Which therapies are effective?

Drug therapy
The NICE (National Institute for Health and Clinical Excellence) guidelines on the treatment of anxiety state that benzodiazepine tranquillisers, such as diazepam (Valium), are associated with a less good outcome in the long-term and should not be used to treat panic disorder. If drug treatment is used, SSRI antidepressants, such as Prozac, should be used first, and if these are not effective, the tricyclic antidepressants imipramine or clomipramine (Anafranil) may be tried instead. SSRI antidepressants are difficult to come off for many people, so when you are ready to stop taking them, you should always withdraw slowly. When starting antidepressants, the side effects may include anxious, jittery feelings. The longer you are on them, the more likely you are to experience withdrawal symptoms, which can cause panic attacks. (See Mind’s Making sense of series.)

Psychotherapy/COUNSELLING
Emotional conflicts and past difficulties may lead to anxiety, which is released through panic attacks. Without realising it, you may be experiencing these bodily sensations and physical reactions as a way of avoiding painful emotions. Psychotherapy can help you to understand your present reactions in the light of past difficulties, and to overcome them. (For more information, see Useful organisations.)

Cognitive behaviour therapy (CBT)
Our thoughts have a very powerful impact on our behaviour. You may be unaware of seemingly automatic thoughts and misinterpretations that provoke attacks. This is because thoughts happen so quickly and may take the form of images and sensations, rather than words. The way we interpret things can cause extreme distress. But it is possible to bring about a state of wellbeing by changing habitual thought patterns. If we think that our racing heart is a sign of a possible heart attack we'll be very frightened, but if we think that it is due to excitement or too much coffee, we'll feel very differently about it.

CBT aims to identify and change the negative thought patterns and misinterpretations that are feeding your panic attacks. If you are interested in this kind of therapy, ask your GP to refer you to a clinical psychologist. It’s also possible to apply self-help techniques. (See Making sense of cognitive behaviour therapy.)

Behaviour therapy
Many people develop a pattern of avoiding situations that have previously provoked a panic attack. They may become withdrawn and phobic. A clinical psychologist can address the problem using behavioural therapy. The therapy concentrates on encouraging you to imagine anxiety-provoking situations, at the same time as practising relaxation. You will be encouraged to confront your fears, in fantasy, and then move on to facing your fears in reality. In learning to relax and face up to feared situations, you will unlearn your feelings of panic.

Complementary and alternative therapies
Complementary and alternative therapies have proved to be helpful when people are experiencing stress-related symptoms, anxiety and depression. They can be a useful tool in promoting relaxation and inducing a state of wellbeing. Complementary health practitioners stress the connections between mind and body, and aren’t concerned with merely treating symptoms. There is an enormous number of different therapies: acupuncture, aromatherapy, autogenic training and homeopathy, to name but a few.