emotions, particularly anger, can actually bring on anxiety if not properly dealt with. Expression of anger can propel a patient in their anxiety by their realization of their feelings toward a person or a situation, while in other instances the inability to express anger can stunt one’s progress. The latter is more common as several who suffer from panic disorder wish to escape from their emotions; therefore they are either unwilling or fearful to emit such strong underlying emotions. Ablon et al (2006) state that, “empirical connection between alexithymia (characterized by difficulty recognizing and verbalizing feeling, a paucity of fantasy life, concrete speech and thought closely tied to external events) and panic disorder supports this assertion”. If a patient is consistently hesitant to show their true desires and emotions when examining stressful attacks and underlying fears can prove to be paralyzing to one’s therapeutic growth. In the present study below, valuable empirical research was conducted to evaluate the effects of naturalistic treatment in a controlled setting to document the improvements in patients. It is vital to ones research to note the variables that affect the outcome of one’s research. McNally (2006), states the importance of proper, standardized testing is strongly advocated for. In the National Institute of Mental Health’s Committee on Standardized Assessment for Panic Disorder, such meticulous standards are mandatory to be met for all of the research and experiments done. The reason for such high standards is simple and understandable. Without such criteria that are established prior to one’s research and testing, it becomes more difficult to analyze the outcomes post-treatment. In conducting this research, their goal was to change the perspective of medicated venues to focus on how a natural approach would be effective in an appropriate therapeutic setting:
Assuming that experienced clinicians might help their patients achieve symptomatic improvement, we used empirical methods to identify the change processes present in a naturalistic treatment so that we could learn how and why patients improved. If empirically validated change processes could be identified, we would have an empirical basis from which to develop or amend clinically relevant treatment (2006).
Ablon et al remind their readers the importance of taking all the variables of a psychiatric experiment into consideration before one can draw conclusions.
Initially, Ablon (2006) hypothesized that their method of naturalistic treatment would be effective if the following variables were considered among the following conditions or a positive outcome:
Specifically, we hypothesized that (1) naturalistic psychotherapy for panic disorder would be a highly effective treatment with gains commensurate with those achieved by prescriptive treatments; (2) that the treatments would be characterized by a high degree of psychodynamic process and significantly less be elements of interpersonal and cognitive-behavioral process; (3) that positive outcome would be predicted by the degree to which psychodynamic (rather than interpersonal and cognitive-behavioral) process was fostered; (4) that the treatments would be chacterized by elements typical of psychodynamic therapy including attention to the therapeutic alliance and relationship, interpretation of defense mechanisms, identification of unconscious feelings and wishes deemed dangerous, and the linking of current symptoms, behaviors, and feelings to past experiences; and (5) that these specific variables along with a focus on facilitating emotional expression would be most predictive of positive outcome …show more content…
(2006).
The participants for this research consisted of 17 patients between the ages of 24-55 (average age 35) diagnosed with the DSM-IV at the Massachusetts General Hospital. Therapists consisted of seven different clinicians who handles anywhere from one to four patients over the allotted time for treatment. Treatment was conducted over six to seven months with an average rate of 21 sessions. The outcome of this study was used through the gathering information from the therapist, patient, and independent raters utilizing numerous means of collection statistical information. The data gathered measured the beginning of treatment to six months after treatment was terminated. As further explained in this article, the comfort of the patient is key in order to have a positive and effective relationship with their therapist. Their studies showed that a positive collaborative relationship between therapist and patient proved to be effective for treatment. An effective therapeutic relationship allows the patient to freely express their fears and insecurities, while also being invested in their treatment and having full trust in their therapist. As reiterated by the research of Ablon (2006) a positive relationship between therapist and patient increases the likelihood of progress. After considering the results of the conducted study, it is easy to see the positive effect a healthy therapeutic relationship can have on the progress of the patient. Clinically, there were statistical improvements in a number of the patient’s moral standards, including self-esteem, while defensive behavior and function still proved to be an issue for participants. It is often said that laughter is the best medicine, and perhaps this statement is not far-fetched. One of the variables that proved to be helpful in the study was humor. After establishing a comfortable working relationship, the expectations of therapy were clarified along with a commitment to one’s progress in therapy (2006). While it is vital to have a clear expectation in therapy, it is usually important for both patient and therapist to commonly understand those expectations, therefore, providing a clear perspective on the process to take place and understanding where they each stand. It is also important to note the specific numerous improvements patients made statistically over the several months of their treatment. With a proper approach to the patient’s emotional stance, progress was statistically made in a number of areas. Patients were able to face their underlying negative emotions, such as shame. As the therapist would focus on such negative feelings they would elaborate on them, focusing on what is and is not acceptable for the patient. Through allowing the therapist to see into the psychoanalytic mind of a patient with panic disorder, the therapist can identify and focus on the suppressed emotion as therapy takes place (Stoeri, 1987). Such an established goal allows the therapist to clearly see the patient’s perspective and ascertain their needs within the course of their therapy. Upon conclusion of the presented information, it was determined that patients reported statistically significant decreases in both the anticipation and experience of anxiety as well as significant increases in overall functioning Ablon (2006). By the end of this naturalistic study, two patients stopped taking medication due to the improvements mad in coping with panic disorder. The severity of panic attacks was reduced, as well as the ability to function and cope. Some may question the overall scientific ability to measure happiness; however one could surmise that these researchers succeeded in getting their participants closer to a higher level of functioning and perhaps, happier while conducting this study. Emotions, physical health, and the patient’s general satisfaction with their life improved for participants. In closing, the empirical research conducted and documented by Ablon (2006) verify the value of non- prescriptive treatment for panic disorder.
