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Click here to Download this guide, otherwise view below:

  1. What Is Panic Disorder
  2. Who Suffers From Panic Disorder
  3. What Are The Symptoms And Course Of Panic Disorder
  4. Panic Attack Symptoms
  5. Agoraphobia
  6. Treatment Of Panic Disorder
  7. Cognitive-Behavioural Therapy
  8. Strategies For Coping With Panic
  9. Treatment With Medication
  10. Combination Treatments
  11. Co-Existing Conditions
  12. Symptoms Of Depression
  13. Cause Of Panic Disorder
  14. Seeking Help For Panic Disorder
  15. Sources Of Referral To Professional Help For Panic Disorder
  16. Setbacks
  17. Help For The Family
  18. What To Do If A Family Member Suffers From An Anxiety Disorder
  19. Fourteen "On The Spot" Tips To Get Through Panic Attack

What is panic disorder

In panic disorder, brief episodes of intense fear are accompanied by multiple physical symptoms (such as heart palpitations, dizziness, nausea, tingling, out of breath and chest pains) that occur repeatedly and unexpectedly in the absence of any external threat. These "panic attacks", which are the hallmark of panic disorder, are believed to occur when the brain's normal mechanism for reacting to a threat - the so-called "fight or flight" response - becomes inappropriately aroused. Most people with panic disorder also feel anxious about the possibility of having another panic attack and avoid situations in which they believe these attacks are likely to occur. Anxiety about another attack, and the avoidance it causes, can lead to disability in panic disorder.

Fear...heart palpitations...terror, a sense of impending doom...dizziness...fear of fear. The words used to describe panic disorder are often frightening. But there is great hope: treatment can benefit virtually everyone who has this condition. It is extremely important for the person who has panic disorder to obtain information about the problem, the availability of effective treatments and also to seek help.

Who suffers from panic disorder

Encouraging progress in the treatment of panic disorder follows recent, rapid advances in the scientific understanding of the brain. Intensified research on brain disorders continues and the challenge now is to bring information about these conditions to the people who need it.

In the United States, 1.6 percent of the adult population, will have panic disorder at some time in their lives. The disorder typically begins in young adulthood, but older people and children can be affected. Woman are affected twice as frequently as men. While people of all races and social classes can have panic disorder, there appear to be cultural differences in how individual symptoms are expressed.

In many countries, education programmes on panic disorder are underway. The programmes' purpose is to educate the public and health care professionals about the disorder and encourage people with it to obtain effective treatments.

What are the symptoms and course of panic disorder

Initial panic attack typically, a first attack, seems to arise "out of the blue", occurring while a person is engaged in some ordinary activity like driving a car or walking to work. Suddenly, the person is struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality, or fear of losing control.

Panic Attack Symptoms

During a panic attack, some or all of the following symptoms occur:
Sense of being overwhelmed by fright and terror, with accompanying physical distress for between four and six minutes.
Racing or pounding heartbeat
Chest pains
Dizziness, light-headedness, nausea
Difficulty breathing
Tingling or numbness in the hands
Flushes or chills
Sense of unreality
Fear of losing control, going "crazy", or doing something embarrassing
Fear of dying

This barrage of symptoms usually lasts several seconds, but may continue for several minutes. The symptoms gradually fade over the course of about an hour. People who have experienced a panic attack can attest to the extreme discomfort they felt and to the fear that they had been stricken with some terrible, life-threatening disease or were "going crazy". Often people who are having a panic attack seek help at a hospital casualty department.
Initial panic attacks may occur when people are under considerable stress, from an overload of work, for example, or from the loss of a family member or close friend. The attacks may also follow surgery, a serious accident, illness or childbirth. Excessive consumption of caffeine or use of cocaine or other stimulant drugs or medicines, such as the stimulants used in treating asthma, can also trigger panic attacks.
Nevertheless panic attacks usually take a person completely by surprise. This unpredictability is one reason they are so devastating.

