Part II. Treatment of panic fear and phobias

Identifying and understanding the mechanisms of neurotic behavior is a necessary step in the treatment of constant fear and panic attacks. Such mechanisms support your not entirely adequate reactions and drive you into the trap of neurotic experiences.

Among the standard mechanisms, the most common is avoidance behavior. Experiencing anxiety with numerous uncomfortable experiences is not pleasant, and people begin to avoid situations that are associated with unpleasant experiences.

Let me give you a few typical examples. For example, a person has social fears (social phobia or fear of contact with people): he does not like to be in the center of attention, participate in public speaking, conflicts, avoids people and situations where he may not be on his best, informal contacts, and so on. That is, he avoids any contact where he is not guaranteed a good attitude. Another example: a person, in order to feel calm/avoid problems, wants to be able to “leave”/stop the situation. These people may begin to avoid traveling in the subway, in the elevator, flying on an airplane, large crowds of people, meetings, visits to dentists, and hairdressers.

As you noticed, the situations/“scenery” for panic attacks are different. Despite this, an anxious arousal unfolds in the human body and his psyche, always the same , which can differ in intensity, and the consciousness is simply filled with different “horror stories” (I will die/faint/go crazy/lose control/disgrace myself). That is, the “scenery” is not important, the central figure of this drama is unnecessary anxiety. And avoidant behavior does not allow the psyche to reboot and stop activating the alarm program (fight or flight reaction). Avoiding is bad, everyone knows this, but it’s easy to say “what’s there to be afraid of, pull yourself together, how can you be afraid of fear, let’s fight with each other...”, this is what those who have never experienced a panic attack say. But notice, it’s not so cheerfully that we run to report to our bosses or approach the person of the opposite sex we like. And these experiences are essentially the same as a panic attack, but incomparable in strength.

general information

According to statistics, panic attacks periodically occur in one person out of 20. Young people (age 20-30 years) experience attacks more often than older people, and women more often than men.

The exact mechanism of panic has not yet been identified. Most doctors associate the symptoms with a sharp release of stress hormones into the blood: adrenaline and norepinephrine. As a result, the body turns on the “fight or flight” mode and mobilizes all its forces. A person’s pulse and blood pressure rise, breathing quickens, and a strong feeling of anxiety appears that cannot be suppressed by force of will.

The attacks cause such intense fear that the patient begins to live in anticipation of a new wave of panic. If conditions are repeated periodically, they can cause the development of severe neurosis and depression, completely subjugating a person’s life. Timely help from specialists makes it possible, if not to get rid of attacks completely, then at least to reduce the frequency of their occurrence, and also to learn self-help skills during panic.

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The identification of PR was significant not only according to clinical criteria but also according to the characteristics of the patients’ response to therapy, which include:

1. High effectiveness of antidepressants;
2. Insufficient effect of using traditional benzodiazepine tranquilizers;
3. Insufficient effectiveness of psychotherapy.

The current practice among domestic psychiatrists of using traditional benzodiazepines (diazepam, chlordiazepoxide, phenazepam), less often - small doses of antidepressants (amitriptyline, azaphen) and minor neuroleptics (teralen, sonapax), or combinations of these groups of drugs, often does not lead to persistent and pronounced effect.

It has now been established that PR responds well to pharmacotherapy. Treatment of panic disorders can be divided into 3 main stages:

1. Relief of PP until remission is established (4-6 weeks - 2-3 months)
2. Stabilizing (follow-up) therapy to consolidate results, restore the level of social adaptation, overcome agoraphobic manifestations (anticipation anxiety, avoidant behavior) and early relapses (4-6 months). At this stage, adequate psychotherapy is necessary.
3. Preventive (long-term) therapy aimed at preventing the development of relapses and maintaining stable remission (up to 1 year or more)

Currently, the following anti-panic drugs (used to block the PP) are distinguished: tricyclic antidepressants, selective serotonergic drugs, MAO inhibitors, etc. atypical (or high-potency) benzodiazepines (alprazolam and clonazepam).

A) Tricyclic antidepressants (TADs).

The most commonly used tricyclic antidepressants are clomipramine (Anafranil), imipramine (Melipramine), desimipramine (Petylyl, Pertofran), nortriptyline and amitriptyline. The effectiveness of the tetracyclic antidepressant maprotiline (ludiomil) and the atypical TAD tianeptine (Coaxil, Stablon), which is similar in action to TAD, is described for PR. Clomipramine (anafranil) is used most often and has the greatest effectiveness among TADs in the treatment of PR.

Treatment with TAD begins with small doses (12.5-25 mg/day), then the dose is gradually increased to a tolerable level (on average by 12.5-25 mg over 3-5 days). The average effective daily dose is usually 150-200 mg/day, rarely reaching 300 mg. The antipanic effect of TAD is also “delayed” like the thymoanaleptic one, but it occurs somewhat faster - the latent period is usually about two weeks. TAD has an effect in PD mainly due to its effect on the thymic and especially the phobic component, having less effect on anticipatory anxiety and somatovegetative manifestations. In the case of a good reaction, a decrease in the frequency of PR occurs quite quickly, anxiety and phobias are reduced, and the mood is evened out. However, in half of the patients, from the first days of using TAD, an increase in anxiety and vegetative symptoms occurs, which increases the occurrence of PP, therefore, with an inadequate increase in dosage, the patient’s condition either does not improve at all, or the initial improvement will be lost after a few weeks. Patients may reach a “plateau of tolerance” two or three times before selecting the final dose. To avoid premature drug withdrawal, you can add any benzodiazepine drugs to TAD (diazepam 5-10 mg/day, phenazepam 0.5-1 mg/day), as well as adrenergic blockers (anaprilin 20-40 mg/day), which allows you to reduce severity of exacerbation of PR and wait for the somewhat delayed effect of the antidepressant. Treatment with TAD is continued for 4-6 months, and if the condition is stable, a gradual reduction in dose level is begun, which usually lasts 1-2 months. In the future, the issue of carrying out longer-term preventive therapy is decided. Thus, the main disadvantages of TAD are the delayed effect and pronounced side effects, especially those associated with hyperstimulation of the autonomic nervous system: palpitations, tremor, hyperhidrosis, dizziness, anticholinergic effects, paradoxical increase in blood pressure, sexual function disorders, weight gain. These effects are especially pronounced in amitriptyline, which significantly limits its use in this group of patients. The effectiveness of the atypical TAD tianeptine (Coaxil) at a dose of 37.5 mg/day in some patients with PR was noted. A reduction or blockade of the PP, a reduction or decrease in the intensity of agoraphobia is observed by 5-6 weeks of treatment. A good effect is observed in patients with “atypical” PP and signs of “secondary” depression comorbid with PP.

B) selective serotonin reuptake inhibitors (SSRIs).

