By Carol Sorgen
Reviewed By Brunilda Nazario
Diane Ulicsni knows all too well how terrifying panic attacks can be. For more than 12 years, Ulicsni, director of The Hypnosis Center in Lake Oswego, Ore., suffered from chronic panic attacks that led her on a seemingly endless round of doctor and emergency room visits. Convinced she was having a heart attack -- or a nervous breakdown -- Ulicsni endured the all-too-common symptoms of panic attacks (also known as panic disorder), which include a feeling of intense fear, sense of doom, or feeling of unreality, accompanied by physical symptoms such as a racing or pounding heartbeat; difficulty breathing or a feeling of choking; sweating, shaking, or flushing; chest pains; dizziness, light-headedness, or nausea; fear of losing control; and tingling or numbness in the hands.
Ulicsni, who finally found relief from her panic attacks through hypnosis and is now a board certified hypnotherapist, says that hypnosis -- which has been recognized by the American Medical Association since 1958 as a form of treatment -- is one of several non-drug approaches that can significantly ease, if not cure, panic attacks.
Hypnosis can strengthen the effect of the mind on the body, says Ulicsni, by changing the way you perceive sensations, narrowly focusing your attention so you're not overwhelmed by the symptoms of a panic attack, and relaxing you physically.
In addition to hypnosis, other nondrug therapies that may (or may not, depending on whom you ask) work for panic attacks include humor, energy psychology such as "tapping" (also known as thought field therapy), and -- perhaps the most widely studied, and some would say, most successful -- cognitive behavioral therapy.
Laugh your panic attacks away? That's a good strategy, says Steven Sultanoff, PhD, a clinical psychologist in Irvine, Calif., and past president of the American Association for Therapeutic Humor. Sultanoff uses humor visualization with his panic attack patients, asking them to see themselves in a situation where they've laughed uncontrollably. When panic symptoms arise, the patients go back to that image of themselves laughing.
"Humor replaces the distressing emotions of a panic attack," says Sultanoff, "and, if the humor leads to outright laughter, it changes the physiological responses of the attack as well." When you're anxious, he explains, your serum cortisol -- or stress hormone -- level rises; laughter is believed to reduce the cortisol levels.
Diane Roberts Stoler, EdD, a licensed psychologist in Georgetown, Mass., has been treating patients with panic attacks with cognitive behavioral therapy and hypnosis for more than 25 years and says that until recently, those were always her first choices. But as she has received training in energy psychology and has seen it work quickly for patients, she says, "I am now a true believer and it is now my first choice for anxiety and panic disorders."
Energy psychology, explains Stoler, includes the tapping of acupuncture (or acupressure) points and can be taught so that a person can do it him or herself. "Each thought we have produces an energy field, which triggers chemical changes in the body," says Stoler. "This chemical change produces behavior changes and bodily sensations, such as racing heart, sweaty palms, dilating eyes, dizziness, and shortness of breath. We then associate these bodily reactions to the sensations, such as fear, anxiety, panic, etc."
Talk therapy, says Stoler, can help you understand why you have these reactions, while psychopharmacology (medication) changes the chemicals in your brain and body. Energy psychology, on the other hand, she says, deals with the "chi" -- or energy field -- related to the thought, and by tapping specific acupuncture points in a specific order, you can discharge a negative energy with the specific thought. "In other words, the tapping affects the initial energy change that went with the original thought, such as a fear of flying or of heights," says Stoler.
Northern California psychologist Neil Fiore, PhD, acknowledges that tapping may have its role in treating the physical symptoms of panic disorder; tapping on the acupressure point that corresponds to the adrenal glands, which control the stress response, may serve some purpose, he says, but in general, he considers tapping "a little out there."
Fiore prefers to use a desensitization approach with panic patients, he says. He begins by asking the patient to imagine herself in a situation that normally causes a sense of panic -- in a grocery store or on an airplane are two common scenarios, says Fiore. Then he has the person hold that image for 30 seconds; each time he repeats the exercise, the time increases. "You could call it fear inoculation," he says.
While the patient imagines the scene, Fiore advises that the patient think of the worst-case scenario. "Keep asking yourself, 'What if?'" he says. What if you panic when you're grocery shopping? You can always leave the store. What if you feel faint? Someone will help you. "There's always an answer to 'what if?'" says Fiore.
What desensitization offers is a psychological "safety net," Fiore says. "You learn to face the fear and know that it won't be the end of the world."
Like Fiore, James D. Herbert, PhD, associate professor of clinical psychology at MCP Hahnemann University in Philadelphia, is not averse to alternative medicine per se. Approaches such as thought field therapy, or tapping, however, is just "fringe psychotherapy," he says.
"Anecdotally, it may work," he says, "but scientists don't rely on anecdotes. Anecdotes don't really prove anything. We need more controlled studies."
What research has shown to work in treating panic disorder, says Herbert, is cognitive behavioral therapy. "That's my treatment of choice," he says. "It's as effective, if not more so, than medication, and unlike medication, you don't tend to relapse when you're done."
Therapy for panic attacks is not a long, drawn-out affair either, says Herbert. In an average of eight to 16 weeks, you may very well be completely panic-free. The most important elements of cognitive behavioral therapy include:
- Cognitive restructuring, to help you look at your beliefs, and then see whether they're distorted. For example, your heart is racing and you're afraid you're having a heart attack. "Look at the evidence," says Herbert. You've been checked out by the doctor, your heart is fine, you're perfectly healthy. "Restructuring helps correct the 'catastrophizing' thoughts," says Herbert.
- Exposure, to help you face your fears. In vivo (or, in real life) exposure, Herbert says, means you experience the situation where you tend to panic. If you're afraid to go to the grocery store, take someone with you and stay for just five minutes; the next time, go alone and stay for a bit longer; and so on. Interoceptive exposure, says Herbert, means you're exposed to the physical sensations that can trigger a panic attack. If a rapid heartbeat causes you to panic, Herbert will have you run up and down the stairs until your heart is racing; if dizziness causes your panic, he'll spin you around in a chair; if hyperventilating is your trigger, he'll have you breathe through a cocktail straw while holding your nose. "Exposure to the symptoms will help you recognize them for what they are," he says. Most of us, in fact, have a rapid heartbeat, or become short of breath, or get dizzy from time to time. "Our bodies do not remain static," says Herbert. "It's a matter of getting used to the symptoms we all experience."
Herbert admits that cognitive behavioral therapy doesn't work for everybody.
"But there's no scientific evidence -- emphasis on the "scientific'' -- that these other therapies work any better."
SOURCES: Diane Ulicsni, director, The Hypnosis Center, Lake Oswego, Ore. Steven Sultanoff, PhD, clinical psychologist, Irvine, Calif.; past president, American Association for Therapeutic Humor. Diane Roberts Stoler, EdD, licensed psychologist, Georgetown, Mass. Neil Fiore, PhD, psychologist, California. James D. Herbert, PhD, associate professor of clinical psychology, MCP Hahnemann University, Philadelphia.
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