Sometimes people who have never had a panic attack assume that panic is just a matter of feeling nervous or anxious - the sort of feelings everyone is familiar with. In fact, even though people who have panic attacks may not show outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are going to die, lose their minds or be totally humiliated. These disastrous consequences don't occur, but they seem quite likely to the person who is suffering the panic attack.
Some people who have one panic attack, or an occasional attack, never develop a problem serious enough to affect their lives. For others, however, that attacks persist and cause much suffering.
Panic disorder. In panic disorder, panic attacks recur and the person develops an intense apprehension of having another attack. As noted earlier, this fear - called anticipatory anxiety or fear of fear - can be present most of the time and seriously interfere with the person's life even when the panic attack is not in progress. In addition, the person may develop intense irrational fears called phobias about situations where a panic attack has occurred. For example, someone who has had a panic attack while driving may be afraid to get behind the wheel again, even to drive to the local supermarket.
People who develop these panic-induced phobias will tend to avoid situations they fear will trigger a panic attack, and their lives may be increasingly limited as a result. Their work may suffer because they can't travel or get to work on time. Relationships may be strained or marred by conflict as panic attacks, or the fear of them, rule the affected person and those around them.
Also, sleep may be disturbed because of panic attacks occurring at night, causing the person to awake in a state of terror. The experience is so harrowing that some people who have nocturnal panic attacks become afraid to go to sleep and suffer exhaustion. Also, even if there are no nocturnal panic attacks, sleep may be disturbed because of chronic, panic-related anxiety.
Many people with panic disorder remain intensely concerned about their symptoms even after an initial visit to a doctor yields no indication of a life-threatening condition. They may visit a succession of doctors seeking medical treatment for what they believe is heart disease or a respiratory problem. Or their symptoms may make them think they have a neurological disorder or some gastrointestinal condition. Some patients see as many as 10 doctors and undergo a succession of expensive and unnecessary tests in the effort to find out what is causing their symptoms.

This search for medical help may continue for a long time, because doctors who see these patients frequently fail to diagnose panic disorder. When doctors do recognise the condition, they sometimes explain it in terms that suggest it is of no importance or not treatable. For example, the doctor may say, "There's nothing to worry about, you're just having a panic attack" or "It's just nerves." Although meant to be reassuring, such words can be dispiriting to the worried patient whose symptoms keep recurring. The patient needs to know that the doctor acknowledges the disabling nature of panic disorder and that it can be treated effectively.
Several effective treatments have been developed for panic disorder and agoraphobia. A form of psychotherapy called cognitive-behavioural therapy and medications are both effective for panic disorder. A treatment should be selected according to the individual needs and preferences of the patient, and any treatment that fails to produce an effect within 6 to 8 weeks should be reassessed.


Panic disorder may progress to a more advanced stage in which the person becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack. This condition is called agoraphobia. It affects about a third of all people with panic disorder.
Typically, people with agoraphobia fear being in crowds, standing in queues, entering shopping malls and riding in cars or public transportation. Often, these people restrict themselves to a "zone of safety" that may include only the home or the immediate neighbourhood. Any movement beyond the edges of this zone creates mounting anxiety. Sometimes a person with agoraphobia is unable to leave home alone, but can travel if accompanied by a particular family member or friend. Even when they restrict themselves to "safe" situations, most people with agoraphobia continue to have panic attacks at least a few times a month.
People with agoraphobia can be seriously disabled by their condition. Some are unable to work, and they may need to rely heavily on other family members, who must do the shopping and run all the household errands, as well as accompany the affected person on rare excursions outside the "safety zone." Thus the person with agoraphobia typically leads a life of extreme dependency as well as great discomfort.

Treatment of panic disorder

Treatment can bring significant relief to up to 90 percent of people with panic disorder, and early treatment can help keep the disease from progressing to the later stages where agoraphobia may develop.
Before undergoing any treatment for panic disorder, a person should undergo a thorough medical examination to rule out other possible causes for the distressing symptoms. This is necessary because a number of other conditions, such as excessive levels of thyroid hormone,

