Some Thoughts on Panic Disorder

August 23, 1993

Don’t worry over anything whatever; whenever you pray tell God every detail of your needs in thankful prayer, and the peace of God, which surpasses human understanding, will keep constant guard over your hearts and minds as they rest in Christ Jesus. Phillipians 4:4 (Phillips)

Introduction

Pan, a Greek god of fertility, was depicted as a merry but ugly man with the horns, ears and legs of a goat. When angry or ill tempered, Pan loved to frighten unwary travelers—hence the word panic.

During the past ten years anxiety disorders and phobic disorders have become increasingly common. Only a few short years ago, depression was the most common presenting problem at mental health clinics. Currently, depression and anxiety disorders share this distinction. Today, approximately nine million people in the U.S. (5% of the population) suffer from panic disorder.

The Case of Mary

A few years ago a friend of mine, Mary (a pseudonym intended to protect her identity), a married mother of two children, began experiencing panic attacks. Before choosing to work as an at-home-mother she was successfully employed in the community as an assistant director of a non-profit organization. Her close friends and more casual acquaintances described her as a very balanced, competent, and stable woman.

During her first panic attack Mary was extremely confused and frightened. She thought she might be suffering from a cardiac or endocrine disorder. All lab tests were negative and she was diagnosed as suffering from panic disorder. In a recent telephone conversation she recounted her experience of these initial panic episodes. “They were very frightening. My heart felt like it was about to explode out of my chest, my system was racing—heart pounding, sweating. And I felt like I wouldn’t make it, like I was about to die. It was embarrassing and humiliating.” Mary indicated that in many ways her panic attacks were a sign of unresolved anxieties and insecurities. Some of these unresolved concerns related to events which occurred in her formative years. Through the support of her husband, loyal Christian friends, and Christian mental health professionals, Mary has not experienced a panic attack for over eighteen months.

A Brief Description of Panic Disorder

The ability to experience a panic response is an instinctive and normal part of our behavioral repertoire. We are “hard wired” with the capacity to respond to dangerous or threatening situations by invoking a “flight or fight” response. In many situations this sudden response can be adaptive since it prepares us for or moves us into action.

But for some people this “flight or fight” response is triggered by inappropriate thoughts or events. It is as if the physiological and nervous distress systems misfire leading to a series of behaviors and experiences we call a panic attack.

Panic disorder consists of recurrent, abrupt, and unexpected periods of intense fear.

Associated physical symptoms often include:

• tingling sensations
• sweating
• hot or cold flashes
• faintness
• hyperventelation
• blurred vision
• heart palpitations
• dizziness

Related cognitive factors usually include:

• impaired ability to reappraise danger
• impaired ability to plan alternatives
• mental clarity is lost
• narrowed range of thinking
• misinterpret (catastrophize) bodily sensations

Although panic disorder is often initiated and maintained by a problematic relationship between one’s thoughts, feelings, and behavior—it is important to remember that other physiological and neurochemical factors can also explain and account for these same symptoms. With this possibility in mind, it is important to have the client visit with their physician to consider and rule-out the following disorders:

• hyperthyroidism
• hypertension
• respiratory and pulmonary disorders
• endocrine disorders

Lastly, there is a strong correlation between the incidence of panic disorder and suicide attempts. It appears that those suffering from panic disorder become so terrified and humiliated that they lose hope and perspective. These factors lead to increased risk for suicidal behavior and indicate the need to assess this area of potential harm.

Treatment Strategies

Panic disorder is primarily driven by fear, uncertainty, and a disruptive feedback loop between the mind and body. In many ways, panic disorder perceptibly displays the close working relationship between mind, body, and spirit. Too often the role of spiritual factors is discounted or not considered at all.

It is always important to consider spiritual concerns which may contribute to the problem. Issues related to trust and confidence in God’s provision and love, guilt and anxiety over past sins, and difficulty accepting His gracious gift of forgiveness, may all play a role in the panic experience.

Many times symptoms persist even when these spiritual issues are honestly and humbly addressed. The sequence of thoughts, feelings, and behaviors associated with panic disorder can become so over-learned that the panic response becomes habitual and almost instinctual. In such situations, Christian mental health professionals can be very helpful.

A major focus of treatment concerns the negative feedback loop between the brain and the body. Preceding and during a panic attack there exists an escalating pattern of arousal. The body becomes tense and tight and the mind interprets these sensations and concludes, “I must be getting anxious.” The body then reacts to the belief that it is anxious by becoming more aroused. This cycle leads to increasing physical arousal, accompanied by increasingly dire assessments and predictions (“This is getting so bad I feel like I am going to die”). The pattern of intensifying arousal leads to distorted perceptions of reality and a decreased ability to calm oneself. The self-talk that transpires during a panic attack is characteristically grim and catastrophic. This only serves to heighten the sense of fear and terror.

Consequently, a key component of treating panic disorder is to disrupt and then realign this negative feedback loop. This can be done by changing one’s environment, thoughts, and physical responses. Because it is often difficult to change the environment in which many panic disorders occur (offices, supermarkets, public meeting areas) it is more profitable to target the relationship between the thoughts, appraisal of events, and associated physical responses.

Panic disorder revolves around three key themes:

• dangerousness (“I am in danger and something bad is going to happen here.”)
• uncontrollability (“I won’t be able to do anything about this frightful situation.”)
• unpredicitability (“I never know when the next panic attack is coming.”)

These themes lead to a pervading sense of powerlessness, hopelessness, and defeat. The goal then turns from dealing with the panic attacks to avoiding them. To counteract this tendency, it is imperative that the therapist work with the client to develop coping strategies which allow them to remain in the anxiety provoking situation rather than engage in avoidant tactics. Specific tools that are often helpful include reappraising anxiety provoking events and the use of relaxation techniques. As the client becomes more skilled in monitoring and regulating their feelings of anxiety it is usually beneficial to gradually expose them to certain situations where panic is likely to occur. Through a series of planned and practiced in-vivo exercises the client has the opportunity to employ coping strategies and techniques in the midst of situations that were formerly anxiety provoking.

The Role of the Christian Community

My friend Mary reported to me that her Christian friends were most helpful when they listened to her story and took her seriously. They worked to identify with and understand her terrifying experiences. Often times Mary felt very alone and isolated and came to deeply value the continuing concern of others shown through shared times of prayer, encouragement, and gentle listening.

Christians can also come alongside those suffering from panic disorder by helping them reorient to the reality that God is alive and aware of their pain. Sufferers may find it helpful to be reminded of God’s promises of security and significance in Him. Those suffering from panic disorder can also benefit from being reminded that God is faithful and committed to making us into men and women more life Himself. He will never abandon us.

Lastly, it is critical that the Christian body remain faithful and loyal to these sufferers as they sort out and deal with the variety of issues that contribute to their problem with panic disorder.