PROBLEM SHARED
For 30 years I’ve been suffering from panic attacks, some quite severe. Psychotherapy made things worse, so I am on antidepressants. Now I am retired and less stressed, I would like to stop the pills. I have heard about cognitive behavioural therapy and I think it sounds ideal. Can you tell me more about it and suggest how to find a good therapist?
TANYA SAYS Panic attacks are frightening experiences that can be extremely debilitating and cause sufferers to avoid situations where their panic is triggered – which can ultimately narrow engagement with life. You don’t say why the attacks started, but they can be triggered for a variety of reasons – places, people, social situations – and sometimes seem to appear out of nowhere.
Anxiety is a normal, instinctive response to threat and fear, but an anxiety disorder exists when panic is triggered by situations that are not in reality threatening, but are perceived as being so. The person can experience a surge of adrenaline and cortisol, and the resulting attack can feel uncontrollable, causing significant fear. Sufferers describe a sense of ‘going mad’ as the rational brain switches down to enable survival instincts to take over.
Medication works for you because it has acted on the receptors in your brain that regulate the chemical serotonin, which reduces the number and severity of attacks. But now you are at a stage in your life where you experience less stress and have more time to spend on yourself, I congratulate you for considering stopping the medication and trying cognitive behavioural therapy (CBT).
CBT treats the psychological impact of panic and teaches strategies to manage mind and body when dealing with it. For a self-help guide see moodjuice.scot.nhs.uk/panic.asp. The cognitive restructuring part of CBT enables our logical brain to take control back when we slip into emotional panic areas. You will learn to understand your anxiety-provoking thought patterns, and replace them with more balanced reasoning where you rationally talk yourself down, challenging irrational thinking. You will get skilled at spotting the anticipatory anxiety thoughts, enabling yourself to stop avoiding situations by slowly exposing yourself to those that have induced panic in the past.
You will also be taught techniques to manage panic and bring your heart rate and other reactions down. Progressive muscle relaxation and breathing techniques teach you to manage panic-driven physical responses. Mindfulness, a meditative approach, is used to help to short-circuit the vicious cycle of fear and panic by teaching you to manage unpleasant physical sensations without reacting negatively to them. You can learn these techniques yourself via the app Headspace (headspace.com).
It’s important that you don’t stop medication until you have successfully started CBT, then reduce it over time as you become more confident in managing the panic. Your GP should oversee this process and can refer you for CBT or you can find a practitioner at bps.org.uk. It might be that you will need to remain on medication, perhaps at a low dose, even after successfully completing CBT – for some people who have long-term and wellestablished panic disorder, this combination of treatments shows the best outcomes.
I have great respect for you and your motivation to engage in psychological therapy. This is a real investment in yourself and takes courage. It will be liberating for you to really address the psychological aspects of this debilitating condition and I have no doubt that with your insight, self-awareness and motivation, you will do very well.
Therapy is a real investment in yourself and takes courage