Panic attacks and agoraphobia
How Julia started enjoying her life again after several years of suffering with panic attacks and agoraphobic tendencies.
This illustrative example of a case study is based on our experience of over 25 years of working with clients.
Julia had been referred by her doctor and was described as having panic attacks and agoraphobic tendencies. She had undertaken counselling in a group setting before, as well as a 'listening therapy' approach 18 months previously. Although she felt listened to during counselling, her problems had recently become much worse. Julia needed her husband to go with her for food shopping now, or even leaving the house to see family and friends. She had 2 teenage children, both living at home. Julia's father had died 5 years ago and her mother had recently been diagnosed with having dementia. Julia was seeing her GP on a regular basis, seeking re-assurance with chest pains. She had undergone a number of medical tests and her physical health was deemed as good.
Julia reported that she first experienced panic attacks as a teenager, and could remember difficult arguments with her father. Her GP prescribed medication for anxiety and panic attacks when she was in her early twenties, during a stressful time in her work environment, being married with 2 small children and running a home. The work situation was not resolved and Julia was eventually made redundant. She remained at home, looking after the children and her husband. Julia's father died when she in her thirties, which left Julia feeling responsible for her mother, who could not adjust to losing her husband.
Cognitive behavioural psychotherapy (CBT) was deemed to be suitable for Julia and her presenting problems. In the initial assessment, there was clear evidence that Julia wanted to make a change and she was keen to engage in homework tasks. She was able to focus on the relevant issues for therapy and her treatment goals were discussed and agreed. In CBT, a case formulation is devised to summarise the pre-disposing, precipitating and maintaining factors for the current problems, that have led to the formation of unhelpful beliefs and thinking styles. At times of increased stress for Julia, a vicious cycle was activated, involving fear, physical symptoms, catastrophic interpretations of bodily sensations, and safety behaviours. Treatment work addressed the panic attacks which, in turn, led to a shift with the agoraphobic symptoms. The validity of Julia's catastrophic interpretations were tested out through discussion and behavioural experiments. Alternative non-catastrophic thinking was introduced and safety behaviours were identified and decreased. Throughout therapy, Julia was encouraged to keep a diary to identify her unhelpful thinking which led to her negative feelings and behaviour. She was also encouraged to talk about her fears which enabled Julia to see that they were unfounded and, during therapy, she was able to develop some good coping strategies to deal with difficult situations as they arose.
Due to Julia's high level of motivation, therapy progressed well and 8 sessions of CBT were appropriate to bring about lasting change.