Panic Disorder & Phobias
Panic attacks and panic disorder are a type of anxiety that may be rooted in an actual situational experience: getting sick when you were little, being extremely embarrassed by a situation, or being stuck somewhere. Following such an experience, you may find yourself avoiding similar situations from fear that the panic will happen again.
Panic and full-blown panic attacks are so unbelievably unpleasant and uncomfortable that we will do pretty much anything to try and avoid having them again.
Unlike PTSD, the subsequent anxiety symptoms are not about the memory of the incident specifically, but rather the fear that they will lose control again. This avoidance of anything stressful fosters a fear of panic or of the activation symptoms, which in turn triggers a cycle of additional anxiety and panic.
Exposure Therapy
The most effective way to challenge the combination of physical panic symptoms, plus behavioral avoidance, is to engage in exposure therapy that is specifically tailored to the client’s symptoms. When treating panic I usually work to help expose patients first to the physical bodily sensations associated with panic attacks (interoceptive symptoms) and later the thoughts, activities, and environments that are avoided due to fear of experiencing panic in everyday life.
Phobias are very similar to panic disorder, though they are specific to a feared trigger. Common phobias include the fear of driving, fear of flying, fear of vomiting, or the fear of dogs.
I treat phobias just like panic, using exposure therapy that focuses on bodily sensations, thoughts, and the avoided everyday experiences.
This may include:
Exposures in session (e.g. watching videos or viewing images)
Virtual in-session in vivo exposures (e.g. going on exposure “field trips”)
Imaginal exposures (e.g. using imagery in-session to talk through a triggering experience)
Exposure homework (e.g. engaging in various out-of-session exposures on your own)