Panic Disorder Without Agoraphobia
Many of the symptoms commonly associated with Panic Disorder can be caused by factors which are physiological in their origins. I.e., in order for an appropriate diagnosis of any Panic Disorder to take place, it's important that the therapist rule out any physiological sources such as a narcotic effect (e.g.,. Cocaine use or the result of an addiction of any sort), medical causes (high blood pressure or a heart condition). It's important that this be thorough-- in my own experience, the physiological effects of hypoglycemia when I haven't eaten properly are extremely similar to those I experienced when I used to have chronic panic attacks.
It's also essential in cases Panic Disorder that the panic attacks not be directly linked to or better explained by another disorder. I.e., if a client has a specific phobia about spiders, and the panic attacks only take place in the presence of spiders, then Panic Disorder is probably not the appropriate diagnosis. If an individual consistently suffers panic attacks before speaking in public, it's much more likely that the client is exhibiting symptoms of a public speaking phobia.
Similarly, a client with Obsessive-Compulsive Disorder who has panic attacks over the issue of whether or not they remembered to lock every lock on their door is probably not best placed under the category of Panic Disorder.
Holistic Responses
Some people's nervous systems flash danger signals... without any provocation, they feel the same emotional and physical sensations they would if their lives were in jeopardy. The attacks seem to come out of thin air, in places where there is nothing to fear.
It's difficult to know exactly what causes generalized panic attacks. It's lack of attachment to any specific event or circumstance makes it very difficult to assertain. However, from a holistic standpoint, it seems that it must in some fashion be tied into prior events which do not get properly resolved. I.e., the attacks do not take place in a vacuum.
Thus it's important, from a holistic perspective, to look for common themes between the attacks, even if the attacks are not necessarily triggered by incidents which have any similarity on the surface. I.e., most clients who suffer from panic attacks experience them differently from one another, but have common themes that run through the events. In my own case, there was a specific set of physiological symptoms which would come into place when the panic attack was first beginning. I'd notice a certain type of tension in my neck, followed by a sensation which felt as though my face was starting to burn, followed by a falling sensation inside my head, as though I were on my way into a deep void or pit, and then I'd begin to hyperventilate and my hands would shake.
Even though different events preceeded the event, and there wasn't clear predictability regarding when and where an attack would take place, over time I learned to notice when the attack was beginning. Unlike a phobic disorder, I wasn't able to prepare myself when about to encounter a specific stimuli which might trigger an attack. I couldn't do the sort of exercises which might help prepare a claustrophobic whenever entering an elevator. But I could practice techniques for alleviating the attack whenever it began.
I found two techniques which worked extremely well for me: Since there was a sensation of heat whenever the attack began, I began to picture a small candle in my head, and would mentally extinguish it. This didn't always eliminate the attack, but it did make the attack much less traumatic.
The second technique I developed was musical-- I found Beethoven's Ninth Symphony to be very calming, so I made a point of starting to hum it to myself whenever I felt a panic attack coming on. However, when I'd begin, I'd always end up humming it much faster and more abrasive than it was intended. Slowly, I'd reduce the speed and calm the music down, until it developed itself into a more proportionate level.
I'd investigate similar approaches for clients who came to me with unspecific panic disorders. Even if we couldn't pinpoint a stimulus which created the circumstance of the attack, we could try to begin to associate the events with situations which the client finds calming or soothing. A possible means by which to discover what sort of techniques might be helpful would be by using expressive arts therapies-- leading the client through a visualization process in which the client is first asked to draw the experience of the attack, and then a follow-up in which they're asked to transform it in some fashion. (for a summary of my outside client report from the Expressive Arts Therapy class I took at Salve, for examples of the sort of visualization and techniques I use, go to http://songweaver.com/eat/hlc.html)
The visualizations are extremely helpful because they tend to bring the patient directly into body experience and provide expression which is more readily accessible than traditional talk therapy. They also help make abstract thoughts and feelings more concrete. When the client has visual representations of the panic attacks right there, it's sometimes easier to get a handle on what's going on, and figure out what might be an effective means of responding to the attack. I.e., in my own case, I might have drawn myself surrounded in flames when depicting the attacks. In my transformation, I might have drawn myself with a fire extinguisher, or blowing out the flames, etc. It might have shown me how to deal with the attacks internally had I not derived the solution on my own beforehand.
For others, physical activities such as yoga or other meditative techniques might prove effective. A panic attack is basically a part of ourselves we don't quite understand which has temporarily gone out of control. When I learned to extinguish my internal flame, I developed control over the fire of the attack. When a visualizations lead clients to better understand what's going on inside their own heads, they've got the opportunity to gather some degree of control over the condition. Since Yoga helps develop better control over one's own body and physiological processes, it might provide good techniques for dealing with the attacks as well.
References