In addition to TAD, selective serotonin reuptake inhibitors are effective in the treatment of PR: fluoxetine (Prozac, Portal, Prodep), fluvoxamine (fevarin, floxifral, Luvox), sertraline (Zoloft), paroxetine (Paxil), citalopram (Cipramil). The main disadvantage of this group is the occurrence during the first 2-3 weeks of treatment of hyperstimulation (irritability, insomnia, nervousness) and increased anxiety and panic symptoms (probably due to excessive stimulation of serotonin autoreceptors). The method of application does not differ from the treatment of depression, but the initial doses are usually minimal (5 mg fluoxetine, 50 mg fluvoxamine, 25 mg sertraline). Over the course of 2 weeks, the dose is adjusted to the average dose, and then, if necessary, it is increased or remains the same. Subsequently, even with long-term therapy, the dose does not change. For long-term (maintenance) treatment, drugs are much more convenient than TAD due to the lack of anticholinergic and adrenergic effects and possible single administration during the day.

B) monoamine oxidase inhibitors (MAOIs).

In Russia, in recent years, only the so-called. reversible MAOIs (moclobemide (Aurorix) and pyrazidol). They are usually used in case of intolerance to the above listed drugs - research on their use is insufficient. In general, they appear to be inferior in effectiveness to the drugs described above, but are much better tolerated. Moclobemide is especially effective when PP is combined with social phobia. Treatment begins with 25-50 mg/day with a gradual increase in dose by 50 mg/day. The effective daily dose is usually 450-600 mg/day.

D) Atypical (high-potency) benzodiszepines (ABZDs).

An important group for the treatment of PR are atypical benzodiazepines: alprazolam (Xanax, Cassadane) and clonazepam (Antelepsin, Rivotril). A special feature of ABZDs is their high affinity for benzodiazepine receptors (3 times higher than that of typical BZDs). Unlike antidepressants, which reduce PP and agoraphobia, but have little effect on the anxiety of anticipating an attack, alprozalam not only suppresses the anticipation and avoidance component (agoraphobic), but also stops the actual psychopathological and somatovegetative manifestations of the attack itself (panic component) and prevents the development of PP. In addition, it causes virtually no side effects up to a dose of 4-6 mg/day, i.e. it is very well tolerated. The drug does not cause exacerbation of anxiety like antidepressants; the antipanic effect develops without a “latent period.” In addition, alprazolam has a distinct antidepressant (thymoanaleptic) effect, which develops 2-3 weeks after the start of therapy. The disadvantage is the possibility of developing dependence (substance abuse) and “withdrawal syndrome”, as well as the need for 3-4 doses per day due to the short half-life (the prolonged form of Xanax retard does not have this disadvantage). Rarely compared to other BZDs, weakness, lethargy, drowsiness, fatigue, and ataxia are observed. The likelihood of developing dependence limits the possibility of long-term (more than 4-6 weeks) use of the drug, however, if antidepressants are intolerant, alprazolam must be prescribed for a long period, followed by an extremely slow dose reduction. Initial doses of alprazolam are 0.25-0.5 mg/day, increasing by 0.25-0.5 mg every 3 days until the onset of PP is completely blocked. The persistence of PP or their recurrence indicates an insufficient dose of the drug, and side effects (sedation, lethargy, drowsiness) indicate the need to reduce the dose. Average doses are 4-6 mg/day, treatment is continued for 4-6 months, after which, with good adaptation of patients, the dose is reduced at an average rate of 0.5 mg per week to avoid withdrawal syndrome.

Clonazepam (antelepsin, rivotril) also has a pronounced antipanic effect at a dose of 2-6 mg/day, however, it has more pronounced side effects (drowsiness, lethargy, ataxia, depressogenicity), which limits its use. At the same time, due to the longer half-life, a milder “withdrawal syndrome” is observed, there is no need for three mandatory prescriptions, and it is easier to reduce the dose. The initial dose is usually 0.5 mg 2 times a day, with a gradual increase to 2-6 mg/day.

During long-term treatment with BZDs, the safety, efficacy, and indications for therapy should be periodically assessed. It is recommended to answer the following questions at certain intervals (2-4 months):

1. Do existing disorders justify continued therapy? Did the patient feel significantly better from BZD therapy?
2. Is the duration of use within the prescribed limits, has the patient avoided taking other medications that were not prescribed to him?
3. Does the patient show any signs of intoxication or confusion associated with taking BZDs or their combination with other drugs?

Any answer “no” is an indication that treatment should be discontinued. Attempts to gradually reduce the dose are recommended every 4 months. In some patients, the drug can be completely discontinued; in others, an exacerbation occurs, requiring resumption of treatment. Periodic breaks in treatment can help identify patients with persistent anxiety, but a good effect of BZD: long-term therapy is especially indicated for them. The FDA Commission (USA) in its recommendations indicates that the use of BZDs for more than 4 months has not been studied. In addition, patients with personality disorders and substance abuse tendencies (including alcohol abuse), even with a history of it, should not be treated long-term with BZD.

Traditional BZDs in isolated form are now rarely used in cases of PR, being prescribed only as “correctors” of antidepressants in the initial phase of treatment or even preceding the prescription of the latter (“premedication”).

D) Criteria for choosing drugs.

Therapy with TAD and, especially, clomipramine is clearly effective in patients with rapid addition to PD of depression with features of “endogeneity”, with a high proportion of maniophobia and depersonalization-derealization disorders in the structure of PD. In patients with late addition of depression to PD, its atypical, erased nature, a high proportion of pseudosomatic (somatovegetative) and conversion disorders, and the rarity of agoraphobia, the effectiveness of TAD is usually low. This subtype of PD is closer to the diagnosis of hypochondriacal development or “somatoform disorder” according to ICD-10. Thus, the more pronounced the mental component of anxiety and the more phobic experiences are represented, the greater the effect of TAD can be expected and the less exacerbation of PR during treatment.

With a stronger representation of the somatovegetative components of the PR (compared to the “mental”), the effectiveness of TAD is less, they are less tolerated and more often cause exacerbation of the PR. In these cases, it is necessary to decide on replacing TAD with ABZD or MAOI.

The ideal target for ABZD is predominantly somatovegetative PP without distinct agoraphobia; with severe phobic symptoms, their use does not lead to a clear effect, only relieving anxiety of anticipation and PP. Predictors of low effectiveness of ABZD are also a high frequency of PP and alexithymia (i.e., the inability of patients to adequately express their experiences or talk about them).

Thus, if we proceed from traditional nosological ideas about the place of PR as a syndrome in the structure of a particular disease, then when choosing therapy the following must be taken into account:

in case of PR within the framework of MDP (cyclothymia) or low-progressive schizophrenia, when the clinical picture is rich in psychopathological phenomena (fear of going crazy, depression, depersonalization, anxiety), “large” TADs (clomipramine, impramine, amitriptyline) are most effective. Their significance will increase even more as the PR picture approaches melancholic raptus. Clomipramine, SSRIs, MAOIs are also the drug of choice for severe agoraphobia or the presence of other concomitant phobias or obsessions that may not be thematically related to agoraphobia, i.e. with a large proportion of ideational obsessions within the framework of sluggish schizophrenia, cyclothymia. TIR.

In case of PR within the framework of neuroses, the value of clomipramine and SSRIs is high in the case of obsessive-compulsive neurosis, but decreases in asthenic neurosis and hysteria, where ABZD or MAOIs are more effective.

