Panic Disorder(PD) is a disease characterized by panic attacks consisting of physical and cognitive symptoms that occur suddenly and spontaneously (Angst 1998, APA 2000). Panic attacks are quite short-lived but intense. It usually peaks within 10 minutes; Afterwards, attacks usually last 20 to 30 minutes and rarely last more than 1 hour (Butcher, Mineka, Hooley 2013). These attacks negatively affect the daily life of individuals and disrupt the person's functionality. Panic attacks are typically regenerative and occur unexpectedly. Therefore, patients often worry that they will have another seizure. This situation is called anticipatory anxiety. The expectation that panic attacks may result in situations such as losing control, having a heart attack, or going crazy, and the intense distress experienced in this regard, constitute another feature of this disorder (Tükel 1997). The main presenting complaint is the physical symptoms that are most frightening for that person, such as shortness of breath, palpitations, chest pain, and dizziness (Kaplan 1995). In addition, in some cases, symptoms such as chills and hot flushes, tremors, derealization or depersonalization may also be observed (Butcher, Minekave Hooley 2013). Although panic attacks themselves seem to appear 'out of nowhere', the first attack often occurs following feelings of discomfort or highly stressful events such as the loss of a loved one, the loss of an important relationship, losing a job, or being the victim of a crime (Falsetti et al. 1995). ). However, it cannot be said that all patients with panic attacks developed as a result of a stressful situation. There are various measurement and evaluation tools for panic disorder. The most commonly used of these are the panic agoraphobia scale, panic disorder severity scale and lifetime panic-agoraphobic spectrum scale self-report form (Öztürk, Uluşahin 2015).
In the research, 91% of people with panic disorder had other psychiatric disorders. was also detected. These psychiatric disorders are mostly depression, somatization disorder and other anxiety disorders (Merikangas, Angst, Eaton, 1996). Panic disorder more often begins in young adulthood. Even though the age of onset is in the 20s There is a risk of occurrence in every period of life. The risk of this disease in women is twice as high as in men (American Psychiatric Association, 1994). Low socio-economic level and the severity of phobic avoidance are also factors in the formation of panic disorder. In addition, panic disorder also has a genetic aspect. According to family and twin studies, there is an average heritability of panic disorder (Mackinnon, Foley 1996). In a large twin study, Knedler et al. (2001) found that 33% to 43% of the differences in susceptibility to panic disorder were due to genetic factors.
Panic disorder; It is a disorder that is the most common among anxiety disorders, has a chronic and recurrent course, and causes familial, social and functional disability. In a study using the short form 36 quality of life scale, patients with panic disorder were compared with patients with depression or chronic disease, and it was determined that panic disorder caused high psychological stress and limitations in physical role function, but physical functions were relatively preserved (Altıntaş, Uğuz, Levent). 2015).
Medication and/or cognitive behavioral therapy (CBT) are generally used in the treatment of Panic Disorder (Barlow 1988). In fact, the effectiveness of drug treatment for panic disorder has been proven. However, it is known that symptoms recur in many patients while receiving medication. Therefore, cognitive behavioral therapy (CBT) can be considered a strong alternative to drug treatment (Başaran and Sütçü 2016) for reasons such as having no side effects and being applied to patient groups that are resistant to drug treatment (Otto et al. 1999). Although Cognitive Behavioral Therapy has been reported as an effective treatment method used in the treatment of Panic Disorder, it has generally been applied individually (Sokol et al. 1989, Beck et al. 1992). Recently, Cognitive Behavioral Therapy technique has been used quite frequently on panic disorder. In this review, the Cognitive Behavioral Therapy technique applied to Panic Disorder will be discussed.
Cognitive Behavioral Therapy (CBT); It is a combination of cognitive technique and behavioral technique. Albert Ellis and Aaron Beck cognitive behavioral therapy They are the founders of . This technique is a problem-focused form of treatment that deals with the 'here and now' and applies learning theories to help individuals when they encounter difficulties and life problems that they cannot overcome in their daily lives (Stuart 2001). The aim of Cognitive Behavioral Therapy is to identify unrealistic, problematic and dysfunctional thoughts for the individual. Because defining the thought that is a problem also means defining the effect of that thought on the individual. This is the first stage of the treatment plan. The next step is to replace the dysfunctional thoughts that negatively affect the individual's life with a mindset that is highly functional and compatible with real life. The last step is for the patient to adapt these new functional thoughts to his/her life and receive feedback.
