by Dana Terrell, LCSW, EAC
Anyone who has experienced an anxiety or panic attack knows it is no joking matter. On a scale of 1-10, where 10 represents the worst disturbance a person can imagine, panic disordered clients generally rate their panic attacks at 9 or 10. (An anxiety attack might be rated 6-8.) Their negative belief about themselves may be, “I will faint,” “I’m dying,” or “I’m having a heart attack.” Because these thoughts are accompanied by such intense emotion, they seem completely true. Because people fear that they are truly dying, they often also qualify for PTSD as well as Panic Disorder.
Panic Attack Symptoms Can Include:
* shortness of breath or difficulty breathing
* feeling “out of control” with fear or dread, wondering “Am I crazy?”
* trembling, tingling or shaking
* sensations of choking, nausea or stomach distress
* chills or hot flashes
* uncomfortably rapid heartbeat, often prompting a trip to the ER
“Good News! It’s only panic.”
The terrified person rushes to the ER, only to get the response: “Good news! You’re not having a heart attack. It’s only Panic.” They are often sent home with Xanax. But they are thinking, “Great! I feel like I’m having a heart attack, but I’m not. They are basically telling me it’s in my head. So I must be crazy.”
No. People with panic are not crazy. Their anxious experiences are simply stored dysfunctionally in their brain. The memories are still in an agitated state, and it makes life very hard. EMDR can do amazing things with these dysfunctionally stored memories. The brain is very talented at healing, with the assistance of a Certified EMDR therapist.
What Causes Panic or Anxiety?
People with Panic Disorder, in my practice, often have a backload of negative experiences which they rarely took the time to address. Perhaps they didn’t get the support they needed to resolve them. These experiences could be “large T” trauma, recognized by any objective person as horrific. Or some could be “small t” trauma – those smaller hurts of life. For a young child or teen these became terrible because of the negative conclusions the person drew about himself. From the assessment of their trauma symptoms, they may actually qualify for a diagnosis of Post-Traumatic Stress Disorder (PTSD) in addition to Panic Disorder. Or they may not.
Special Care in Treatment of Panic
As an EMDR therapist, we often work to resolve the traumas, whether big or small, after a period of history taking and preparation. But for a client with Panic Disorder, it is essential to treat the Panic before the trauma because the person does not feel safe in the present. To add working on trauma is only more stressful to such a person.
Marcia Whisman developed an EMDR treatment for Panic
This realization was the discovery of Marcia Whisman, LCSW, of St. Louis, MO, who is an internationally respected expert in anxiety disorders. She has integrated the EMDR approach developed by Francine Shapiro, PhD into the standard cognitive-behavioral treatment of Panic Disorder. After taking Marcia’s training in Seattle in 2005, I hosted her in 2006 when she gave her two day EMDR specialty workshop for treating Panic and OCD (Obsessive-Compulsive Disorder) in San Diego.
Stage 1: Treat Panic as Traumatic Memories, dysfunctionally stored in the brain.
Ms. Whisman has a 3 stage treatment for Panic. In Stage 1, the therapist assists the client to process the memories of specific panic attacks. The EMDR helps the person’s brain let go of the false beliefs, and accept true beliefs: “this is just an adrenaline reaction in the body,” “this will pass, it always has and it always will.”
State 2: Learn to Manage Anxiety and Panic in the Present
In Stage 2, we use EMDR to address the present concerns about learning to manage bodily sensations of panic when they arise. The client is educated in skills for self-calming, and EMDR is used positively to enhance their confidence in those skills.
Stage 3: Desensitize triggers for anxiety, one at a time (easiest first)
Finally, in Stage 3, we address the hierarchy of fears. These are situations rated for their ability to trigger panic attacks in the past (and which are often avoided by the time a client comes to treatment). We start with the lowest level fear that still feels relevant. Using EMDR, we imagine in detail being exposed to that fear and handling it well. Once the client is confident they can do that, they schedule a time to do it, perhaps with a supportive friend or loved one present during the actual exposure. Any effort is considered success, and the client comes back to evaluate all aspects of success and to note what difficulties may have arisen and process those. This process is continued until each fear can be faced alone comfortably and successfully.
Now, being safe in the present, it is important to process unresolved past experiences which made the person vulnerable to panicy feelings
At that point, the client has safety in the present. Then they can begin the processing of old traumas. Those unresolved anxieties (along with possible genetic predispositions) are what made the person vulnerable to some form of anxiety disorder. It is still essential to clear those experiences for EMDR treatment to be complete. Complete treatment means being able to live life confidently, able to face and overcome problems, one at a time.
Panic is Treatable, the Results are Rewarding
Treating Panic Disorder is hard work for both client and clinician. But it is well worth the effort to get one’s life back from the dictates of anxiety. One client stayed for years in a job she hated, because it was isolated and she didn’t have to face many of the fears she had about being in the world. Now she is working in a bank, and hasn’t had a panic attack. “I’m doing fine,” she said. “I’ll call you if I need to.”
Do People Need to Learn to Live with Panic? No.
On the radio one day I heard a national expert in treating Panic Disorder state that people have to learn to live with panic. To me that is very sad. I don’t believe it. I am so grateful to be an EMDR therapist and to have received Whisman’s training. I love helping people to free their lives from panic, and regain the ability to joke, have fun and have real choices in their lives. To me, this is very rewarding work. Many of my EMDR colleagues on this website who treat anxiety would agree with me.
©2012 Dana Terrell, LCSW