Jasmine Arthur-Jones and Bronwyn Fox
The role of fear triggering within uncued panic attacks is investigated. A model for the physiological structure of an uncued panic attack is developed by investigation into "energy" movement, dissociative experiences, physical symptoms, light and sound phenomenon, breathing, perceived physical changes. Also investigated meditation as an effective recovery method for Panic Disorder and Anxiety Disorders.Introduction
Panic Disorder, the experience of Panic Attacks, was included for the first time in the DSM-111(1) in 1980. Over the last fourteen years, research has increased the knowledge and understanding of this Disorder which is clearly evident in the recently released DSM-4(2).
In 1980 Panic Disorder was diagnosed when a person experienced at least three panic attacks over a three week period. In the DSM-111 and the DSM-111R(3) there was no specific distinction made in the type of Panic attacks people experienced. While the DSM-111R acknowledged that the avoidance behaviour (Agoraphobia) relating to the Panic Disorder was a result of a fear of having a Panic Attack, this lack of distinction upheld the prevailing view of the time that a panic attack and the avoidance behaviour resulting from the attack was a "phobic" response to situations and/or places. Many of the earlier treatment methods for Panic Disorder/ Agoraphobia focused on gradual exposure to the avoided situation and/or place and did not directly deal with the panic attack itself.
Specific distinctions in the type of panic attacks experienced have now been clearly stated in the DSM-4. The first type of attack and the one which is pivotal to this paper is the "unexpected" (Uncued) panic attack in which the onset of the Panic Attack is not associated with a situational trigger, i.e. occurring spontaneously ("out of the blue").
The second is "situationally bound (cued) panic attacks, in which the panic attack almost invariably occurs immediately on exposure to or in anticipations of the situational cue or trigger.
The third is "situationally predisposed panic attacks, which are more likely to occur on exposure to the situational cue or trigger, but do not necessarily occur immediately after the exposure(2).
Agoraphobia in Panic Disorder is recognised "as anxiety about being in situations and places from which escape may be difficult or embarrassing or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic like symptoms(2)". Besides Agoraphobia, other secondary conditions and effects of Panic Disorder are major depression, drug and/or alcohol abuse and suicide(2).
Another feature of Panic Disorder included in the DSM-4 is the experience of nocturnal panic attacks which are said to occur between stage two and stage three of sleep(4).
The symptoms of a panic attack are described in the DSM-4 as a "discrete period of intense fear or discomfort in which four (or more) of the following symptoms developed abruptly and reached a peak within ten minutes.
Palpitations, pounding heart or accelerated heart rate, sweating, trembling or shaking, sensations of shortness of breath or smothering, feeling of chocking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, light headedness or faint, Derealisation or depersonalisation, fear of losing control or going crazy, fear of dying, numbness or tingling sensations, chills or hot flushes(2)."