Diagnosis and treatment: panic disorder and agoraphobia

The person's constant hyper-vigilance of themselves, their breathing, their heart rate, their balance, etc., as well as a strong desire to impose control on any alterations in his physiology, precipitate the very fear that the patient seeks to control. When we reach this point, we can say that the "genie is out of the bottle" and the body's natural arousal system is triggered. The greater the level of control one seeks to impose on one's bodily reactions, the worse these become - leading to panic disorder. The patient's solution has now become his problem, and his problem is the result of his solution (see previous article on mental traps). The person is now trapped and any attempt at resolution by control is doomed to failure. This fear of panic and, later, the fear of it occurring outdoors and in solitude, induces agoraphobia, or even claustrophobia with panic attacks.

In the case of agoraphobia, the patient usually seeks help and looks for anyone who could help by accompanying him in social situations or on any trips outside the home. As we've mentioned before in this blog, all human behavior is a form of communication, and every time a person asks for and gets help, they're trapping themselves in what Watzlawick et al. (1967) call it a double bind. Whenever someone accompanies her, "she confirms that she is safe because she has help, but she also confirms that she is unable because she needs help" and so his solution fuels his problem, which pushes his phobia to new extremes. Some people with panic disorder have a clear, distinct place or situation that triggers the fear, and others seem to live in constant dread of that ghost that frightens them all the time, living their lives like a soldier on a minefield perpetually anticipating a loss of control. An effective treatment can act on these mechanisms and quickly block the problem and resolve their disorder in 7 to 10 sessions.

• Not all people who have panic attacks have panic disorder. For a classic diagnosis of panic disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists the following criteria:
• You must have frequent and unexpected panic attacks.
• At least one of your attacks was followed by a month or more of constant worry about having another attack; an ongoing fear of the consequences of an attack, such as losing control, having a heart attack, or "going crazy"; or significant changes in your behavior, such as avoiding situations that you think could trigger a panic attack.
• Your panic attacks are not due to drug or substance use, a medical condition, or another mental health condition, such as social phobia or obsessive-compulsive disorder.
• Panic is often misdiagnosed as a generalized anxiety disorder, when in reality there is no experience of total loss of control, typical of panic with GAD. In generalized anxiety disorder, the state of excitement is constant, but there is rarely, if ever, a tipping point in fear. Panic, as we have defined it, is characterized by an extreme form of excitement of fear, which begins to block people in their lives or, one might say, becomes "pathological" and therefore requires professional help. . When the person is stuck with the problem, despite their personal attempts to solve it, the help of a professional becomes the most useful solution. If we want to solve this problem quickly, then we use strategic diagnosis, in which we focus our attention, not on describing the problem, but on intervening in the functions or operations of the problem in the person's life and on how we can intervene in the patient's attempts to solve what is in fact the root of the problem.

Systemicist Padraic Gibson sheds light on the treatment of panic disorder and agoraphobia with brief systemic therapy. Padraic Gibson is a family therapist and supervisor. He works in Ireland, Italy and Malta. He is a Senior Research Associate and Lecturer at Dublin City University and Clinical Director of The OCD Clinic®.

They try to avoid situations out of fear, which makes them less able to deal with this monster that consumes their thinking and behavior and increases their fear of these avoided situations and therefore their self-confidence.

They seek help and protection from fear, which at the same time causes the feeling of security, but further fuels the perception of fear and the feeling of being unable to manage their fears. By delegating our fears to others, we become completely unable to face these situations on our own and thus feed our feeling of dependence and incapacity.  

The permanent and continuous attempt to control one's own physiological reactions to fear, which paradoxically leads to a total loss of control of our natural reactions.

In order to resolve this type of difficulty, the clinician must act on the avoidance behavior as we have described it. To do this, he must employ a series of suggestive interventions capable of redirecting the person's conscious attention during the feared situations, which leads the patient to adopt counter-avoidance measures. Finally, through the use of refined and specific techniques (Gibson, 2021), we can interrupt their attempt to voluntarily suppress their spontaneous reactions and with minimal effort and we can then produce an emotional detachment from the situation and create a new capacity on the part of the patient, to better manage their situations. In a later post, I will talk about the difference between a type of panic that is triggered by a fear of losing control and one that comes from a fear of dying, because the treatment is different. (Clarke., 2018; Gibson, 2016, 2021; Nardone, and Portelli and Nardone, 2005).

The treatment of phobias and panic disorders by the systemic approach is taught in the third year of the LACT course of the Clinician of the Relationship and in the clinical master of Giorgio Nardone .

• Monophobias, specific phobias and generalized phobias
• Diagnostic criteria for monophobias or specific phobias (DSM-5).
• List of the most common forms of monophobia.
• Dysfunctional solution attempts related monophobias, specific phobias and generalized phobia.
• The treatment of monophobias or specific phobias in brief strategic therapy (strategy, communication and therapeutic relationship).
• Explanation of the therapeutic maneuver "study your enemy".
• Explanation of the therapeutic maneuver "logbook".