Coping with panic attacks in therapy: a case study

Note: Permission has been obtained from our client, whose presentation is presented here, to discuss the therapy process for informational and educational purposes. No personal information was given to the client.

The 29-year-old male client applied to our institution with the complaint of panic attacks. The self-employed consultant, Lecturer Dr. He started to use drugs by conducting the treatment process with Zengibar Özarslan. It was thought that he needed a psychotherapy process along with drug treatment, so he was directed to me and a psychotherapy process was started.

The client stated that he was afraid of hospitals, that situations such as fights and earthquakes triggered his anxiety a lot, and that he could not even go to the dentist despite his dental discomfort. The client, who made statements such as “my heartbeat speeds up, I get goosebumps” especially when he thinks about getting an injection, fainted twice.

His fear arose for the first time during his military service. While he was waiting in line for the vaccine, when he saw that both arms were vaccinated at the same time, his heartbeat accelerated and he fainted. After his discharge, he was injured in the football match, and after the patient lying on his side bed in the hospital he was taken to, he panicked again and fainted after saying “you will have the surgery”. For these reasons, he could not go to the hospital in any way at the time he applied.

His first aid application was made at the age of 21, he started using drugs, and after 6-7 months of treatment, he thought that he felt better and stopped the treatment without consulting his doctor. In this process, he received only drug treatment and did not go to therapy. When the symptoms reappeared at the age of 26, she applied for treatment for the second time. There are 2 points to note here. First, when the treatment process starts to improve, the clients think that they are well and leave the treatment incomplete without consulting their doctor and psychotherapist. This causes the gains up to that period to become dysfunctional and causes the discomfort to reappear. The second point is that drug therapy is a very valuable and functional approach. However, many studies show that continuation of psychotherapy together with drug treatment greatly reduces the relapse rate of the disease.

Considering the past history of the client, it was seen that she did not experience any fear before military service, and there was no experience that could trigger this fear during her childhood, adolescence and young adulthood. He stated that apart from these symptoms, he did not experience any distress that might suggest another psychological disorder.

As a result of the initial evaluation, it was seen that the client’s memory of vaccination during his military service was a traumatic experience, and it was understood that he was experiencing panic attack symptoms. While panic attacks are often seen as a disease, panic attacks are a symptom, not a disease. It is seen that the client develops Panic Disorder. In other words, along with panic attack symptoms, she constantly experiences anxiety that she will experience panic attacks and avoids environments where she thinks she will experience panic attacks.

Panic Attack Symptoms

chest pain or tightness in the chest,

Palpitations, strong or rapid heartbeat,

Sweating,

shortness of breath or choking,

cut off,

Dizziness, lightheadedness, falling or fainting

numbness or tingling,

Chills, chills or hot flashes

nausea or abdominal pain,

shaking or shaking,

Feeling strange and different, that oneself or those around them have changed,

Fear of losing control or going crazy

The fear of death.

Note: A panic attack must have at least 4 or more of these symptoms.

Panic Disorder

Recurrent unexpected panic attacks and persistent anxiety that there will be more panic attacks in between attacks,

Persistent sadness or the belief that Panic Attacks may have dire consequences, such as “I’m going to die”, “I’m going to have a heart attack” or “I’m going to go crazy”

It is a disorder in which some behavioral changes are seen as a precaution against panic attacks and possible bad consequences (such as not going to the hospital, not being able to get on the minibus, carrying medicine, water, etc.).

While creating this table, the website https://www.psychiatry.org.tr/halka-yonelik/27/panik-bozuklugu was used.

After the information-gathering phase, the client Panic Disorder was found to be. A “record of emotions, thoughts and behaviors” has been created to record such situations. In short, in this form, in which he records what he feels in these situations, what is in his mind at that moment and how he acts, it is aimed to both notice the triggers and gain awareness. He was taught muscle and breathing exercises that he could use when panic attack symptoms appeared, and he was recommended to do this exercise at least once a day, 5 days a week, as homework.

A method proven to be effective in Panic Disorder. EMDR Therapy It is intended to be used, and it is explained to the client what EMDR therapy is and how it will affect the discomfort experienced (If you want to learn what EMDR therapy is, you can read the article https://www.adeldanismanlik.com/online-terapide-emdr-teknigi-nasil-usil/). After the client stated that he wanted to work with this method, his negative automatic thought was determined based on the panic attack experience he experienced during the last Friday prayer (he stated that he focused on the thought of “I am in danger” when he looked at that memory). Based on the idea of ​​”I am in danger”, the first memory, the worst memory and other memories were determined. Example: First memory: when she started kindergarten and tried to run away. Worst moment: When he went to military service, he fainted when he was going to be vaccinated..) Then the triggers were determined (Example: Needle, hospital, getting an emergency). After the safe place exercise was done, desensitization studies were made about the memories, and after the discomfort level related to the recorded memories was “0”, the triggers were started to be studied. After the discomfort level of the triggers was “0”, a future template was created for each trigger. In other words, a future story about each trigger was created and a desensitization study was carried out.

At the end of 4 sessions, the EMDR study was terminated. The client adapted very well to the therapy and did the exercises regularly. He has learned to control panic attack symptoms with muscle and breathing exercises. As the memories and triggers started to be studied, her anxiety decreased in a short time, at the end of the 2nd Session she went to the dentist for a checkup and experienced very mild anxiety. At the end of the 4th session, she started dental treatment and when a relative got sick, she went to the hospital to visit him without any worries. A termination session was held with the client, who stated that he did not have any anxiety about panic attack symptoms, and a control session was held 3 months later.

Very good progress has been made with the client in a short time. Here, the harmony of the client as well as the therapist has been very effective. He attended the sessions regularly and did what he needed to do at home regularly. The fact that the first traumatic memory was in early adulthood, the scarcity of traumatic memories, and the functionality of EMDR therapy were the factors that made the process short.

If you are experiencing these and similar fears, do not hesitate to seek help, especially if you have difficulty coping with your anxiety normally, especially during a serious stressor such as Corona. Moreover, you do not have to come to our institution to get help in this process. With online therapy, you can carry out a therapy process and deal with your problems as face-to-face with a specialist therapist.

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