Donal wonders how it can be that the etiology of panic attacks seems at once
physiological and cognitive -- as if the wave properties and particle
properties of energy weren't staring him in the face every instant of his
being. Get used to it, fella, life is a chimera. For my part as a
chemicalist, I wonder how placebos work to cure some people. Psychosomatic
magic? Or maybe we should all be studying Mary Baker Eddy.
Carol K wrote: "It's true that cognitive-behavioral therapies (CBT or "brief
therapy" here) has [been] shown more effective in quelling panic attacks
than previous exposure techniques popularized in the 1980s."
I don't doubt that cognitive therapies work in some cases just as placebos
work in some cases, but I do have serious reservations accepting the theory
that "inappropriate behaviors" (as a psychological judgment) might be rooted
in dissonant cognitive processes. Beliefs (i.e., most thoughts) do affect
the hormonal output of our bodies (no, I don't have any sources to support
me in this, just accept it as true, for christsake). Cognitive therapies,
as with placebos -- which are essentially a faith-based cognitive therapy
(provided the taker believes the placebo isn't a placebo), work by changing
the brain chemistry, etc., etc. (yes, I know I'm cheating here, so sue me.
I'm right, irregardless.). I remember a theory of Behavior Adjustment from
back in my teaching days that was based on the theory of "do anything". Any
attention given to a person will affect that person's behavior. Positive
attention more often yields positive change than negative attention does.
Etc., etc., etc. It's not any cognitive eureka that changes us, it's
endorphins, especially dopamine (why do you think they call it dope?), that
redoes us. But then I could be wrong, it's knowing nothing about any of
this that makes me feel brave -- dopaminely.
A case in point: my younger brother had been diagnosed as having panic
attacks for some 30 years -- eye twitch, shortness of breath, high anxiety,
fatigue, insomnia, etc. But then worse came to worst and he was rushed to
the hospital and they discovered that he had a congenital heart valve
problem that flooded his heart with a backflow of blood, supplying him with
half the blood his body needed. After 30 years of psychological care for
panic attacks, it was decided that the cause of his "panic attacks" was
physiological. The boy was dying, his poor body knew it and went into a
panic. Ach. Such is life. But I have no religion. If cognitive therapy
works, do it, if placebos work, do it, if prayers work, do it. The mind is
the body and the body is the mind. Etc., etc.
Mike Geary Memphis
donal:Clark turned this on its head;...
judy:the thought that panic attacks are anticipatory fearis rather old. I realise David Clark isn't saying precisely that, still...
ck: I thank Donal for bringing David Clark's work to my attention. He's not that well known in the US, compared to Aaron Beck, David Burns, Albert Ellis, among other researching theorists in the cognitive-behavioral area. Judy's right in pointing out the ever-blurry distinction between "biological" and "psychological" over the past 30 years or so. Currently, the encompassing term "psychobiosocial" is gaining popularity. Add "cogno" and that should cover the whole "bodymind" thing.
Interesting, isn't it, that the old "mind-body" schism has pretty much been fuzzed away. It's true that cognitive-behavioral therapies (CBT or "brief therapy" here) has shown more effective in quelling panic attacks than previous exposure techniques popularized in the 1980s. (CBT was developed for popular consumption in the 1970s, btw. Earlier forms are based on Ellis's retitled REBT.)
CBT has been around for quite a while. It's the only form of "talk therapy" that has tried, actively, to be quantifiable and, thus, scientific. The development of CBT's primacy in the psychological marketplace has much to do with the development of managed care in the US, the appeal to HMOs and insurance companies of treatment for mental illness within 12 sessions, and the elimination of mental institutions in the US, circa 1975.
However, psychodynamic therapy is still useful in treating agoraphobia, PD's stubborn first cousin. Thing is, you can extinguish panic attacks through a combination of behavioral exposure and cognitive restructuring, but the range of emotions that surface with panic attacks very often uncover debilitating anxieties and negative self-beliefs. Panic disorder is one cluster of symptoms. Eliminate the most disabling symptom in that cluster--the panic attack--and you don't necessarily have a symptoom-free individual. The cluster of symptoms associated with obsessive-compulsive disorder may emerge in force, for instance. (Sounds like Freud's observation about anxieties being "repressed," and ready to pop up somewhere else. Freud's observations were amazingly keen, and the theories he developed to explain them were pretty good models, considering what he had to work with, imho.)
I hadn't heard of Clark's experiment with lactate. Did Donal post the citation? I'd like to read it. No argument, just interested.
Carol
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