It should be noted that in the treatment of patients with PD it is often necessary to combine basic “anti-panic” drugs with drugs that allow them to influence psychopathic-like (most often hysterical) and overvalued (hypochondriacal) disorders. In such situations, drugs from the group of antipsychotics are added to the basic drugs: thioridazine (Sonapax), alimemazine (Teralen), periciazine (Neuleptil), sulpiride (Eglonil), chrolprothixene. In addition, when diagnosing the schizophrenic process, it is necessary to add to the “syndromic” therapy antipsychotics that have an anti-negative effect and affect the overall progression of the disease (trifluoperazine (triftazine, stelazine), clozapine (azaleptin, leponex), risperidone (rispolept), etc.).

E) psychotherapy for PR.

Effective therapy for PD requires (especially in cases complicated by agoraphobia) the use of psychotherapeutic techniques. The latter usually begin to be used at the stage of stabilizing (follow-up) psychopharmacotherapy and continue for some time after stopping medication (in many ways facilitating the latter).

Behavioral and, less often, cognitive psychotherapy are most effective in treating PD. They allow you to reduce the level of anxiety in phobic situations and reduce the fear of expecting an attack.

Cognitive psychotherapy is aimed at correcting the fixed misconceptions of patients, according to which they give exaggerated reactions to non-life-threatening somatic sensations.

The leading method of behavioral therapy (BT) is systematic desensitization, i.e. immersion in a phobia situation (imaginary or real). The patient and therapist create a scale of scenes associated with the occurrence of symptoms, ranking them from least to most painful. Using progressive muscle relaxation techniques, the patient learns to relax by imagining increasingly painful scenes. Then the sessions are transferred from the office to a real-life setting, in situations that cause anxiety. In other behavioral techniques, the patient is directly immersed in a situation that provokes anxiety: after several weeks, during which the patient is no longer bothered by the PP, the therapist encourages him to deliberately confront the phobic stimuli. After a little training, many patients begin to feel free in previously avoided situations. More formal PT may, however, be needed for long-standing and severe phobias. There are many techniques for treating them, all of which have in common the encounter with a phobic stimulus in real life. Most important for therapeutic success is the duration of exposure: sessions lasting 2-3 hours are preferable to those lasting less than an hour. Another important condition is frequent repetition of sessions, prevention of the patient’s usual avoidance reaction and, if possible, reproduction in sessions of circumstances close to real life. The effect of PT increases significantly when it is carried out in groups, when patients, after training with imaginary situations, first, accompanied by a therapist, travel together, finding themselves in real phobic situations. An important modification of the method is the involvement of an instructed relative of the patient as a behavioral co-therapist.

Underestimation of the need for PT leads to a rapid relapse of PT after cessation of psychopharmacotherapy and the persistence of agoraphobic avoidance. On the other hand, there are patients who recover with only pharmacological treatment, and some patients, despite taking medications, remain too “scared” to even begin to participate in PT.

The effectiveness of other psychotherapeutic methods for PD is low and differs little from placebo (in particular, the use of psychodynamic therapy itself gives a positive effect in only 13% of cases).

Causes

The causes of panic attacks are unknown. It has been proven that predisposing factors are:

• hereditary predisposition;
• suffered psycho-emotional trauma in childhood and adolescence;
• lack of protective hormones in the body, in particular serotonin;
• prolonged or very severe stress;
• physical injuries and surgical interventions;
• lack of sleep;
• overwork;
• excessive physical activity;
• pregnancy;
• alcohol abuse, etc.

Psychologists and psychoanalysts also analyze the causes of panic attacks. Among the possible risk factors, they especially highlight:

• increased sensitivity to internal sensations, which leads to a significant increase in even minimal discomfort;
• excessive demands on oneself and perfectionism;
• unresolved internal conflict.

Most likely, the body is exposed to several pathological factors at once, which together cause an unreasonably strong reaction to external or internal stimuli.

Symptoms

Unlike many other conditions, the symptoms of a panic attack are sudden and occur against a background of complete well-being.

A person develops:

• severe anxiety, unreasonable fear of death, an inexplicable feeling of great danger;
• increased heart rate and breathing;
• a feeling of difficulty breathing or suffocation, severe shortness of breath;
• persistent feeling of a lump in the throat;
• discomfort, feeling of squeezing or pain in the chest (usually in the left side);
• dizziness;
• abdominal pain, nausea; in severe cases, vomiting or diarrhea may occur;
• trembling in the arms and/or legs;
• numbness or tingling sensation in the limbs;
• sweating, flush of heat to the face and body;
• blurred vision, flickering of spots before the eyes.

Most patients note a strong feeling of unreality of what is happening, they are afraid of going crazy or losing control over their behavior.

Unlike other diseases and conditions accompanied by similar symptoms, the signs of a panic attack disappear within 10-30 minutes and leave no trace. Depending on the state of the person’s nervous system, concomitant diseases and external factors, waves of panic can be repeated with varying frequencies from once every 1-2 months to several times a day.

Typically, the first panic attack is the most severe and severe. It leaves behind a persistent fear of a repetition of what is happening, which is also a provoking factor. A pathological vicious circle develops, which is almost impossible to break without the help of specialists.

Clinical manifestations of coronavirus

People with coronavirus may have only partial symptoms or no symptoms at all. But most patients experience the following symptoms:

• Increase in body temperature to 37-39 degrees Celsius;
• Feverish state;
• Pain throughout the body, aches, severe weakness;
• Fatigue;
• Shortness of breath and difficulty breathing;
• Loss of smell and taste;
• Headache;
• Conjunctivitis;
• Myalgia;
• A sore throat;
• Nasal congestion (usually without runny nose);
• Nausea, vomiting, digestive system disorders (uncommon).

The incubation period for coronavirus ranges from 2 to 14 days. Symptoms usually appear suddenly, most often on the 7th day. In most cases, the disease occurs in mild to moderate form, and patients are treated on an outpatient basis. The risk of developing complications and severe disease increases with age, in the presence of chronic diseases, immunodeficiency conditions, mental disorders, obesity, problems with the heart, kidneys, and lungs.

Severe forms of coronavirus are characterized by shortness of breath, lack of air, hypoxia, and extensive lung damage, which can lead to respiratory failure, shock, multiple organ failure, and premature death. When the disease is severe, a person often requires oxygen support or connection to a ventilator.

Coronavirus can also cause serious problems such as heart disease (arrhythmia, cardiomyopathy, acute heart injury), coagulation disorders (thromboembolism, arterial clot formation, hemorrhage), sepsis, shock.

But in addition to the above symptoms, COVID-19 can also cause serious disturbances in a person’s psycho-emotional state. One of the most common problems is the occurrence of panic attacks in people who have had coronavirus.

Why do panic attacks occur after coronavirus?

Panic attacks are a neurotic disorder characterized by attacks of unreasonable anxiety and severe fear, combined with somatic manifestations. The causes of panic attacks are still not fully understood, but it is known for sure that they arise as a result of severe emotional shock or stress (excessive physical activity, pregnancy, stress, illness).

