Panic Disorder and Agoraphobia Revisited

Well, surely in the past I've written about how abandonment and trauma in life, especially the death of loved ones, is a set up for Panic Disorder and Agoraphobia. 

The psychotherapy for symptom abatement in psychodynamic therapy has always been about making connections between bodily sensations and past events to resolve old trauma.  come to an understanding that simply because of that neurological set up, thinking that something awful will happen and that life is out of control, is a natural, normal process that leads to anxious conclusions about the future. But the thinking is false. 

Yes, we're programmed in that direction, but we can also deprogram. We can identify our bodily symptoms and connect them to unconscious thoughts, bring those thoughts forward and go, 

'Oh well. What's done is done. It is not predictive of anything horrible happening today or tomorrow.'

Now that's a great therapy alone. 

Since the late 80's many of us have added a Cognitive Behavioral Therapy component, mostly a pause and relaxation, breaking the cycle of misinterpreting body signals to mean catastrophe awaits. Panic Control Therapy emphasizes psychoeducation about anxiety and panic, identifies and corrects irrational thoughts, exposes (at least mentally) the patient to What If, the catastrophic expectation isn't likely and if it did happen, then what, and adds a self-relaxation to the mix. 

Add the reflective thinking (RF) of Panic Focused Psychodynamic Psychotherapy (PFPP) to address the client's assessment of the problem, and you have a dynamic duo. They both work, why not use both. That's my take-away from a relatively recent study, Processes of Therapeutic Change: Results From the Cornell-Penn Study of Psychotherapies for Panic Disorder (Barber & Milrod, et al). The authors compared CBT and the reflective function psychodynamic approach and found early signs of improvement relevant to both. 

I'd add, And take a vacation to reflect on the whole gestalt, truthfully, but I haven't seen any research on that. 

Best, 

therapydoc