Anxiety and Panic Disorder

Patient Treatment Manual

This manual is both a guide to treatment and a workbook for persons who suffer
from Anxiety and Panic Disorder. During treatment, it is a workbook in which
individuals can record their own experience of their disorder, together with the
additional advice for their particular case given by their clinician. After treatment
has concluded, this manual will serve as a self‐help resource enabling those who
have recovered, but who encounter further stressors or difficulties, to read the
appropriate section and, by putting the content into action, stay well.
1. Panic Attacks, Panic Disorder & Agoraphobia
A Panic Attack is a sudden spell or attack when you felt frightened, anxious or very uneasy in a
situation when most people would not feel afraid. During one of these attacks the following
symptoms may occur:
shortness of breath trembling or shaking
pounding heart hot or cold flushes
dizzy or light headed things around you feel unreal
tingling fingers or feet dry mouth
tightness or pain in the chest nausea or butterflies
a choking or smothering feeling "jelly legs"
feeling faint blurred vision
sweating muscle tension
feeling you can’t get your thoughts together or speak
fear you might die, lose control or act in a crazy way
Panic Disorder is the name given to the condition in which people have unexpected panic attacks,
worry about what panic attacks might do or mean, and change their behaviour as a result of having
panic attacks. Individuals with panic disorder will have experienced a number of these symptoms
during a panic attack. Different people will find different symptoms more frightening or unpleasant
than others.
When the panic becomes severe most people try to get out of the particular situation, hoping the
panic will stop. Alternatively, they get help because of fears they might collapse, have a heart
attack, or go crazy. Occasionally, some people want to be alone so that they don't embarrass
themselves in some way. When individuals start associating panic attacks with certain situations,
they often try to minimise the panic attacks by avoiding the same or similar situations. For
example, some people who have their first panic attack on a train may start to avoid trains and
buses in the future. When this avoidance is widespread and severe, the condition is called
Agoraphobia.
Situations that are avoided by people with agoraphobia (or endured with anxiety or discomfort) can
usually be understood as situations from which escape might be difficult (physically or socially) or
in which it might be difficult to obtain help if a panic attack occurs. An underground train is an
example of a situation from which it is physically difficult to escape, whereas a dinner party is an
example of a situation from which leaving might be socially awkward. Being alone at home or
alternatively, a long way from home, are examples of situations in which it might be difficult to
obtain help. There are, of course, situations that combine elements of these: being on a peak-hour
train could be seen to involve difficulty escaping as well as difficulty obtaining help.