Coronavirus has become a real challenge for many. Fear of getting sick, severe illness, long-term treatment, forced self-isolation, fear of losing a job and source of income, loss of a loved one due to complications due to coronavirus - all this has a negative impact on the people’s psyche. For many, the pandemic has become a real shock, the consequences of which people have been struggling with for a long time. Statistics show that one of the most common problems that arise after coronavirus is panic attacks - a peculiar consequence of COVID-19, a reaction to stress. Mostly young people aged 20-30 years and in most cases women are susceptible to this neurotic disorder.

Symptoms of a panic attack

• Severe groundless fear, panic and horror;
• Chest pain;
• Difficulty breathing, feeling of lack of air;
• Increased pulse and heart rate;
• Chills, trembling in the body;
• Blood pressure surges;
• Dizziness;
• Fogginess, confusion, loss of sense of reality;
• Fear of going crazy or dying.

Additional symptoms may be: frequent urination, stool disorders, increased sweating, a feeling of a lump in the throat and tightness in the chest, cramps in the limbs, impaired motor function, insomnia.

The duration of one panic attack ranges from several minutes to several hours (most often up to 30 minutes). The attack usually begins suddenly under the influence of an external irritating factor - a situation in which the patient experiences discomfort, for example, while traveling in transport, air travel, being in a crowd, etc. Depending on the severity of the disease, panic attacks can occur 1-2 times a month up to several times a day.

Panic disorder is not limited to one attack. The first episodes frighten a person so much that he begins to anxiously await the onset of the next attack. This further increases emotional stress, making the situation worse.

At the same time, panic disorder is not always an independent disorder, but may be a manifestation of another disease, for example, heochromocytoma, somatoform dysfunctions, depression, phobic disorders, post-traumatic stress disorder, diseases of the endocrine, cardiovascular system, due to taking medications, etc. Panic attacks , developing after coronavirus, experts classify as disorders that arise against the background of stress and a high drug load on the body.

Why are panic attacks dangerous?

Panic and anxiety attacks, when repeated frequently, can cause death. When the first symptoms of this neurological disorder appear, you should seek help from a specialist. Otherwise, there is a risk of developing phobias, when, in anticipation of a new panic attack, a person will consciously avoid people, public places, and transport. Fear of a panic attack can lead to conscious reclusiveness.

Panic attacks can cause the following complications:

• Depression;
• Asthenia;
• Sleep disorders (insomnia, shallow sleep, nightmares);
• Neurasthenia;
• Phobic disorders;
• Neuroses.

Lack of timely medical care for panic attacks can lead to a personality disorder from which the patient will no longer be able to get rid of. Some patients with frequent panic attacks may deliberately refuse food, which leads to dystrophy and diseases of the internal organs.

Treatment of covid (COVID-19) at home

Call a narcologist Call a psychiatrist

Call an ambulance Call an emergency service

A person withdraws into himself, not understanding how to get rid of panic attacks, he becomes depressed, does not believe that anyone can help him, refuses psychological help and may attempt suicide.

Treatment of panic attacks in patients after coronavirus

Panic attacks themselves do not threaten a person’s life, but without proper medical care, their frequency and intensity increases, the intensity of the manifestation of somatic disorders increases, which significantly worsens a person’s quality of life.

Treatment of panic attacks has a positive prognosis, provided that you consult a doctor in a timely manner. Complex therapy allows you to reduce the frequency and intensity of attacks, and then completely rid the person of the problem. The most pronounced effect is achieved when using an integrated approach - prescribing drug maintenance therapy, psychotherapy and physiotherapeutic treatment to the patient.

The treatment of panic attacks in patients after coronavirus is somewhat different from the treatment of panic attacks in other patients. After Covid, a person’s body is very weakened, he needs more time to recover from the illness. If the coronavirus was in moderate or severe form, then the patient probably received treatment with antibiotics, immunomodulators, antitussives, antiallergic drugs, and took vitamin complexes. It is necessary to prescribe drugs to such a patient to correct the mental state carefully, strictly according to indications and taking into account contraindications and possible side effects.

Drug treatment for panic attacks

There are two types of medications for the treatment of panic attacks: for quick help during an attack (act instantly) and medications for continuous use (preventive).

The first group includes benzodiazepine tranquilizers (alprazolam (Xanax), clonazepam, diazepam (Relanium), phenazepam). These are potent prescription drugs that are not commercially available. They quickly relieve an acute condition, relieve anxiety and eliminate vegetative manifestations during an attack. Such drugs are used once as an emergency aid to a patient who has a severe panic attack, or in short courses. Long-term use of benzodiazepine tranquilizers causes persistent mental dependence in the patient and forms tolerance to the drug - the need to increase the dose to obtain an effect.

Non-benzodiazepine tranquilizers (hydroxyzine (atarax), mebicar, etifoxine, meprobamate) have a less pronounced effect compared to benzodiazepine drugs, do not cause addiction, are well tolerated by the patient, and can be used both once and systematically to prevent panic attacks.

Neuroleptics with a sedative effect are drugs that can eliminate feelings of anxiety and stop a panic attack. The most commonly used are Thioridazine (Sonapax), Periciazine (Neuleptil), Chlorprothixene (Truxal), Quetiapine (Seroquel), Alimemazine (Teraligen), Sulpiride (Eglonil). The disadvantage of this group of drugs is that not only the feeling of anxiety is suppressed, but also other feelings - joy, surprise, curiosity, etc.

Antidepressants with sedative effects are used as first aid and to prevent panic attacks. The effect develops gradually, but is long-lasting.

Normotics - allow you to restore the balance between the processes of excitation and inhibition of the nervous system. Widely used in the treatment of panic attacks in people with brain injuries, stroke survivors, and hypoxia.

Drug treatment should be prescribed by an experienced doctor, taking into account the overall clinical picture, collecting anamnesis, assessing all the risks and the expected result.

Psychotherapy in the treatment of panic attacks after covid

All over the world, cognitive behavioral psychotherapy is recognized as the most effective in treating panic attacks. This method of psychotherapeutic influence allows one to achieve positive results in a relatively short time (6-12 sessions), enhance the effect of drug treatment or completely eliminate the need for pharmacotherapy.

The psychotherapist, using special tests and techniques, determines the root cause of the disorder, identifies the triggers of panic, explains to the patient what is happening from a scientific point of view (psychoeducation of the patient), identifies erroneous ideas about panic, helps to divide the individual’s emotions into productive and unproductive, and as a result, change the patient’s idea of situations and about your condition. The duration of the course of psychotherapy is determined for each patient individually. Treatment is anonymous.

Physiotherapeutic methods for treating panic attacks

Physiotherapeutic treatment for panic attacks after coronavirus in combination gives good results. COVID-19 in most cases affects the upper and lower respiratory tract, causing complications on the nervous system, musculoskeletal system, and cardiovascular system. Physiotherapeutic procedures allow the body to recover faster from illness, correct the psychophysical state, normalize the functioning of internal organs, and improve blood formation processes.