Cognitive-behavioural therapy

This is a combination of cognitive therapy, which can modify or eliminate thought patterns contributing to the patient's symptoms, and behavioural therapy, which aims to help the patient to change his or her behaviour.
Typically the patient undergoing cognitive therapy meets with a therapist for an hour or two each week. In the cognitive portion of the therapy, the therapist usually conducts a careful search for the thoughts and feelings that accompany the panic attacks. These mental events are discussed in terms of the "cognitive model" of panic attacks.
The cognitive model states that individuals with panic disorder often have distortions in their thinking, of which they may be unaware, and these may give rise to a cycle of fear. The cycle is believed to operate this way: First the individual feels a potentially worrying sensation such as an increasing heart rate, tightened chest muscles, or a queasy stomach. This sensation may be triggered by some worry, an unpleasant mental image, a minor illness, or even exercise. The person thinks "I am having a heart attack" or "I am going insane," or some similar thought. As the vicious cycle continues, a panic attack results. The whole cycle might take only a few seconds, and the individual may not be aware of the initial sensations or thoughts.
Proponents of this theory point out that, with the help of a skilled therapist, people with panic disorder often can learn to recognise the earliest thoughts and feeling in this sequence and modify their response to them. Patients are taught that typical thoughts such as "That terrible feeling is getting worse!" or "I'm going to have a panic attack" or "I'm going to have a heart attack" can be replaced with substitutes such as "It's only uneasiness - it will pass" that help to reduce anxiety and ward off a panic attack. Specific procedures for accomplishing this are taught. By modifying thought patterns in this way, the patient gains more control over the problem.

Strategies for coping with Panic

1. Remember that although your feelings and symptoms are very frightening, they are not
dangerous or harmful.
2. Understand that what you are experiencing is only an exaggeration of your normal bodily
reactions to stress.
3. Do not fight your feelings or try to wish them away. The more you are willing to face
them, the less intense they will become.
4. Do not add to your panic by thinking about what "might" happen. If you find yourself
asking "What if?" tell yourself "So what!"
5. Remain focused on the present. Notice what is really happening to you as opposed to
what you think might happen.
6. Label your fear level from zero to ten and watch it fluctuate. Notice that is does not stay
at a very high level for more than a few seconds.
7. When you find yourself thinking about the fear, change your "what if thinking. Focus on
and carry out a simple and manageable task such as counting backwards from 100 in 3's
or snapping a rubber band on your wrist.
8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade.
9. When the fear comes, expect and accept it. Wait and give it time to pass without running
away from it.
10. Be proud of yourself for your progress thus far, and think about how good you will feel
when you succeed this time.

In cognitive therapy, discussions between the patient and the therapist are not usually focused on the patient's past, as is the case with some forms of psychotherapy. Instead, conversations focus on the difficulties and successes the patient is having at the present time, and on skills the patient needs to learn.
The behavioural portion of cognitive-behavioural therapy may involve systematic training in relaxation techniques. By learning to relax, the patient may acquire the ability to reduce generalized anxiety and stress that often sets the stage for panic attacks.
Breathing exercises are often included in the behavioural therapy. The patient learns to control his or her breathing and avoid hyperventilation - pattern of rapid, shallow breathing that can trigger or exacerbate some people's panic attacks.
Another important aspect of behavioural therapy is exposure to internal sensations called interceptive exposure. During interceptive exposure the therapist will do an individual assessment of internal sensations associated with panic. Depending on the assessment, the therapists may then encourage the patient to bring on some of the sensations of a panic attack by, for example, exercising to increase heart rate, breathing rapidly to trigger light-headedness and respiratory symptoms, or spinning around to trigger dizziness. Exercises to produce feelings of unreality may also be used. Then the therapist teaches the patient to cope effectively with these sensations and to replace alarmist thoughts such as "I am going to die," with more appropriate ones, such as "It's just a little dizziness -1 can handle it."
A further important aspect of behavioural therapy is "in vivo" or "real-life exposure. The therapist and the patient determine whether the patient has been avoiding particular places and situations, and which patterns of avoidance are causing the patient problems. They agree to work on the avoidance behaviours that are most seriously interfering with the patient's life. For example, fear of driving may be of paramount importance for one patient, while inability to go to the grocery store may be most handicapping for another.
Sometimes in severe cases some therapists will go to an agoraphobic patient's home to conduct the initial sessions. Often therapists take their patients on excursions to shopping malls and other places the patients have been avoiding, or they may recommend the use of a phobic aide to accompany their patients who are trying to overcome the fear of driving a car.
The patient approaches a feared situation gradually, attempting to stay in spite of rising levels of anxiety. In this way the patient sees that as frightening as the feelings are, they are not dangerous, and they do pass. On each attempt, the patient faces as much fear as he or she can stand. Patients find that with this step-by-step approach, aided by encouragement and skilled advice from the therapist, they can gradually master their fears and enter situations that had seemed unapproachable.
Many therapists assign the patient "homework" to do between sessions. Sometimes patients spend only a few sessions in one-on-one contact with a therapist and continue to work on their own with the aid of a printed manual, or a phobic aide.
Often the patient will join a therapy group with others striving to overcome panic disorder or phobias, meeting with them weekly to discuss progress, exchange encouragement, and receive guidance from the therapist.

