Panic Disorder Case Study

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1. Marlene’s repetitive episodes of chest pain, breathing problems, severe perspiration, and dizziness, a feeling of impending death, constant rumination and fear of recurrence of the symptoms are indicative of the presence of Panic Disorder. As per the DSM-IV TR, for the diagnosis, essentially, repeated, unexpected panic attacks are followed by at least one month of enduring concern about having another panic attack, accompanied by worry about the possible consequences of these attacks, or a significant behavioral change related to the attacks. These attacks are not caused by the direct physiological effects of a substance or a general medical condition, or accounted for by the presence of any other mental disorder. Since the recurrent panic attacks are accompanied by anxiety about being in places where escape might be difficult or help may not be available (being outside home alone, driving), Marlene would be diagnosed with Panic Disorder, with Agoraphobia (300.21). The DSM V lists both the disorders as separate diagnoses. 2. According to the cognitive model, emotions, behavior and physiology of an individual are influenced by his or her perception of events. In other words, how one construes or interprets an event or situation determines the consequent feeling arousing from that thought. Moulding one’s thinking to be realistic and adaptive leads to improvements in one’s mood, behavior and beliefs. The cognitive behavioral model of panic proposes that fear is a natural and adaptive response to perceived threat, wherein the fight or flight response on spotting danger is activated to ensure survival. Panic, however is viewed as a learnt response, wherein an individual’s “fear of fear” i.e. the physiological changes occurring ... ... middle of paper ... ...ty would be reduced through tolerance of feared situations and understanding fear response as normal. Hence, safety behaviors of breathing or drinking would be excluded from use during exposure exercises and extinguished gradually if present. Session 7-10 would be spaced out once in every 2 weeks. We would emphasize relapse prevention and focus of reinforcing the therapeutic goals, emphasizing the management and not elimination of anxiety as an optimum outcome of the therapy process. We would review the learning, facing challenges situations, and focus on honing the new coping skills. If needed, imagery, progressive muscular relaxation, controlled breathing would be taught in initial sessions and as HW, and systematic desensitization (with exposure) and distraction techniques would be incorporated in therapy. After the 15th session, monthly follow-up would be done.
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