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stresses. The mid-twenties are when many panic disorders start.
Biological factors may also play a role in causing panics, it runs in
families.
Further confusing the situation, several chemicals or conditions
occasionally produce attacks in panic prone people: sodium lactate,
caffeine, mitral valve prolapse, thyroid gland malfunctioning, and
hyperventilation. Likewise, since anxiety produces or contributes to
many physical disorders, and, conversely, many physical, biochemical,
and hormonal problems produce anxiety or anxiety-like symptoms, it
is always a good idea to have a good physical exam to diagnose or
rule out physical-hormonal factors, including hypoglycemia and PMS.
(But remember 50% of angiograms are given to panic disorder
patients.)
Anti-depressive drugs or Xanax "greatly improves" only about 30%
of clients with panic attacks and/or with agoraphobia (but a placebo
reportedly improves 25%). The drug treatment approach is simple and
takes six months to one year. However, there are several possible
problems: some of these drugs are highly addictive (especially if one
has a tendency towards alcoholism) and may have side effects; drugs
have high refusal-drop out rates (50%) and high relapse rates (from
35 to 85%); drugs do not solve underlying problems, if there are any.
For the 70% of panic disorders and agoraphobics who do not
respond to drugs, according to Michelson & Marchione (1991), Craske
& Barlow (1990), and Hoffart (1993), the treatment of choice involves
cognitive therapy (reducing negative thinking, irrational ideas, false
conclusions about dying, going crazy, etc.) combined with gradual
exposure to stressful situations (with support, relaxation, useful skills,
and more confidence). Misinterpretations of bodily sensations are
challenged, e.g. a therapist helps you test your belief that feeling faint
will actually lead to fainting. This kind of therapy is supposedly
effective 75%-85% of the time (with tentative indications that the
relapse rate is low). Some specialists dealing with panic disorders
claim that "guided mastery" is more effective than simple "exposure"
to the scary situation. This might be because more attention is given
to developing helpful self-instructions and self-confidence in mastering
the situation. For instance, in guided mastery, the helper (therapist or
friend) of a person afraid of heights would observe the phobic's
behavior and do such things as offer encouragement when
approaching the top railing of a high building, ask the phobic to look in
all directions and down, to let go of the railing, to approach the railing
over and over, and to do so more rapidly, and so on. Cognitive-
behavioral treatment may have fewer relapses than drug treatment
but its placebo effect is probably at least as high (25%?).
As we saw in the last section, research has produced many
interesting findings about exposure to the fear in vivo (in the real
situation). This is the best simple approach for dealing with most fears.
Direct exposure is more effective than imagining being in the situation;
prolonged exposure (4+ hours) is better than briefer exposure; the
