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Slide ___________________________________ 1 ___________________________________ ___________________________________ ___________________________________ ___________________________________ Rachel Strohl, Psy.D. ___________________________________ www.StressAndAnxiety.com ___________________________________ Slide ___________________________________ 2 CBT for Panic Disorder ___________________________________ The goal is NOT to end anxiety. That’s ___________________________________ impossible. The goal is NOT to end panic ___________________________________ attacks. That’s beyond our control. The goal is to learn how to normalize and ___________________________________ respond effectively to anxiety. If you learn to accept that panic attacks can ___________________________________ happen but are not to be feared, you no longer have panic disorder. Although ___________________________________ unpleasant, panic attacks are only a problem if they control your choices. Fortunately, panic can’t control your choices. You are always in charge. Therefore, panic is not a problem; it’s just temporary pain. Slide ___________________________________ 3 ___________________________________ Our goals for today ___________________________________ We will differentiate panic attack symptoms in several of ___________________________________ the common anxiety disorders. ___________________________________ We will learn how to assess and diagnose Panic Disorder. ___________________________________ We will discuss some of the hypotheses behind why ___________________________________ someone has panic attacks. We will review Cognitive Behavioral Therapy (CBT) protocol for the treatment of Panic Disorder for adults. Slide ___________________________________ 4 ___________________________________ Panic Disorder DSM-V criteria ___________________________________ Criteria A: Recurrent and often unexpected panic attacks. ___________________________________ An anxiety disorder based primarily on the occurrence of ___________________________________ panic attacks. ___________________________________ At least one panic attack is followed by a month or more of ___________________________________ the person fearing that they will have more attacks. Panic vs. anxiety – share some symptoms but differ in intensity, duration, and whether or not there is a trigger. Slide ___________________________________ 5 ___________________________________ Panic Symptoms ___________________________________ A panic attack is an abrupt surge of intense fear or intense ___________________________________ discomfort that reaches a peak within minutes, and during which time 4 (or more) of the following symptoms occur: ___________________________________ 1. Palpitations, pounding heart, or accelerated heart rate ___________________________________ 2. Sweating ___________________________________ 3. Trembling 4. Sensations of shortness of breath 5. Feelings of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress Slide ___________________________________ 6 ___________________________________ Panic Symptoms ___________________________________ 8. Feeling dizzy, unsteady, lightheaded, or faint ___________________________________ 9. Chills or heat sensations 10. Parasthesias (numbness or tingling sensations) ___________________________________ 11. Derealization (feelings of unreality) or ___________________________________ depersonalization (being detached from one self) 12. Fear of losing control or "going crazy“ ___________________________________ 13. Fear of dying Slide ___________________________________ 7 ___________________________________ DSM-V Criteria ___________________________________ Criteria B: At least one of the attacks has been followed by ___________________________________ one month (or more) of one or both of the following: 1. Persistent concern or worry about additional panic attacks or the consequences. ___________________________________ 2. A significant maladaptive change in behavior related to the attacks (typically avoidance). ___________________________________ Criteria C: Panic is not better explained by a medical ___________________________________ condition. Criteria D: Panic is not due to another psychological disorder. Slide ___________________________________ 8 ___________________________________ Why do People Panic? ___________________________________ Suffocation Alarm Theory: ___________________________________ “I can’t get enough air. Something is wrong! Danger!” A catastrophic misinterpretation of physiological response. ___________________________________ Conditioning: Some subconscious connection was made with an environment or ___________________________________ stimuli, through conditioning, that triggers a panic response. ___________________________________ Slide ___________________________________ 9 ___________________________________ Why do People Panic? ___________________________________ The Fight or Flight response ___________________________________ A physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. ___________________________________ It is important to help the patient see panic as a normal ___________________________________ biological process that is not dangerous, while empathizing how unpleasant it is. It feels harmful, but it’s the body trying to be helpful. ___________________________________ Teaching acceptance of normal anxiety helps patients learn not to overreact to symptoms that precede panic. Our job is to help them to learn how to respond peacefully and effectively. Slide ___________________________________ 10 ___________________________________ Exclusion Criteria ___________________________________ The following may trigger panic attacks, but if that’s the ___________________________________ case then technically you wouldn’t diagnose panic disorder, because the panic attack is not unexpected: ___________________________________ OCD/Health Anxiety PTSD ___________________________________ Social Anxiety Specific Phobias ___________________________________ Emetophobia Slide ___________________________________ 11 ___________________________________ Social Anxiety Disorder ___________________________________ Excessive and persistent fear that others are evaluating ___________________________________ you. Fear that you will do or say something that is ___________________________________ embarrassing, will make you look bad, or will make ___________________________________ you the center of unwanted attention. As a result, the sufferer will actively avoid social ___________________________________ situations where evaluation may occur. The sufferer acknowledges that their fear is overblown. Slide ___________________________________ 12 ___________________________________ Generalized Anxiety Disorder ___________________________________ Characterized by excessive, uncontrollable and often irrational ___________________________________ worry about everyday things that is disproportionate to the actual source of worry. ___________________________________ Catastrophize, anticipate disaster, and are overly concerned ___________________________________ about everyday matters such as health issues, money, death, family or friends problems, or work difficulties. ___________________________________ They often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, bouts of difficulty breathing, trembling, twitching, irritability, sweating, and hot flashes.
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