I-Search, You-Search, We-All-Search

By Sarah Byron

My Topic: The question and What I know, Assume, or Imagine

Anxiety Disorders: how are they managed, how do they differ person to person even within the same family, and other inquiries such as therapy versus medication, situational versus genetics, and lifelong demon vs childhood consumer. To elaborate, how does an individual manage an anxiety outbreak or attack in comparison to others? Is it personalized to the individual or is there a blanket technique which soothes all? Even if hereditary, does an anxiety disorder differ in more ways than intensity? Do I feel anxiety differently than my mom or my sister? Can some people “outgrow” their anxiety issues or, if diagnosed, are you stuck with it for life? Do some people fare better with just therapy to treat anxiety and why? Can someone develop an anxiety disorder because of an extended situation they are placed in and in that case, would the problem go away once separated from that situation? I know these are a lot of questions to have, but I have a general idea about most of them already.

I have two anxiety disorders: a general anxiety-depression disorder and a panic disorder. Being personally affected by anxiety, I know quite a lot about it. There are many different types of anxiety disorders (general anxiety, panic disorder, PTSD, and OCD). My mom, my aunt, my sister and I have anxiety disorders; it’s hereditary. Anxiety is a mental illness; it is much more than feeling nervous now and then. It’s a chemical imbalance in the brain which triggers a fight or flight response to situations which are minimal and mundane. For example, people with obsessive compulsive disorder have an obsession such as washing their hands they feel they MUST do, the compulsion, to live. In the case of panic disorders, individuals are struck with the physical aftermath of adrenalin, leaving them short of breath, dizzy, and immobile with an elevated heart rate and with no logical reason for it at all. Anxiety is often a physical reaction in the body; many people seek emergency medical attention under the assumption they have brain tumors or heart attacks, but, in reality, they are just experiencing a panic attack. Although physical, anxiety is very much mental; it forces you to think negatively, to make assumptions, to panic. The unraveling of terrible thoughts, of dying, of losing your mind just make the physical gut wrenching feelings worse and vice versa. Anxiety is closely linked with depression; if you have one you are likely to have the other sometime in your life. The difference between an anxiety disorder and feeling nervous is that one interferes with your ability to function and daily routines. There are many different medications out there to treat anxiety disorders many of which are the same drugs used to treat depression. Some people, however can get by with just therapy.

Anxiety can be made worse and appear in certain situations, but I, however, do not know whether situations can cause anxiety; I assume they cannot and that somewhere down your blood line there is an anxiety disorder. I assume within the same disorder and intensity that people interpret their anxiety differently and that it’s very individualized, but I do not know because I have only ever felt my own anxiety.

My Search Process

My first action was to narrow my search from generally anxiety disorders to panic disorders. I started on the academic search complete data base searching “panic disorders and heredity,” but got no results. I then changed my word choice to “genetics.” Many of those articles were about DNA sequencing and advanced chemical bonding and abnormalities which were over my head to say the least. I took a different approach and searched “diagnosing panic disorders” I used the google search engine to try and understand what I was reading better. For example, I had to look up the words “agoraphobia,” “etiology,” “genetics of panic disorders,” “primary and secondary cognitions,” and “comorbidity.” I searched panic disorders in relation to “misdiagnosis,” “polymorphism,” and “betablockers,” but got little to nothing useful. I did however keep running into “gender differentiation” in relation to panic disorders, so I decided to give that a whirl, but in the end, I just wasn’t interested in it so I moved on to “neurochemistry and neurocircuitry of panic disorders.” Again, the material was full of confusing jargon and math and was boring, so I tried replacing “panic disorder” with “panic attacks” and comparing the results. This lead me to other questions such as “what’s a nocturnal panic attack?” and “how do drugs (not prescription) affect panic attacks?” I then searched “panic attack variations,” “panic attacks affected by drugs,” “panic attacks and marijuana,” “panic attacks and cannabis,” “panic attack nocturnal,” and “panic attack cognition.”  While the topic of cannabis in relation to panic disorders was interesting, there weren’t many results so I left that idea. I did however find that there were subcategories of panic attacks and different approaches for treating different symptoms. As a result, my final searches were “onset of panic attacks,” “breathing techniques,” “panic attacks and breathing,” “coming down,” “calming down,” “panic attacks with cognitive therapy and treatment,” “self-treatment of panic attacks,” and “panic attack causation.”

What I discovered

The origin of the panic disorder is largely unknown, but it’s not disputed that there is a neurological explanation for such disorder. In their article “When the Treat Comes from Inside the Body: A Neuroscience Based Learning Perspective of the Etiology of Panic Disorder.” Alfons O. Hamm, Jan Richter, and Christiane A. Pané-Farré tackle understanding the beginnings of panic disorders and how they are distinct to nervous apprehension. They first hypothesized that panic disorders are an anomaly in our nervous defense circuitry. They then compared and contrasted reactions, brain scans and the neurochemistry in both panic attacks and legitimate stress to discern a possible correlation. They found that there not only are panic attacks autonomic surges to escape caused by unconditioned internal threat, but that they are completely different from nervous apprehension which is a post-encounter defense behavior.