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COST OF TREATMENT

In medicine, the following methods of physiotherapeutic treatment are used to treat panic attacks and other mental disorders in patients who have suffered from coronavirus:

Xenon therapy - inhalation of the inert gas xenon mixed with oxygen through an inhalation mask. Xenon has sedative, hypnotic, analgesic, and regenerating properties. The gas is non-toxic, does not cause allergic reactions, and is quickly eliminated from the body unchanged through the lungs. Xenon therapy accelerates the process of oxygen saturation of the blood, improves metabolic processes at the cellular level, helps restore the functioning of the respiratory system, including after covid pneumonia, bronchitis, tracheitis, etc. During panic attacks, xenon helps to quickly relieve nervous tension, correct the psycho-emotional state, and normalize dream. In combination with drug therapy, inhalation of a xenon-oxygen mixture can achieve lasting results. The duration and intensity of the xenon therapy course is determined by the doctor for each patient individually.

Heliox - inhalation of a helium-oxygen mixture heated to the optimal temperature. Helium is an inert gas, tasteless, colorless and odorless. Heliox today is widely used for the treatment of pulmonary, cardiological and ophthalmological diseases, for removing a person from hypoxia and hypothermia, for the treatment of alcohol and drug addiction. Helium inhalations allow better transport of oxygen to brain cells, into the cells of the lower respiratory tract, and normalize blood supply to the brain. Helium-oxygen inhalations are one of the best solutions for recovery after coronavirus and for the treatment of panic disorders, as they have a regenerative and sedative effect. The required number of Heliox sessions is determined for each patient individually.

Ozone therapy intravenously (drip) is a therapeutic method that has many therapeutic effects. Intravenous injections with saline solution enriched with ozone have antiviral, antibacterial, anti-inflammatory, and antioxidant effects. Ozone therapy is actively used in medicine to treat diseases of the cardiovascular system, neurological diseases, problems of the gastrointestinal tract, gynecological and urological diseases and diseases of the ENT organs. Ozone therapy allows you to restore the functioning of all organs and systems of the body after coronavirus, strengthen the immune system, and improve the functioning of the central nervous system. The procedure is carried out strictly according to indications.

ILBI (intravenous laser blood irradiation) is a method of light therapy, which is based on the impact on human blood cells with a special LED sensor inserted intravenously using a thin needle. Low-intensity laser irradiation is applied to blood cells directly in the vascular bed. ILBI has a powerful sanogenic effect, allows you to systemically increase immunity and restore the body. In addition, ILBI has a beneficial effect on the hematopoiesis process, changes the composition of plasma, rheological properties, which is useful after surgery, severe respiratory diseases, after infections, etc. The ILBI procedure is prescribed exclusively by a doctor based on a study of the patient’s medical history, clinical picture and assessment general psycho-emotional state of the patient.

Electrosleep is one of the most widely used electrotherapy methods. It is based on the use of pulsed low-frequency currents that affect the central nervous system, causing its inhibition and, as a result, a state close to sleep. To carry out the procedure, a special device is used that converts the current into pulses. The impulses have an effect directly on the cerebral cortex and subcortical formations of the patient. The procedure allows you to restore emotional, vegetative and humoral balance, normalizes higher nervous activity, and has a sedative and hypnotic effect. Electrosleep also has a positive effect on the process of hematopoiesis in the body, improving blood clotting and lowering cholesterol levels in the blood. The procedure improves carbohydrate, lipid, protein, mineral metabolism, and accelerates regeneration processes. Electrosleep treatment is recognized as one of the safest. It is prescribed to children from 3 years of age, as well as pregnant and lactating women. This method of therapy is effective in the treatment of panic attacks of any etiology, including after coronavirus infection.

Treatment of panic attacks after coronavirus at the KORSAKOV clinic

In medicine, modern pharmacological, psychotherapeutic and physiotherapeutic methods are used to treat panic attacks and anxiety disorders that occur after coronavirus. Therapy is carried out around the clock in the hospital, on an outpatient basis and at the patient’s home, while maintaining the anonymity of clients.

The clinic employs highly qualified therapists, psychiatrists, psychotherapists, physiotherapists, narcologists, resuscitators, who are ready to take on the most difficult cases to help a person return to a full social life. The cost of services is fixed.

You can ask any questions you may have by calling the hotline of the KORSAKOV clinic +7 (499) 288-19-74.

Why are panic attacks dangerous?

A panic attack in itself is not dangerous to the body, especially if the person does not suffer from any chronic diseases. However, during an attack, he loses touch with reality and may behave inappropriately. Dizziness and loss of orientation in space lead to falls and injuries; panic while driving a car causes accidents.

Frequent recurrence of attacks disrupts a person's daily life and leads to mental disorders, especially if the person does not receive support from others. Depression, apathy, and a feeling of inferiority often accompany people suffering from panic attacks.

Diagnostics

In search of the causes of their condition, patients often turn to doctors of various specialties: cardiologist, neurologist, gastroenterologist or therapist. In fact, a psychotherapist or psychiatrist is involved in diagnosing panic attacks. The following methods are used for this:

• collection of complaints and medical history: the patient is carefully questioned about his condition and feelings during attacks, the circumstances of their occurrence, frequency, etc.; special attention is paid to life history: relationships with parents, psychological trauma and other possible risk factors;
• pathopsychological tests and examinations, in particular, scales for determining anxiety.

Consultations with narrow specialists and examinations are mandatory to exclude other diseases:

• ECG, ultrasound of the heart;
• 24-hour monitoring of blood pressure and ECG;
• MRI of the brain;
• FGDS;
• Doppler ultrasound of cerebral vessels;
• X-ray of the lungs, etc.

As a rule, the final diagnosis of “panic attacks” is made after four or more attacks with characteristic symptoms have been recorded. In this case, isolated episodes associated with excessive physical or neuropsychic stress, an acute reaction to stress or real danger are not taken into account.

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Comprehensive treatment of panic disorder

Panic disorder is an extremely common, chronic disease that manifests itself at a young, socially active age. Its prevalence, according to epidemiological studies, is 1.9–3.6%. It is observed 2–3 times more often in women aged 20–30 years. In the modern American classification DSM-IV, panic disorder is included in the class “Anxiety disorders” and is divided into two independent headings: “Panic disorder without agoraphobia” and “Panic disorder with agoraphobia”. Following DSM-IV, the International Classification of Mental Diseases, 10th Revision (ICD-10) included panic disorders under the heading “Neurotic, stress-related, and somatoform disorders.” In this section, “Panic disorders” were included in the class “Other anxiety disorders,” and “Agoraphobia with panic disorder” was included in the class “Anxiety-phobic disorders.” At the same time, domestic researchers rightly assess the symptom complex “panic disorder” as nosologically nonspecific, which can be observed not only in neuroses, but also in affective disorders (depression), various forms of schizophrenia.

The main (core) syndrome of panic disorder is repeated, unexpected panic attacks. A panic attack usually occurs against the background of psychogenic factors (the climax of a conflict, acute stress), as well as biological (hormonal changes, onset of sexual activity, abortion, taking hormonal drugs) and physiological (alcoholic excesses, first use of drugs, insolation, physical activity) factors. A panic attack, however, can also occur autochronically, in the absence of previous emotional and physical stress, against the background of the patient’s daily activities.