Cognitive-behavioural therapy generally requires at least 8 to 12 weeks. Some people may need a longer time in treatment to learn and implement the skills. The kind of therapy, which is reported to have a low relapse rate, is effective in eliminating panic attacks or reducing their frequency. It also reduces anticipatory anxiety and the avoidance of feared situations.

Treatment With medication

In this treatment approach, which is also called pharmacotherapy, a prescription medication is used both to prevent panic attacks or reduce their frequency and severity, and to decrease the associated anticipatory anxiety. When patients find that their panic attacks are less frequent and severe, they are increasingly able to venture into situations that had been off-limits to them. In this way, they benefit from exposure to previously feared situations as well as from the medication.
The four groups of medications most commonly used are the Selective Reuptake Inhibitors (SSRIs), the Tricyclic Antidepressants, the high-potency Benzodiazepines and the Monoamine Oxidase Inhibitors (MAOIs). Determination of which drug to use is based on considerations of safety, efficacy, and the personal needs and preferences of the patient. Some information about each of the classes of drugs follows.
The SSRIs are a new generation of antidepressant drugs, shown to be effective in the treatment of panic disorder. Included in this group are paroxetine, fluoxetine, fluvoxamine, citalopram and sertraline. SSRIs are started at a lower dose than is used to treat depression, and the dose is increased slowly to the full dose over a period of weeks. The SSRIs are in general associated with few side effects. An initial increase in anxiety may be seen, but this is usually self-limiting. Patients should be counselled about the possibility of this occurring.
The tricyclic antidepressants were the first medications shown to have a beneficial effect against panic disorder. Imipramine is the tricyclic most commonly used for this condition. When imipramine is prescribed, the patient usually starts with small daily doses that are increased every few days until an effective dosage is reached. The slow introduction of imipramine helps minimize side effects such as dry mouth, constipation, and blurred vision. People with panic disorder, who are inclined to be hypervigilant about physical sensations, often find these side effects disturbing at the outset.

Side effects usually fade after the patient has been on the medication for a few weeks. It usually takes several weeks for imipramine to have a beneficial effect on panic disorder. Most patients treated with imipramine will be panic-free within a few weeks or months. Treatment generally lasts from 6 to 12 months. Treatment for a shorter period of time is possible, but there is substantial risk that when imipramine is stopped, panic attacks will recur. Extending the period of treatment to 6 months to a year may reduce this risk of a relapse. When the treatment period is complete, the dosage of imipramine is tapered over a period of several weeks.
The high-potency benzodiazepines are a class of medications that effectively reduce anxiety. Alprazolam, clonazepam, and lorazepam are medications that belong to this class. They take effect rapidly, have few bothersome side-effects, and are well tolerated by the majority of patients. However, some patients, especially those who have had problems with alcohol or drug dependency, may become dependent on benzodiazepines. The benzodiazepines are often used in combination with an antidepressant on an "as required" rather than a regular basis until the panic attacks have settled with antidepressant therapy.
If a doctor prescribes one of these drugs as a single therapy, the patient starts on a low dose and gradually raises it until panic attacks cease. This procedure minimizes side effects. Treatment with high-potency benzodiazepines is sometimes continued for 6 months to a year. One drawback of these medication is that patients may experience withdrawal symptoms-malaise, weakness, and other unpleasant effects - when the treatment is discontinued. Reducing the dose gradually generally minimizes these problems. There may also be a recurrence of panic attacks after the medication is withdrawn.
Of the MAOIs, a class of antidepressants which have been shown to be effective against panic disorder, tranyclypromine is the most commonly used. Treatment with tranyclypromine usually starts with a relatively low daily dosage that is increased gradually until panic attacks cease or the patient reaches a maximum dosage of about 60 - 80 milligrams a day.
Use of tranyclypromine or any other MAOI requires the patient to observe exacting dietary restrictions, because there are foods and prescription drugs and certain substances of abuse that can interact with the MAOI to cause a sudden, dangerous rise in blood pressure. All patients who are taking MAOIs should obtain their doctor's guidance concerning dietary restrictions and should consult with their physician before using any over-the-counter or prescription medications.
As in the case if the high-potency benzodiazepines and imipramine, treatment with tranyclypromine or another MAOI generally lasts 6 months to a year. At the conclusion of the treatment period, the medication is gradually tapered.