As stated by the author, “This study provides evidence that non-prescriptive treatment, particularly psychodynamic psychotherapy, may hold promise as a stand-alone treatment for panic disorder that could be offered as an alternative to compare to EST’s such as Panic Control Therapy in controlled trials.” The psychodynamic approach that was taken is deemed more acceptable regarding improvements versus an approach the concentrates on combating symptoms alone. Overall, the effective outcomes were credited to the emotion-based approach. This non-prescriptive, naturalistic approach is highly recommended for those that suffer from panic disorder and who are looking for an effective approach to deal with symptoms and source of their
disorder.
Reference
Ablon, J; Levy, R, A; & Katzenstein, T. (2006). Beyond brand names of psychotherapy: Identifying
Empirically supported change processes. Psychotherapy: Theory, Research, Practice, Training 43(2) 216-231
McNally, R. J. (1996). Methodological controversies in the treatment of panic disorder. Journal of
Consulting and Clinical Psychology 64(1) 88-91
Roth, W. T; Wilhelm, F. H; & Pettit, D. (2005). Are current theories of panic falsifiable? Psychological
Bulletin 131(2) 171-192
Stoeri, J. H. (1987). Psychoanalytic psychotherapy with panic states: A case presentation. Psychoanalytic
Psychology 4(2) 101-113
Teachman, B. A; Marker, C. D; & Clerkin, E. M. (2010). Catastrophic misinterpretations as a predictor of
Symptom change during treatment for panic disorder. Journal of Consulting and Clinical
Psychology 78(6) 964-973
Hypothetical Counseling Session
Therapist: How have you been since our last session?
Patient: As if you really care. As if, when I tell you, a person like you could appreciate or experience what I go through day to day.
Therapist: Do you blame others when you feel like you are going to have a panic attack?
Patient: Yes, I do. I’m tired of people telling me to get over it, tired of being given ridiculous advice from family members who say, “just breathe deeply and count to ten” when I feel anxious or upset. Thinking about breathing, concentrating on breathing when I can’t breathe is only going to make me more upset and I can’t breathe!
Therapist: Actually slow deep breathing actually calms the mind and body. Let’s try an exercise, is that okay with you?
Patient: I guess so.
Therapist: What I want you to do is sit back and close your eyes. Think of a warm, gentle place where you used to go when you felt calm and relaxed. As you begin to think of this wonderful place I want you to slowly breathe in your nose and slowly exhale out of your mouth.
Patient: Okay.
Therapist: Now do this for about eight to ten times visualizing where you are and focus on being in the present moment. I know this may feel awkward at first, but it will take a lot of practice. Try to say a soothing word when you breathe as well. When you feel like you are going to have a panic attack in the future trust in yourself to use a cue word and breathe slowly and let the panic attack takes its course.
Patient: What do I do when I feel like feeling?
Therapist: I know it will be difficult, but try your best to stay where you are and continue to with the deep breathing exercises. What’s happening to you is you are hyperventilating which means your body is getting too much carbon monoxide and not enough oxygen. Now for our next visit I want to talk about some of your emotions that you might be suppressing that I believe is causing your anxiety.
Patient: Okay. I have a lot of anger and frustration. And I don’t know where it comes from.
Therapist: I believe together we can bring some of those feelings into your conscious awareness so your anxiety won’t have such a hold on you. I will see you next week. Keep up with the breathing exercises meanwhile.
Patient: I will. Thank you.