Symptoms of a panic attack occur unexpectedly, the attack develops quickly, reaching its peak within 10 minutes. Its usual duration is 20–30 minutes, less often - about an hour. The long duration of the attack casts doubt on the correct classification of panic disorder. It is important that, unlike many paroxysmal conditions, a panic attack is not characterized by a prodromal period (aura). The post-attack period is characterized by general weakness and weakness. Some patients report a feeling of “relief” after the attack ends. The presence of post-ictal confusion and sleep makes the diagnosis of a panic attack questionable. The frequency of attacks varies from daily to once every few months. Typically, patients experience 2–4 attacks per week.

The attack is characterized by vegetative, mental disorders. The latter include affective disorders, phobias, depersonalization-derealization disorders, hysterical-conversion symptoms and senestopathies. Autonomic disorders are represented by a picture of sympathicotonic crisis, less often mixed or vagoinsular.

The most frequent and persistent symptoms of a panic attack are disturbances in the cardiovascular and respiratory systems. Often, patients, when describing an attack, report a sudden onset of “strong heartbeat”, a feeling of “interruptions”, “stopping”, discomfort or pain in the heart area. Most panic attacks are accompanied by a rise in blood pressure (BP), the numbers of which can be quite significant. As the disease progresses, blood pressure numbers decrease in parallel with the deactualization of fear, which can serve as a reliable diagnostic criterion for the differential diagnosis of hypertension with a crisis course and panic disorder. The most pronounced disorders in the respiratory system: difficulty breathing, a feeling of lack of air with shortness of breath and hyperventilation, “a feeling of suffocation.” Describing the attack, patients report that their “throat was tight,” “the air stopped flowing,” and “it became stuffy.” It is these sensations that force the patient to open the windows, the balcony, and look for “fresh air.” The attack may begin with a feeling of suffocation, and in these cases the fear of death arises as a consequence of “difficulty” in breathing. Less commonly, during a panic attack, gastrointestinal disorders are observed, such as nausea, vomiting, belching, and discomfort in the epigastrium. As a rule, at the time of crisis, dizziness, sweating, tremors with a feeling of chills, “waves” of heat and cold, paresthesia, and cold hands and feet are observed. At the final stage of the attack, polyuria or frequent loose stools are observed. Objectively, changes in complexion, pulse rate, and blood pressure fluctuations are determined, and a dissociation is often found between the subjective registration of vegetative disorders by patients and their severity during an objective examination. The mental components of panic attacks include primarily emotionally charged phobias (fear of death, fear of heart failure, heart attack, stroke, falling, “loss of control” or “fear of madness”). Dysphoric manifestations are also possible (irritability, resentment, aggression), as well as depressive ones - with melancholy, depression, hopelessness, self-pity.

At the same time, panic attacks are observed, in which clear emotional disturbances cannot be identified. In recent years, panic attacks without fear have attracted particular interest. The names of these attacks have many synonyms: “panic without panic”, “somatically manifested panic”, “alexithymic panic”, “masked anxiety”. Such conditions are often observed in patients seeking primary medical care in departments of cardiology and neurology, and are extremely rare among patients in psychiatric clinics. Hysterical-conversion (functional neurological) disorders during attacks are most often represented by a “feeling of a lump in the throat,” aphonia, amaurosis, mutism, numbness or weakness in the limbs; Ataxia and stretching, “twisting,” and “twisting” of the arms are also noted. Derealization and depersonalization disorders are rarely observed: “lightheadedness” in the head, a “dream-like state,” a feeling of “remoteness and separation” from the environment (the so-called “neurotic” or “hysterical” depersonalization).

Treatment of panic disorder

There are several strategies in the treatment of panic disorder: first, stopping the panic attack itself; the second is the prevention (control) of a panic attack and syndromes secondary to panic (agoraphobia, depression, hypochondria, etc.).

To relieve a panic attack, medications and psychophysiological techniques are used. The most effective drugs are benzodiazepines, of which fast-acting drugs are more preferable: diazepam, lorazepam. Average therapeutic doses are used. Both oral and intravenous administration of the drug is possible. Relief of the attack is achieved a few minutes (15–30) after administration of the drug. However, frequent (daily) use of these drugs leads to the development of an addiction syndrome, and they stop working in the usual dosages. At the same time, irregular use of benzodiazepines (“on-demand use”) and the associated rebound phenomenon may contribute to an increase in panic attacks. Psychophysiological methods for stopping paroxysm include: relaxation training, switching to diaphragmatic breathing, “breathing into a bag.”

Stabilizing therapy, aimed at consolidating the results (control of panic attacks), restoring the level of social adaptation, overcoming agoraphobic manifestations (anticipation anxiety, avoidant behavior) and preventing early relapses (4–6 months), includes the prescription of drugs that have an antipanic effect. Currently, the following antipanic drugs are available: tricyclic antidepressants (TADs), selective serotonergic drugs and monoamine oxidase inhibitors (MAOIs).

Tricyclic antidepressants are the first class of drugs that have been found to have a full antipanic effect. The most commonly used drugs of this class for panic disorder include imipramine, clomipramine, and amitriptyline. TADs are the drugs of choice in cases of concomitant depressive disorders and severe agoraphobia.

Treatment with TAD begins with small doses (12.5–25 mg/day), then the dose is gradually increased to a tolerable level (on average by 12.5–25 mg over 3–5 days). The average effective daily dose is usually 150–200 mg/day, rarely reaching 300 mg. An extremely negative property of TADs is the remoteness in time of their anti-panic effectiveness - the first improvement occurs after 2-3 weeks. Sometimes in the first weeks of treatment there is an exacerbation of symptoms. Another important obstacle to the prescription and long-term use of TAD is the wide range of side effects (dry mouth, weight gain, constipation, palpitations, internal tremors).

Another class of antidepressants widely used in the treatment of panic disorder are selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac, Portal, Prodep), fluvoxamine (fevarin, floxifral, Luvox), sertraline (Zoloft), paroxetine (Paxil), citalopram (cipramil). The main disadvantage of this group is the occurrence during the first 2-3 weeks of treatment of hyperstimulation (irritability, insomnia, nervousness) and increased anxiety and panic symptoms. Initial doses are usually minimal (5 mg fluoxetine, 50 mg fluvoxamine, 25 mg sertraline) and within 2 weeks the dose is brought to the average, and then, if necessary, increases or remains the same. Subsequently, even with long-term therapy, the dose does not change. For long-term (maintenance) treatment, these drugs are much more convenient than TAD, due to the lack of anticholinergic and adrenergic effects and possible single administration during the day.