Combination treatments

It has been widely documented and acknowledged that a combination of medication and some form of psychotherapy produce the best treatment response rates. Combination treatments are advantageous as they bring about more rapid relief from symptoms, and usually result in lower relapse rates. Support groups and other social institutions offer further support and encouragement, easing the recovery process dramatically.
Psychotherapy treatment. This is a form of "talk therapy" in which the therapist and the patient, working together, seek to uncover emotional conflicts that may underlie the patient's problems. By talking about these conflicts and gaining a better understanding of them, the patient is helped to overcome the problems. Often, psychodynamic treatment focuses on events of the past and making the patient aware of the ramifications of long-buried problems.
Although psychodynamic approaches may help to relieve the stress that contributes to panic attacks, they do not seem to stop the attacks directly. In fact, there is no scientific evidence that this form of therapy by itself is effective in helping people to overcome panic disorder or agoraphobia. However, if a patient's panic disorder occurs along with some broader and preexisting emotional disturbance, psychodynamic treatment may be a helpful addition to the overall treatment program.

Coexisting conditions

It is generally recommended that patients be carefully evaluated for other conditions that may be present along with panic disorder. These may influence the choice of treatment. Among the conditions that are frequently found to coexist with panic disorder are:
Depression. About half of panic disorder patients will have an episode of clinical depression sometime during their lives. Major depression is marked by persistent sadness or feelings of emptiness, a sense of hopelessness, and other symptoms (see box).
When major depression occurs in a person suffering from panic disorder, it should be treated as a separate illness. Fortunately, several of the antidepressant drugs are effective for the treatment of both conditions. Imbalances in serotonin are considered by many to play a role in both panic disorder and depression. Cognitive-behavioural therapy may also be a useful adjunct in the treatment of depression.

Symptoms of Depression

• Persistent sadness or feelings of emptiness
• A sense of hopelessness
• Feelings of guilt
• Problems sleeping
• Loss of interest or pleasure in ordinary activities
• Fatigue or decreased energy
• Difficulty concentrating, remembering and making decisions.

Simple phobias. People with the panic disorder often develop irrational fears of specific events or situations they associate with the possibility of having a panic attack. Fear of heights and fear of crossing bridges are examples of simple phobias. Generally, these fears can be resolved through repeated exposure to the dreaded situations, while practicing specific cognitive-behavioural techniques to become less sensitive to them.

Drug abuse. As in the case of alcoholism, drug abuse is more common in people with panic disorder than in the population at large. In fact, about 17 percent of people with panic disorder abuse drugs. The drug problems often need to be addressed prior to treatment for panic disorder.

Social Phobia. This is a persistent dread of situations in which the person is exposed to possible scrutiny by others and fears acting in a way that will be embarrassing or humiliating. Social phobia can be treated effectively with cognitive-behavioural therapy or medications, or both.

Obsessive-Compulsive disorder (OCD). In OCD, a person becomes trapped in a pattern of repetitive thoughts and behaviours that are senseless and distressing but extremely difficult to overcome. Such rituals as counting, prolonged handwashing, and repeatedly checking for danger may occupy much of the person's time and interfere with other activities. Today, OCD can be treated effectively with medications (such as the SSRIs fluoxetine, paroxetine & sertraline) or cognitive-behavioural activities.

