One theory explains it like this: In the brain, there is a kind of alarm system. For example, if I am asleep, and someone cuts off the oxygen supply in the room, my brain will wake me up. It is a good alarm system: Something in the brain senses danger and wakes us up, even when we are asleep.
In a panic attack, the alarm system is misfiring. It is sending a false alarm. There is nothing really dangerous, but the brain is giving the sensation that there is. Frequently, patients find this explanation reassuring.
We still need to treat the condition, but at least it makes patients feel a little easier to know it is a false alarm.
What is the treatment?
There are three components. First, we educate the patient about what it is and get them to understand it. Then there are medications that typically readjust the chemicals in the brain that are possibly making that misfiring happen.
Then we use a specific type of psychotherapy: behavioral cognitive therapy. This is particularly helpful with a condition called agoraphobia, which frequently accompanies panic attacks. [Agoraphobia is when a person develops an irrational fear of being in a place or situation, from which they feel that they cannot readily escape.]
The first part of the therapy is education. And there also is an element of teaching relaxation techniques. Through these, we help them work through the panic attacks as they happen. They learn to retrain the brain and prevent it from engaging in catastrophic and false thinking, which makes the physical symptoms much worse.
Can a patient who has panic attacks be cured?
Some people can be cured. Typically, you want them to be on the medications for a year at least. ... We don't know if the treatment is not the curative element. Sometimes we think the disorder itself is self-limiting like a cold -- a person with a cold is going to get better. Indeed in some people, the panic attacks simply will run their course. The problem is we have no way of knowing who is who. ... So we provide the treatment, and after about a year of stability we gradually have the patient come off the medications. After the medication is stopped, many people do well, but for some the attacks may come back. These people may need to be on the medication for a longer time.
Is there anything else you would like to say about panic attacks?
I think that a panic attack is one great example of how so-called mental disorders are misnamed. You can see that the majority of the symptoms of panic attacks are physical symptoms, and the emotional component is just one of many.
So calling it a mental condition -- is not only terribly stigmatizing and has been the cause of much discrimination, but it is inaccurate. ... I believe that to be true of all the conditions that people call mental disorders, and panic disorder is a great case in point.
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