The widespread use of drugs with anti-panic effectiveness contributed to an increase in the interictal period, which, in turn, made it possible to conduct adequate psychotherapy. Psychotherapeutic treatment usually begins to be used at the stage of stabilizing (follow-up) psychopharmacotherapy and continues for some time after stopping medication, greatly facilitating the process of their withdrawal. Currently, the most common treatment for panic disorder is behavioral and, less commonly, cognitive psychotherapy. Its use can reduce the level of anxiety in phobic situations and reduce the fear of expecting an attack. Cognitive psychotherapy is aimed at correcting the fixed misconceptions of patients, according to which patients experience exaggerated reactions to non-life-threatening somatic sensations. Despite the fact that behavioral methods of psychotherapy in the treatment of panic disorder are currently considered the most effective, it is necessary to take into account that, while positively influencing the symptoms of the disease, they can leave neurotic structures formed in childhood unaffected. This, in turn, can end the initial success of treatment and lead to the appearance of new symptoms or the recurrence of old ones. Thus, there is a need to study the effectiveness of other types of psychotherapy and their use in the treatment of panic disorder.

In the department of neuroses and psychotherapy of the NIPNI named after. For a number of years, V. M. Bekhterev has successfully used individual and group personality-oriented (reconstructive) psychotherapy for the treatment of panic disorders, the main goal of which is to achieve positive personal changes (correction of a disturbed system of relationships, inadequate cognitive, emotional and behavioral stereotypes), which leads both to an improvement in the patient’s subjective well-being and elimination of symptoms, and to the restoration of full functioning of the individual. The use of a group form of psychotherapy is all the more justified if, with panic disorder, patients often experience restrictive behavior, social maladjustment, and disturbances in interpersonal functioning. However, given the need to provide psychotherapeutic assistance to an ever-increasing number of patients with panic disorder, without increasing material costs, but while maintaining the degree of effectiveness of the therapeutic intervention, the need for the development and use of short-term group methods of psychotherapy becomes obvious. The staff of the department developed and tested a method of group psychotherapy, combining the theoretical foundations and principles of interpersonal and personality-oriented (reconstructive) psychotherapy. Such integration makes it possible to take into account in therapeutic work the factors of internal (intrapsychic mechanisms) and external (psychosocial factors) determination of personality functioning, while the psychotherapist gets the opportunity to shift the emphasis when analyzing intrapersonal and interpersonal problems. In the process of psychotherapy, focused on correcting inadequate interactions, the patient’s conflictual relationships lose their indispensable and central character. This entails a decrease in the intensity of neurotic symptoms. There is also a decrease in intrapersonal problems, in particular due to an improved attitude towards oneself (increased self-esteem).

Our study examined the effectiveness of short-term interpersonal group psychotherapy and individual person-oriented (reconstructive) psychotherapy in the treatment of panic disorders. We examined 60 patients aged from 18 to 51 years, of whom 42 were women and 18 men. All patients were diagnosed with panic disorder according to ICD-10 criteria. Depending on the treatment received, all subjects were divided into three groups: patients of group 1 received only drug therapy; in patients of group 2, complex treatment was used, including the prescription of pharmacological agents and individual person-oriented (reconstructive) psychotherapy; When treating patients of group 3, drug therapy was used in combination with short-term interpersonal group psychotherapy. Drug therapy included the prescription of the following drugs in various versions: antipsychotics - eglonil, atarax, clopixol; antidepressants - Remeron, Lerivon, Coaxil, Paxil; anxiolytics from the benzodiazepine class - clonazepam, alprazolam.

In order to test the effectiveness of the proposed methods of treating panic disorders, clinical and experimental psychological research methods were used. Methods of experimental psychological research included:

• symptom questionnaire SCL-90;
• method for studying the stages of the psychotherapeutic process URICA;
• integrative anxiety test.

Experimental psychological studies were carried out twice - at the diagnostic stage before treatment and on the last day of the patient's stay in the hospital.

Preliminary data obtained in our study allow us to assume with a reasonable degree of certainty that the combination of drug therapy with short-term interpersonal group psychotherapy (group 3) provides a reduction in the level of symptoms that is more rapid, qualitative and sustainable than monotherapy with drugs (group 1 ) or a combination of individual personality-oriented psychotherapy with anxiolytics (group 2) in patients with anxiety-panic conditions. Motivation for treatment in patients of the 3rd group is formed faster, their readiness for change is much higher and the elaboration of intrapersonal conflicts is better, which ensures a more favorable prognosis and a lower frequency of relapses. The combination of psychopharmacotherapy and group interpersonal therapy improves interpersonal interaction and in a relatively short time increases the adaptive abilities of patients, which is very important in modern socio-economic conditions.

Literature

1. Vein A. M., Kolosova O. A. Vegetative-vascular paroxysms. M., 1971.
2. Dyukova G.M. Psychovegetative paroxysms: clinical picture, pathogenesis, treatment: Dis. ...Dr. med. Sci. M., 1995.
3. Isurina G. L. Mechanisms of psychological correction of personality in the process of group psychotherapy in the light of the concept of relationships//Group psychotherapy. M., 1990. pp. 89–121.
4. Karvasarsky B. D., Murzenko V. A. Group psychotherapy for neuroses // Current issues in medical psychology. L., 1974. pp. 70–77.
5. Clinical psychology/Ed. M. Perret, W. Baumann. St. Petersburg: Peter, 2002.
6. Kolotilshchikova E. A. Methodology of interpersonal group psychotherapy for the treatment of neurotic disorders: Abstract of thesis. dis. ...cand. psychol. Sci. St. Petersburg, 2004.
7. Mizinova E. B. Short-term group personality-oriented (reconstructive) psychotherapy for neurotic disorders: Abstract of thesis. dis. ...cand. psychol. Sci. St. Petersburg, 2004.
8. ICD-10. International Classification of Diseases (10th revision).
9. Psychotherapeutic Encyclopedia / ed. B. D. Karvasarsky. St. Petersburg: Peter, 1998.
10. Yalom I. Theory and practice of group psychotherapy. St. Petersburg: Peter, 2000.

M. V. Fursova NIPNI im. V. M. Bekhtereva, St. Petersburg

Treatment

The process of treating panic attacks requires the interaction of a psychotherapist/psychiatrist and a neurologist, and a combination of medication and psychotherapeutic effects. If necessary, classical methods can be supplemented with herbal medicine and physiotherapy. The selection of treatment is carried out taking into account:

• circumstances of occurrence and symptoms of panic attacks;
• concomitant diseases;
• individual characteristics of the patient.

Psychotherapeutic treatment

Psychotherapeutic techniques for treating panic attacks include:

• cognitive behavioral therapy: aimed at changing the patient’s perception of panic attacks and his behavior during them; courses to combat fear are effective with a minimum of 8-10 sessions;
• psychoanalysis: search for the causes of increased anxiety: psycho-emotional trauma, pent-up emotions, etc.;
• body-oriented psychotherapy: training in relaxation and breathing control techniques to reduce anxiety during an attack;
• family sessions: therapy sessions with family members so that they can help with the attack and create a positive environment at home;
• Gestalt therapy: identifying unmet needs and restoring psychological balance.

