PANIC DISORDER AND EMDR TREATMENT
Panic attack is one of the most common situations today. The results of epidemiological studies conducted in various countries have revealed that the lifetime prevalence of panic disorder is 1.5-2.5% (Lepine and Pelissolo 1999). Although the lifetime prevalence of panic attacks varies depending on the diagnostic criteria used, it has been found to be between 7% and 9% in many countries (Lepine and Pelissolo 1999). This article aims to both define panic disorder and provide information about how it can be treated with EMDR.
I think the most important point to focus on when defining panic is to be able to define some specific differences between panic, fear and anxiety. Because there is so much in common between these, it is important to determine in what ways these terms are similar or different from each other.
Barlow (1988) defines anxiety as It is defined as a widespread affective network that is kept in memory. Anxiety is defined as a future-oriented emotional state in which negative emotions are felt intensely and future events are perceived as uncontrollable and unpredictable.
Fear is a known potential. It is seen as an alarm response to escape from a danger, and in this case the organism becomes physically and cognitively mobilized to take action. Fear is a fight-flight response that exists across cultures and species, and the severity of this reaction depends on the situation.
The fear response given when intense fear is experienced even though there is no real element of fear. It is called false alarm or panic attack.
Panic disorder most commonly begins in the period between late adolescence and the thirties. In the clinical sample, the average age of onset is around 25 years. Panic disorder can also begin in childhood or over the age of 40, although at lower rates. It is a common finding of various epidemiological and clinical studies that panic disorder is more common in women.
Panic attacks can occur in different types. A known situational trigger Panic attacks that occur without warning are the "unexpected" type of panic attacks. Panic attacks that are likely to occur in certain situations, but do not necessarily occur, are called "situationally predisposed" panic attacks. Another type of panic attack is "situational" panic attacks, which occur immediately after encountering a situational trigger.
Panic attacks typically involve intense fear, anxiety, and the feeling of something bad happening. It starts suddenly with the expectation that it will happen and reaches its highest level in a short time. During a panic attack, physical symptoms such as difficulty breathing, feeling of suffocation, dizziness, feeling faint, palpitations, increased heart rate, tremors, nausea, abdominal discomfort, numbness, tingling sensation, hot flushes, chills, and chest pain occur. In addition to physical symptoms, cognitive symptoms such as fear of death, fear of going crazy, or fear of losing control are often added to the picture. Additionally, depending on the intensity of the anxiety, the person may perceive himself or his environment as changed and unreal. People who have a panic attack feel like they are facing a disaster. Because of their complaints such as increased heart rate, palpitations, and chest pain, they often think that they are having a heart attack or that they may die. Although a panic attack usually subsides within ten to fifteen minutes, it may last longer. The frequency and severity of panic attacks vary during the course of the disease.
After the panic attack subsides, anticipatory anxiety, defined as the fear of having a new attack, often develops. In addition to the fear that a new attack may develop, patients also experience intense anxiety about the consequences that may occur after the attack. Anticipatory anxiety may have an effect that increases the risk of new attacks by lowering the threshold of panic attacks to the extent of its intensity.
Klein (1964) stated that patients with panic attacks suddenly, when they are away from help, They reported that they increasingly restricted their activities for fear of becoming incapacitated, to the point of being unable to go out alone. Klein (1981), later In the new anxiety disorder concept he developed, he revealed that anticipatory anxiety is the successor of panic attacks, and that agoraphobia develops following panic attacks and anticipatory anxiety; It included panic attacks and agoraphobia in a single diagnostic category.
Among the early life events seen in panic disorder patients, the most emphasized one is separation from parents. Studies have found that 1/4-1/2 of panic disorder patients had long-term separation from their parents during childhood. Early exposure to sexual or physical abuse is another issue investigated in patients with panic disorder. In a study, it was determined that 8% of panic disorder cases were exposed to sexual abuse and 12% were exposed to physical abuse.
Stressful life events may precede the development of panic disorder. In a study conducted on this subject, it was found that approximately 2/3 of the cases had stressful life events within 6 months before the onset of the disease (Breier et al. 1986). These events are listed as follows, taking into account their frequency of occurrence: separation or threat of separation from a loved one, job change, pregnancy, migration, marriage, graduation from school, death of a loved one, physical illness. In another study conducted on this subject, the rate of encountering a stressful life event before the first panic attack in panic disorder patients was found to be 80% (Uhde et al. 1985).
EMDR, in its Turkish meaning. Eye Movement Desensitization and Reprocessing is a powerful psychotherapy approach. To date, it has enabled millions of people of all ages to successfully treat different types of psychological disorders.
According to the Adaptive Information Processing Model, which forms the basis of EMDR theory, the brain processes and functionalizes the information that reaches it through each new experience, with a physiologically based system. Information such as emotion, thought, sensation, image, sound, smell are processed and integrated by connecting to related memory networks. Thus, learning related to that experience occurs. The information we acquire is stored to appropriately direct our reactions in the future. When this system works normally, mental health It is considered an adaptive, harmonious mechanism because it supports human health and human development through learning.
This system seems to break down when traumatic or very disturbing events occur. New information is not processed and integrated into the existing memory network. In order to make sense of the experience, functional information in the memory networks cannot be connected and sane conclusions cannot be drawn. As a result, learning does not occur. Emotions, thoughts, images, sounds, body sensations are stored as they are experienced. Therefore, if some situations experienced today trigger these isolated memories, the person will be affected as if he or she is reliving a part or all of that memory.
According to EMDR, maladaptive disorders are behind the disorders, negative emotions, thoughts, behaviors and personality traits. Such memories lie dysfunctional, unprocessed, and stored in isolation. The person's negative beliefs about himself (e.g., I am stupid), negative emotional reactions (fear of failure) and negative somatic reactions (abdominal pain the night before the exam) are not the problem itself, but its symptoms, its current manifestations. Unprocessed memories that lead to these negative beliefs and emotions are triggered by events in the present.
In addition to significant traumas such as natural disasters, major accidents, losses, war, harassment, rape, and other events experienced at all ages, especially childhood, Any experience that has a traumatic effect; Negative events experienced in daily life in the family, school, work environment, exposure to violence, humiliation, rejection, neglect and failures may be among the unprocessed memories.
How are panic attacks treated with EMDR? There are two important points here; First of all, when starting to work with EMDR, the starting point is to work on the memory of the panic attack. The aim here is; It is to eliminate the panic attack process that has become traumatic for the client and the anticipatory anxiety that develops afterwards. During this process, when the client remembers the memories of panic attacks, he sees that they do not bother him and he realizes that he begins to have control over his own body. If you have had a panic attack even once in your life, how can you gain control over panic attacks and find the strength to cope with them? You know how important it is. As the client feels this power within himself, his anticipatory anxiety begins to decrease and he begins to reduce the distance between himself and the situations he avoids (going out in public, entering crowded places, even doing sports).
While this is the first part of the work with the client, based on my clinical observations, I think that the point that is at least as important as the first part is to study the client's past life events. As stated in the research conducted above, many of the people who go through this process have negativities in their past experiences. Or a process that the client has recently experienced but cannot cope with is a very common pattern. We can say that working with these is important for a complete treatment.
I often see in my clients with panic disorder how difficult it is to experience a panic attack and then restrict life with the expectation of this attack, and how it negatively affects people's quality of life. I think that addressing this issue and entering the therapy and treatment process is one of the best actions you can do for yourself in order to move from this process to a different point and improve your quality of life. EMDR is one of the therapy schools in the treatment process that brings a different solution to this issue and creates significant differences. We hope you find the most suitable method for yourself…
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