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A New Approach: Using Virtual Reality Psychotherapy in Panic Disorder With Agoraphobia

(PSYCHIATRIC TIMES) - As listed in the DSM-IV-TR, the essential features of panic disorder are "the presence of recurrent, unexpected Panic Attacks, followed by at least 1 month of persistent concern ... or a significant behavioral change related to the attacks" (American Psychiatric Association, 2000). Panic disorder is characterized by instances of an intense sense of impending doom in which many patients will feel dizzy, hyperventilate and sweat. They can also experience chest pain, nausea and a fear of losing control. Because panic disorder can be accompanied by a high incidence of physical symptoms, it may be misdiagnosed or overlooked in assessments of a general medical condition by physicians or in emergency room care (APA, 2000; Hales et al., 1997). Panic disorder is chronic and may interrupt an individual's normal functioning. Each year, panic disorder will afflict more individuals than AIDS, stroke or epilepsy. Patients with panic disorder have a 20% incidence of suicide attempts, particularly when other psychiatric disorders are present.

Agoraphobia is a condition that can be diagnosed either with or without panic. According to the DSM-IV-TR, the patient fears being in places where escape would be difficult or embarrassing or where help might not be available. The situations are avoided or endured with marked distress or anxiety about having a panic attack or panic-like symptoms. For those suffering from panic disorder, agoraphobic avoidance may first occur in situations associated with the first panic attack (Faravelli et al., 1992).

Treatment of both panic disorder and panic disorder with agoraphobia will usually involve medication, cognitive-behavioral therapy (CBT) or a combination of the two. Medications used include selective serotonin reuptake inhibitors, tricyclic antidepressants, benzodiazepines and monoamine oxidase inhibitors (Saeed and Bruce, 1998). Cognitive-behavioral therapies may include relaxation, breathing retraining with or without the use of physiological monitoring, exposure therapy, and cognitive restructuring. It is generally understood that CBT is the most effective psychotherapeutic treatment modality for panic disorder and panic disorder with agoraphobia, and it can be used effectively in combination with pharmacologic therapy (Saeed and Bruce, 1998).

A large number of people who suffer panic attacks describe hyperventilation as one of their symptoms (Holt and Andrews, 1989). This observation lends support to the idea that hyperventilation may play a causal role in panic attacks. Panic attacks are seen as the product of stress-induced respiratory changes that then provoke fear of a heart attack or losing control of the ability to regulate bodily processes. Many researchers have found breathing retraining to be helpful (Ley, 1991). Clark et al. (1985) showed a marked reduction in panic attacks in patients who received two weekly sessions of breathing retraining and cognitive-restructuring training.

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