[lit-ideas] Re: Tune and Turn Off - Panic Attacks
- From: Donal McEvoy <donalmcevoyuk@xxxxxxxxxxx>
- To: lit-ideas@xxxxxxxxxxxxx
- Date: Sat, 6 May 2006 15:12:36 +0100 (BST)
The story of panic attacks:-
1. Before David Clark?s work, the prevailing orthodoxy was that panic
attacks
are primarily ?biological? rather than ?psychological? because:-
a) they can be induced biologically (using sodium lactate infusions, for
example).
b) apparent heritability: more than half of sufferers have relatives with
some anxiety disorder or alcoholism; and if one of two identical twins has
panic attacks then 31 % of co-twins has them whereas if one of two fraternal
twins has them none of the co-twins are so afflicted.
c) specific brain functions appear to be involved with sufferers showing
abnormalities in brain chemistry and abnormal blood flow and oxygen use in
the relevant parts of their brain.
d) drugs can dampen and even eliminate panic attacks.
2. Clark turned this on its head; he argued ? what if an apparent symptom
of
a panic attack (feelings of morbid dread, of having a heart attack, of being
about to faint etc. ? in general terms, a catastrophic interpretation of
bodily sensations) was actually their root cause?
3. This theory fits the biological findings well:
a) sodium lactate makes the heart race creating an initial bodily sensation
that it is then interpreted catastrophically.
b) panic may be partially heritable because having a particularly
noticeable
bodily sensation (e.g. palpitations) is heritable not because panicking is
itself heritable.
c) specific brain areas are activated not as a cause but as a symptom of
panic.
d) drugs relieve panic by quelling the unpleasant bodily sensations that
provoke a catastrophic reaction.
4. Clark and a fellow researcher, Paul Salkovskis, did further experiments
that showed:
a) persons with anxiety disorders are quicker to see the catastrophic
ending
of a sentence than ?normals? (showing they have a catastrophic way of
interpreting).
b) persons prone to panic attacks, but not ?normals? or recovered panic
patients, can have panics induced by reading aloud word pairs such as
?breathlessness-suffocation?.
5. Clark also helped develop a new cognitive therapy for panic attacks that
appeared highly effective ? more effective and less dangerous than drug
treatment. It involves explaining the physiological mechanics of a panic
attack ? for example, that though a person might feel about to faint this
could only in fact happen if their blood pressure dropped but during an
attack blood pressure shoots up; the feeling of faintness is due to a small
drop of oxygen to the brain caused by blood being diverted to the muscles
away from the brain as part of a ?fight-or-flight- response to perceived
danger.
6. The success of this therapy nevertheless does not show the cause of
panic
attacks is cognitive. Clark?s simple and devastating differential prediction
is as follows. Panic-patients were given an infusion of lactate and?Oh god,
I?ve forgotten it again.
Donal
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