Anxiety; It can be defined as a state of intense fear accompanied by distress, restlessness, worry that something bad will happen, and physical symptoms. Anxiety isn't always a bad thing. It is normal to feel anxious, nervous and afraid when faced with a pressure or stressful situation. Anxiety is our body's natural response to danger. Healthy anxiety makes it easier for us to focus our attention and stay alert, mobilizes us and provides motivation to solve our problems. However, if anxiety has started to affect your life and relationships, this indicates that you have crossed the normal anxiety line and entered the borders of an anxiety disorder. Almost everyone feels anxiety all the time. However, a panic attack is severe enough to make the person feel as if they are having a heart attack, going crazy, or losing control of themselves. During a panic attack, you may experience physical symptoms such as shortness of breath, chills, ringing in the ears, feelings of possible disaster, tremors, a feeling of suffocation, chest pain, sweating, and heart palpitations. A person who experiences recurrent, unexpected panic attacks fears having more attacks, worries about their meaning, makes changes in their behavior, and as a result, the person now has panic disorder.
Many people with panic disorder also experience “agoraphobia.” . Agoraphobia is the fear of being in a place or environment where a panic attack may occur or escape may be difficult. For example, people with agoraphobia avoid being alone, going to shopping malls, traveling by train or plane, crossing the street on a bridge, being in a high place, passing through tunnels, walking in open areas and taking elevators.
Some patients with agoraphobia avoid exposure to sunlight. While some may experience anxiety, some become anxious in dim light. Temperature is an important factor in panic disorder. First of all, there is a dramatic increase in panic disorder and agoraphobia in the summer months, as heat increases heart rate, dizziness and dehydration and allows more going outside. The individual is afraid that he will have a panic attack in these situations.
Initially, the panic attack occurs when leaving home, getting married. It is triggered by a stressful situation such as marital/couple problems, surgery, new responsibilities, or physical illness. If the physical sensations (heart palpitations, inability to breathe, sweating, dizziness, etc.) are catastrophized and interpreted as a danger, panic disorder begins. A person may focus on the increase in heart rate and infer that he or she is about to have a heart attack. As a result, a person may develop hypervigilance, resulting in increased arousal (increased physical sensations and anxiety). Hypervigilance: refers to excessive focus on physical sensations. This arousal further triggers catastrophizing interpretations, which we call "false alarms" because they signal that there is danger when there is none. (For example, if a huge dog comes towards you quickly, showing its teeth, you will be frightened, your heart beats faster, you sweat, your body suddenly becomes hot. However, in a panic attack, you experience these symptoms even when the dog is not coming towards you.) A full-blown panic attack can occur from such stimulation and misinterpretations. For this reason, the person develops anticipatory anxiety. Anticipatory anxiety: It is the fear of thinking that you will have a panic attack and waiting for this seizure/that the panic attacks will continue. If escaping such situations is difficult or embarrassing and there is no immediate help available, the child begins to avoid them. In fact, when avoidance and escape become the main coping mechanisms to manage anxiety, agoraphobia develops.(Leahy-Holland,2009)
The most effective treatment for Panic Disorder and agoraphobia is Cognitive Behavioral Therapy. Cognitive behavioral treatment of panic disorder is organized around several goals. The first is to help understand the characteristics of anxiety, panic and agoraphobia, the second is to determine the degree of situations you avoid or fear, the third is to evaluate the characteristics of important symptoms, their severity, frequency and situations that cause a panic attack, the fourth is to determine whether there are other problems accompanying the panic attack (for example, depression , other concerns, overeating, loneliness, or marital/couple problems)
Therapy may include some or all of the following treatments.
Psycho-education about General Cognitive Therapy principles (Reflections Understanding how panic causes feelings such as fear - Learning how thoughts and beliefs can help a person feel better)
Skill training to recognize and reduce panic symptoms when they occur
Treating other problems encountered (such as depression)
Gradual exposure to situations that cause panic attacks
Muscle relaxation training: breathing relaxation training and breathing training
Self-expression training (need when heard)
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