Suicidal tendencies. Recent studies in the general population have suggested that suicide attempts are more common among people who have panic attacks than among those who do not have a mental disorder. Also, it appears that people who have both panic disorder and depression are at an elevated risk for suicide. (However, anxiety disorder experts who have treated many patients emphasise that it is extremely unlikely that anyone would attempt to harm himself or herself during a panic attack).
Anyone who is considering suicide needs immediate attention from a mental health professional, support group, or from a school counsellor, doctor, or member of the clergy. With appropriate help and treatment, it is possible to overcome suicidal tendencies.

Alcohol abuse. About 30 percent of people with panic disorder abuse alcohol. A person who has alcoholism in addition to panic disorder needs specialised care for the alcoholism along with the treatment for the panic disorder. Often the alcoholism will

Irritable bowel Syndrome. The person with this syndrome experiences intermittent bouts of gastrointestinal cramps and diarrhoea or constipation, often occurring during a period of stress. Because the symptoms are so pronounced, panic disorder is often not diagnosed when it occurs in a person with irritable bowel syndrome.
Mitral valve prolapse. This condition involves a defect in the mitral valve, which separates the two chambers on the left side of the heart. Each time the heart muscle contracts in people with this condition, tissue in the mitral valve is pushed for an instant into the wrong chamber. The person with the disorder may experience chest pain, rapid heartbeat, breathing difficulties, and headache. People with mitral valve prolapse may be at higher risk than usual of having panic disorder, but many experts are not convinced this apparent association is real.

Causes of panic disorder

Following is a description of some of the most important new research on panic disorder and its causes.
Genetics. Panic disorder runs in families. One study has shown that if one twin in a genetically identical pair has panic disorder, it is likely that the other twin will also. Fraternal, or non-identical, twin pairs do not show this high degree of "concordance" with respect to panic disorder. Thus, it appears that some genetic factor, in combination with environment, may be responsible for vulnerability to this condition.
Scientists are studying families in which several individuals have panic disorder. The aim of these studies is to identify the specific gene or genes involved in the condition. Identification of these genes may lead to new approaches for diagnosing and treating panic disorder.

In conducting their research, scientists can use several different techniques to provoke panic attacks in people who have panic disorder. The best known method is intravenous administration of sodium lactate, the same chemical that normally builds up in the muscles during heavy exercise. Other substances that can trigger panic attacks in susceptible people include caffeine (generally 5 or more cups of coffee are required). Hyperventilation and breathing air with a higher-than-usual levels of carbon dioxide can also trigger panic attacks in people with panic disorder.
Because these provocations generally do not trigger panic attacks in people who do not have panic disorder, scientists have inferred that individuals who have panic disorder are biologically different in some way from people who do not. However, it is also true that when the people prone to panic attacks are told in advance about the sensations these provocations will cause, they are much less likely to panic. This suggests that there is a strong psychological component, as well as a biological one, to panic disorder.

Cognitive Factors. The cognitive component of Panic Disorder and the resulting panic attacks is composed of both thought processes and emotions that contribute to the development and persistence of the disorder. These basic thought patterns and emotions are currently the subject of extensive study and research is also being conducted to evaluate the impact of various versions of Cognitive Behavioural Therapy on individuals, in order to determine which variants are most effective for Panic Disorder patients.
It has been suggested that Panic Disorder may be brought on as a response to a single, isolated panic attack, with continued fear and anticipation of further attacks perpetuating the stress and anxiety associated with panic. The thought processes that govern these responses will thus be vital indicators of the cognitive dynamics that bring about panic attacks.

Seeking help for panic disorder

Often the person with panic disorder must undertake a strenuous search to find a therapist who is familiar with the most effective treatments for the condition. A list of places to start follows. The Depression and Anxiety Support Group can provide a list of professionals in your area who specialize in the treatment of panic disorder and other anxiety disorders.
Self-help support groups are the least expensive approach to managing panic disorder, and are helpful for some people. A group of between 5 and 10 people meet weekly and share their experiences, encouraging each other to venture into feared situations and cope effectively with panic attacks. Group members are in charge of the sessions. Often family members are invited to attend these groups, and at times a therapist or other panic disorder expert may be brought in to share sights with group members.

Sources of Referral to Professional Help for Panic Disorder

Should you or somebody you know be suffering from the symptoms described in this brochure, thought should be given to seek a formal diagnosis. Further information on Panic Disorder and the necessary diagnosis and treatment can be obtained from a host of specialists and institutions involved in the treatment of mental illness:
* Family doctors
* Mental health specialists (including psychiatrists, psychologists and social workers)
* Community mental health centres
* State hospital psychiatry departments or outpatient clinics
* Private hospitals and outpatient clinics
* University - or medical school-affiliated clinics or education programs
* Medical Aid / Health insurance companies
* Support Groups and patient advocacy organisations.


Hardly anyone recovers from panic attacks without having at least one "setback". If, after a time of feeling better, you suddenly have another panic attack, there is no need to fear that you are back to square one, don't give up. After having suffered from panic attacks for a time it is only natural that they will not dissapear at all once forever, but in time they will be less severe and there will be longer intervals between them and in time they will stop altogether.

Help for the Family

When one member of a family has panic disorder, the entire family is affected by the condition. Family members may be frustrated in their attempts to help the affected member cope with the disorder, overburdened by taking on additional responsibilities, and socially isolated. Family members must encourage the person with panic disorder to seek the help of a qualified mental health professional. Also, it is often helpful for family members to attend an occasional treatment or self-help session or seek guidance of the therapist is dealing with their feelings about the disorder.
Certain strategies, such as encouraging the person with panic disorder to go at least partway toward a place or situation that is feared, can be helpful.

What to do if a Family Member suffers from an Anxiety Disorder

1. Don't make assumptions about what the affected person needs; ask them.
2. Be predictable; don't surprise them.
3. Let the person with the disorder set the pace for recovery.
4. Find something positive in every experience. If the affected person is only able to go
partway to a particular goal, such as a movie theatre or party, consider that an achievement rather than a failure.
5. Don't enable avoidance: negotiate with the person with panic disorder to take one step
forward when he or she wants to avoid something.
6. Don't sacrifice your own life and build resentments.
7. Don't panic when the person with the disorder panics.
8. Remember that it's all right to be anxious yourself; it's natural for you to be concerned
and even worried about the person with panic disorder.
9. Be patient and accepting, but don't settle for the affected person being permanently disabled.
10. Say: "You can do it no matter how you feel. I am proud of you. Tell me what you need now. Breathe slow and low. Stay in the present. It's not the place that's bothering you, it's the thought. I know that what you are feeling is painful, but it's not dangerous. You are courageous."Don't say: "Relax. Calm down. Don't be anxious. Let's see if you can do this (i.e. setting up a test for the affected person). You can fight this. What should we do next? Don't be ridiculous. You have to stay. Don't be a coward."
(Adapted from Sally Winston, Psy.D., The Anxiety and Stress Disorders Institute of Maryland, Towson, MD, 1992.)

Fourteen "on the spot" Tips to get Though a Panic Attack

1. Take a "time out" and slow down. Slow your rate of breathing, slow your racing thoughts,
slow your entire body, head to toe. Then slowly resume your previous activities.
2. Picture a relaxing scene using all your senses. Now put yourself into the scene.
3. If there are places available, take a stroll. If there people available, talk to one of them.
4. Picture a person you trust, someone who believes in you, supports you and cares about your well-being. Now imagine the person is with you, offering you encouragement.
5. Recall a time you handled a similar situation well, or try to bring to mind a past success
and the good feelings you experienced at the time.
6. Focus on the present, on concrete objects around you. Make a game of noticing details or inventing questions about every object you identify.
7. Count backwards from twenty and with every number, picture a different image of
someone you love, something that pleases you or something that calms you. These might
be images you recall from the past or those you only imagine.
8. Occupy your mind with an absorbing task. Plan your schedule for the day or the evening; try to recall names of all the Clint Eastwood movies you've ever seen; plan a sumptuous meal, appetiser through to dessert and imagine yourself eating one bite of every course.
9. Bring to mind the image of a person you admire and imagine yourself to actually be that
person. Think as they might think, act as they might act, even feel as they might feel.
10. Remind yourself that attacks always end. Always.
11. Take a giant yawn and stretch your body, head to toe.
12. Get mad. Vow not to let panic win out. You deserve better.
13. If all else fails, take as deep a breath as you can and hold it as long as you can. Use one of the other strategies to occupy your mind. Your physical symptoms should come down and stay down.
(Courtesy of "Master Your Panic " - Beckfield)


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