Drug treatment

Correctly selected therapy reduces the frequency and severity of panic attacks. Depending on the situation, doctors may prescribe:

• tranquilizers: quick-acting drugs to relieve attacks; used occasionally; significantly reduce the ability to concentrate and cannot be used by drivers;
• antidepressants of various groups: necessary for advanced forms of the disease and concomitant depression; the most popular are serotonin reuptake inhibitors, which significantly improve mood and suppress anxiety;
• Fast-acting beta-blockers: used during attacks accompanied by increased blood pressure and palpitations;
• nootropics: improve metabolism and blood circulation in the brain, help increase resistance to stress and enhance the effect of antidepressants and tranquilizers.

The selection of drug therapy often takes time and is carried out only by a doctor. Independent use of such drugs, as well as unauthorized changes in dosage or discontinuation of them are strictly prohibited.

Additional treatments

To increase the effectiveness of standard treatment for panic attacks, the following are used:

• classical and Ericksonian hypnosis: not effective in all patients;
• physiotherapy: magnetic therapy, electrophoresis and other techniques help improve blood circulation in the structures of the central nervous system and enhance the effect of nootropic drugs;
• massage: relaxing and restorative techniques have a good effect in the fight against excessive anxiety;
• herbal medicine: valerian, mint, hops, motherwort and other herbs in the form of tablets, decoctions or baths have a calming effect.

Treatment of phobias and fears: which methods are useful and which are harmful

So, avoidant behavior is harmful, neurosis will only grow. But if you simply expose your psyche to the “scenery” where you are anxious, and wait until everything passes, then, firstly, this is not pleasant, and secondly, you will probably not be able to meet the necessary conditions for the psyche to be overloaded. The anxiety state should go away (or greatly decrease) in the situation in which it began. This is one of the necessary conditions.

Without this, at best, there will be less fear, but you will still be tense and anxious. Therefore, it is important that you calm yourself down correctly, for example, with relaxation techniques, correct explanations to yourself of the nature of the attack and its consequences...

Incorrect/harmful ways to stop anxiety include :

• trying to avoid the situation
• turning to medication or seeking help from loved ones and doctors (trying to make sure everything is okay, for example, in case of panic, measuring blood pressure),
• for social fears - attempts to make sure (by assessing the reaction to your behavior) that the attitude towards you has not changed.

The tactic of “being in an alarming situation” can be implemented in two ways. Gradually immersing yourself in more and more alarming circumstances (if you are afraid of being far from home, you need to gradually, from day to day, increase the distance; if you are afraid of flying, first learn to calmly watch videos of airplane flights, then go to the airport, and then already flying).

From our point of view, such a tactic of gradually immersing oneself (desensitization) loses the second, when a person goes straight into an alarming situation. This way you can retrain your psyche much faster, because the main thing is to be able to cope with fear, stop being afraid of it and avoid it. If you do not face these experiences during therapy, then important experiences will not appear. But remember, you have to have the tools/techniques to help yourself through the situation and not just try to calm yourself down by willpower. Techniques and methods can be combined, the main thing is that it is comfortable and effective.

So, let's say you've worked through your fears and the mechanisms that support them (avoidance is just one of them). If you have what are called simple phobias (when there is only one situation or object that causes fear, for example, fear of riding in an elevator, in a car, flying on an airplane), then it is quite possible that the techniques described above will be enough to make more of these Don't be afraid of situations.

How to behave during an attack to reduce its intensity

Often, despite therapy, a panic attack still occurs. In this case, it is recommended to adhere to the following tactics:

• move away from the flow of passers-by and the road if the attack occurred in a crowded place;
• take emergency medications if prescribed by a doctor;
• switch attention from internal sensations to surrounding objects: try to name what is in front of your eyes, identify the main characteristics of the objects in question (color, material, etc.);
• focus on sounds and physical sensations, mentally list them;
• control your breathing: it should be even, slow, deep; the duration of inhalation and exhalation is at least 4 seconds for each phase;
• cope with hyperventilation and excess oxygen by breathing into a bag or balloon;
• alternately relax tense muscles;
• doing something that requires concentration, for example, playing a simple game on a smartphone: focusing on the process helps reduce the level of emotionality.

If a panic attack occurs in a loved one, it is important to ensure his safety and, if possible, take him to a calm, quiet place. The attack will pass on its own within 10-30 minutes.

Advantages of the clinic

The priority task of the Energy of Health clinic is to provide affordable, high-quality and complete medical care for every visitor. Within our walls patients are waiting for:

• experienced doctors of various specialties;
• modern equipment for diagnosing and treating diseases;
• everything necessary for laboratory research;
• comfortable day rooms.

We work as a team with our clients and together we find ways to combat diseases. Effective drug therapy regimens, physiotherapy, massage, organization of sanatorium-resort treatment - an integrated approach significantly increases the chances of success.

Do panic attacks strike at the most inopportune moments? Do you dream of forgetting about anxiety and fears? Stop fighting panic on your own. Sign up for a consultation at the Health Energy clinic. We will find a solution to your problem.

Treatment of fears: when to contact a specialist

If you have a full-fledged neurosis, in order to stop anxiety states, you will also need to work with the background.
That is, it is important to optimize your relationships with yourself, with people, and your lifestyle, in order to eliminate the mechanisms that generate your body and psyche being in a state of chronic stress. Otherwise, fears will continue to catch up with you. Imagine a pot of water on a burner that is turned on. To stop the water from boiling, you need to turn off the gas. Otherwise, you will have to endlessly add cold water (do relaxation exercises, meditate, convince yourself that everything is fine and nothing bad will happen, take sedatives...) and open the lid slightly (do physical exercise) to let off the steam.

From the point of view of psychotherapy, this is the most intellectually interesting part of the work for a psychotherapist, because people are all different, their situations are different, and there is a huge field for creativity. It would probably be better for people if everything was standard. Then, with the help of algorithms from specialists, they would be able to independently cope with their fears and anxious experiences.

Drug treatment for neuroses is justified if anxiety states significantly interfere with normal (as before neurosis) functioning.

Mostly drugs are used that remove fear/anxiety at the moment of their appearance, that is, to relieve them. These are tranquilizers (Relanium, phenazepam, Xanax, Atarax) or much weaker drugs (Corvalol, Novopassit, Afobazole, Persen). We rarely prescribe the latter due to their low effectiveness in cases of panic. But for mild anxiety states they may be quite appropriate.

The second group, which is used in the treatment of fears, is antidepressants. They reduce anxiety, stabilize the autonomic nervous system and thereby reduce the likelihood of severe attacks. Unfortunately, medications can only reduce symptoms, nothing more. But, sometimes, this is also very necessary in order to quickly bring a person “into service.”

Anxiety and fear among people? Treatment can be supplemented with the following recommendations:

1. Exercise at least 3 times a week for 45 minutes. Physical activity helps relieve background stress.
2. Optimize your work and rest schedule.
3. Don't drink alcohol or at least reduce the amount. Everyone knows how, after alcoholism, a state of panic can set in in the morning.
4. Try to reduce the amount of stress in your life.

You can get rid of neurosis and start living as before. One patient once said: she used to think that she wouldn’t wish an enemy to go through what she went through. But now I’m even glad that I was able to cope with neurosis, since her life has become much better and more fulfilling. I don’t think that neurosis is given to a person for something or for something, but it can definitely be used to optimize your life. Although, of course, it would be better not to exist.