For this type of treatment to be successful, the therapist and the patient must adhere to some principles. The first and most important of these is a solid therapeutic agreement. For this to occur, the therapist and the patient must be in harmony. Research shows that positive friendships are associated with positive treatment outcomes (Raur and Goldfried 1994). To establish this bond, the therapist should demonstrate good counseling skills and ask for feedback from the patient at the end of the session. In addition, there should be cooperation between the therapist and the patient. And the active participation of the patient is also important for a successful therapy process, and if the therapy is goal-oriented and problem-solving focused, it can go a long way in a short time. In addition to all these, this therapy process is limited to a certain time. Generally, the treatment process is between 6-14 sessions (Beck, 2011). And during these sessions, many different techniques are used to change mood and behavior. Socratic questioning and guided discovery are the most functional and applied of these. In addition to these, exposure technique is also one of the behavioral techniques.
People actually evaluate and see what is happening in their own way (Türkçapar 2007). That is why Cognitive Behavioral Therapy sessions are specific to patients and the therapist guides the patient to become aware of his thoughts (Piştof and Şanlı 2013). Before the patient changes his irrational automatic thoughts, He needs to understand how his emotions affect his emotions (Leahy 2008). The situation itself does not directly determine how they feel or what they do; Their emotional responses are mediated by how they perceive the situation (Beck 2011). Therefore, starting from the first session, the cognitive model is explained to the patient so that the patient can solve current and future problems and the situation he is in, without the need for a therapist, with the skills he will gain. (Padesky and Greenberger 2008). Cognitive Behavioral Therapy technique works through automatic thoughts. Automatic thoughts arise spontaneously and are often quite rapid and general. These thoughts are rarely realized. Instead, one becomes aware of the emotions and behavior that come from automatic thoughts. Underlying automatic thoughts are basic beliefs. Patients actually see data that conforms to the same basic belief since childhood. Data that appears contrary to fundamental belief often goes unnoticed. For example, a client with a core belief of “I am powerless” constantly considers events that seem to prove his/her weakness (Piştof and Şanlı 2013).
Cognitive Behavioral Therapy in Panic Disorder
Cognitive-behavioral methods have been proven to be more effective than other types of psychotherapy in the treatment of Panic Disorder (Öztürk and Uluşahin 2015). In the cognitive behavioral approach, the patient's catastrophic thoughts and the safety-seeking behaviors that sustain them must first be evaluated. Afterwards, the patient is explained how these catastrophizing thoughts emerged and what a vicious circle situation is. He or she is educated about the nature of anxiety and panic and the adaptive value of both. Other thought options that can replace the dysfunctional thought are studied (Salkovskis 2001). In this way, patients who learn the nature of the fight or flight response experienced during panic begin to understand that the sensations they experience during panic are normal and harmless.
In this method, the patient is asked to deal with the situation that causes fear, little by little, to an increasing degree and for a longer period of time. In addition, in order to increase the patient's awareness, they are asked to monitor their own anxiety and panic experiences by keeping a diary. For example, catastrophize body sensations A patient who is afraid of having a heart attack during a panic attack is assigned to exercise for a certain period of time. This exercise time is increased each time. In addition to this method, the reverse intention method can also be used (Salkovskis 2007). Panic disorder patients are already afraid of fear. In the method of invoking fear and practicing it (reverse intention), the patient is asked to want the fear to come. For example, it is desirable to call for a panic attack 4 days a week and not to call for 3 days. In this way, the patient sees that nothing is wrong with him and his self-confidence regains. In this way, the anxiety of expectation is eliminated. In a widely used variant of Panic Control Treatment performed by Barlow and Craske, various different cognitive and behavioral techniques are combined in a program that typically lasts 12 to 15 sessions (Barlow and Craske 1989).
Teaching cognitive formulation to the patient in cognitive behavioral therapy is important in terms of the patient being able to evaluate his own basic and intermediate beliefs and automatic thoughts (Karahan and Sardoğan 2004). Because the biggest problem of panic disorder patients is that they interpret their bodily sensations in a catastrophic way (Clark). ,1986).
Read: 0