There’s a lot to know about panic disorders, how they were first discovered, how they are currently recognized and how they’re treated. The article “Panic Disorder” written by James Whalen and Robin McKenny covers, broadly yet insightfully, all the bases of panic disorders.  While the actual cause of panic disorders is not known, Whalen and Robin explain the three main theories from which it derives: 1) Panic disorders are strictly biological and passed down in families, 2) Panic disorders are caused by negative thoughts and misinterpretations of physical sensations and 3) negative thoughts breed anxiety which in turn breeds more negative thoughts. Along with its origin, they also clear up any confusion surrounding pharmaceutical versus cognitive therapy treatment of panic disorders, elaborating on the many medications on the market, their alternative uses and side effects and different viewpoints of therapy and the idea of combining both drugs and mental exercises to combat panic attacks.

On the topic of therapies, there is also a wide variety of ideas thought to help panic disorders. Walton Roth in his article “Diversity of Effective Treatments of Panic Attacks: What Do They Have in Common?” compares the effectiveness of different exercises and a psychological explanation for their success or failure.  He states that because of the unclear origin of panic attacks, the effectiveness of treating them can only be evaluated by comparing the outcomes to other treatments. Specifically, he completed a comparison analysis for five different situations, psychoactive psychotherapy versus muscle relaxation, hypercapnic breathing training versus waiting, hypocapnic breathing training versus hypercapnic breathing training versus waiting, reprocessing with eye movement desensitization versus reprocessing without eye movement desensitization versus waiting, and muscle relaxation versus CBT. Although some therapies did prove to be more effective than others, they all proved to be more effective than doing nothing or waiting for the panic attack to pass.

Within the panic disorder, there are subtypes which group similar sensations of panic attacks into “types.” Katharina Kircanski, Michelle Craske, Alyssa Epstein, and Hans-Ulrick Wittchen in their article “Subtypes of Panic Attacks: A Critical Review of the Empirical Literature” provide evidence for the existence of differing types of panic attacks along with defining these types with symptom profiles, family histories, comorbidities, ages of onset, courses, clinical features, and treatment responses. The five types of panic disorders identified are respiratory, nocturnal, non-fearful, cognitive, and vestibular.  They conclude that there are panic attack symptom clusters, but to undoubtedly call them “subtypes” of the panic disorder would require further research.

The subtype nocturnal is one reported by many patients having panic disorder; they claim insomnia, night terrors, sleepwalking and other sleep disorders that accompany their nightly panic attacks. Michael Schredl, Golo Kronenberg, Patrick Hovey, and Isabella Heuser in their article “Sleep Quality in Patients with Panic Disorder: Relationship to Nocturnal Panic Attacks” compares the sleep of individuals with panic disorder, sleep disorder, and healthy individuals. In their study, they found that 18% of all panic attacks happen at night while asleep, but that the sleep quality compared to that of a clinically diagnosed insomniac was relatively better. However, evidence did support that sleep disorders and panic disorders were comorbid and further study should be conducted to determine their relationship.

What Does This Mean to Me?

My knowledge of panic disorder did match up with the experts, although I found I was missing a lot of the detailed mechanics of the disease. The most interesting information I found was that on treatment variance and subtypes. I would love to explore the treatment of varying panic disorders and further investigate the individuality of a panic attack for its victims. With this knowledge, I could better the medical community in not only understanding this disorder, but encouraging the movement away of blanket treatment for very different sensations and situations. I feel the reason therapy is so effective for treating anxiety disorders is the personalization of each session; the therapist is tuned into the patient and his or her needs, but sometimes medicine isn’t enough. I also believe that therapy is an educational experience allowing patients to better understand their condition and in that way, better combat it. Combining medication and therapy, or at least making pharmaceutical treatment more personalized could make a world of difference to a patient suffering for panic attacks.

How Will This Transition into an Argument?

Upon research, I have found my attention has shifted from the mechanical and neurological workings of panic disorder to the effective treatment of these patients. I believe, as an individual suffering from panic disorder that I would have an interesting perspective to contribute on the topic. Research has lead me to want to investigate differing management techniques and their effectiveness towards specific subtypes of panic attacks. The thesis of said argument would be “cognitive-behavioral therapy is crucial to living with panic disorder because it teaches valuable techniques for handling panic attacks while educating patients about their disorder, can help discern possible triggers, and offers a more personal and pleasant experience often longed for by patients.”

Work Cited

Roth, Walton T. “Diversity of Effective Treatments of Panic Attacks: What do They Have in Common?” Wiley Interscience, vol.27, 11 Sep. 2009, pp.5-11. Academic Search Complete, Accessed 1 Nov. 2016.

Craske, Michelle G., Alyssa M. Epstein, Katharina Kircanski and Hans-Ulrich Wittchen. “Subtypes of Panic Attacks: ACritical Review of the Empirical Literature.” Wiley Interscience, vol.26, 11 Sep. 2009, pp.878-887. Academic Search Complete, Accessed 1 Nov. 2016.

McKenny, Robin E. and James L. Whalen. “Panic Disorder: Characteristics, Etiology, Psychological Factors, and Treatment Considerations.” American Psychotherapy Association, Spring 2007, pp.12-19. Academic Search Complete, Accessed 1 Nov. 2016.

Heuser, Isabella, Golo Kronenberg, Patrick Nonell and Michael Schredl. “Sleep Quality in Patients with Panic Disorder: Relationship to Nocturnal Panic Attacks.” Somnologie, vol.6, 2002, pp.149-153. Academic Search Complete, Accessed 1 Nov. 2016.

Hamm, Alfons O., Christiane A. Pané-Farré and Jan Richter. “When the Treat Comes from Inside the Body: A Neuroscience Based Learning Perspective of the Etiology of Panic Disorder.” Restorative Neurology and Neuroscience, vol.32, 2004, pp.79-93. Academic Search Complete, Accessed 1 Nov. 2016.