Panic disorder (PD), which is a form of anxiety disorder, is majorly characterized by intense fear that activates acute physical responses for real and imagined dangers. In accordance with DSM -5, the condition is marked by four or more of the prodromes which are associated with panic attacks. The symptoms outlined in the DSM-5 incorporate pulsations or accelerated pulse rates, sweltering, quivering and shaking, dyspnea or suffocation, a choking feeling, pain at the upper parts of the chest, nausea or abdominal discomfort. Other signs according to DSM-5 guidelines encompass dizziness or lightheadedness, depersonalization or feelings of delusions, fear of losing control of oneself or becoming deranged, intense worry about death, stupefaction or paresthesias, chills or heat waves. Due to the increasing occurrence of the condition among different people today, a great understanding of the disorder should be analyzed based on historical perspective, causes, prevention, cross-cultural issues, and the biblical worldview of the sickness.
Historical Context
Psychiatrists and clinicians have had a changing perspective of PD’s mental condition. In the past, PD was not entirely recognized as one of the mental conditions (Kupfer, 2015). Therefore, psychoanalysts were not linking the symptoms of the disorder to any mental deviation. Before 1980, medical researchers and psychologists were not able to establish a comprehensive notion of PD (Kupfer, 2015). The diagnostics that are presently used for this particular sickness have evolved since the inclusion time of PD into DSM. Moreover, according to DSM-3, the prevalence percentages of PD and recurrent panic attacks from the general population were defined at 2.7% and 7.1%, respectively (Na et al., 2011). Over a period of time from 1980, researches that have been conducted have shown that gender has played a significant role in increasing the prevalence of the sickness (Kupfer, 2015). