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Panic disorder is estimated to affect more than 4% of the U.S. population. It is assumed that this incident rate increases during crisis situations. While the professional literature is replete with references on the treatment of panic disorders, few authors address the use of nondrug treatment in conjunction with crisis intervention. This article provides an overview of the latest nonpharmacologic interventions for panic along with a description of their effectiveness in reducing the onset of svmptomatology as well as preventing relapse during crisis.
Assessment and Diagnosis
It is recommended that a brief clinical interview be conducted that includes an excerpt from the panic section of the ADIS-R and screening questions that elicit the individual’s medical history (particularly cardiac or seizure disorders) along with all medication currently in use.
Some of the briefer diagnostic questionnaires may also help to pinpoint specific symptoms and to support information that has been obtained from the patient verbally. Such quick screening questionnaires include: the Beck Anxiety Inventory (BAI) (34), the Body Sensations Questionnaire (BSQ) (35), the Anxiety Sensitivity Index (ASI) (35), and the Zung Anxiety Scale (36), any of which can be completed in a matter of minutes. In addition, Table I includes some of the more important questions to ask during crisis situations:
Because much of the cognitive-behavioral literature stresses the importance of relating symptoms to the misinterpretation of interoceptive cues and catastrophic cognitions (25, 26, 37-41), a formal system for linking panic symptoms to thoughts and emotional-behavioral responses is essential. A recently developed assessment technique, known as the SAEB system (Symptoms-Automatic Thoughts-Emotions- Behavior), is recommended as an approach for helping panic sufferers recognize the link between their panic symptoms and their catastrophic responses to their initial bodily sensations in an emergency situation (39-43).
Table 1. Questions for Crisis Intervention
The unique design of the SAEB system allows the treating clinician to align specific catastrophic thoughts and misinterpretations of symptoms with the onset of subsequent symptoms in a quick, expedient fashion. The system thus allows the panic victim to see the connections between stages of the escalation process setting the stage for the next step, which involves the treatment intervention (Figure 1).
This system is applied by having patients identify the beginning symptom of the panic episode. lithe individual has experienced more than one attack, it lends more credence to the repetitive sequence of each attack. For example; in Figure 1, a "spontaneous increase in heart rate" is often the initial symptom experienced by individuals at the onset of an attack. This can be followed by "difficulty breathing" and subsequently by "hot flashes and sweating" and so on. Once the symptoms have been aligned, the automatic thoughts accompanying each symptom are indicated along with the associated emotion and behavior. Vectors are then drawn in order to demonstrate to the patient in a collaborative fashion how the catastrophic thought content may be in reaction to the autonomic symptoms experienced and how these thoughts contribute to the subsequent behavior and possibly to the subsequent escalation of the symptoms (39). This technique is demonstrated in detail in a previously published videotape (44) as well as in Dattilio and Salas-Auvert (14).
This SAEB system sets the stage for the implementation of several cognitive-behavioral treatment interventions that will be explained later in this article. It is recommended as a quick method of assessment for tracking the cognitive, affective, behavioral, and physiological sequence of panic. Pinpointing specific triggers of panic symptoms is another important aspect of assessment that has been emphasized in the literature (e.g., stress; hot, humid climates; and excessive exercise) (24,43). While the use of the SAEB system may be effective in obtaining the aforementioned goals, there is the possibility of placebo effects that may play a role in the temporary amelioration of symptoms. This is why the use of the technique should be followed by continual exposure to interoceptive cues.
Reflection Exercise #3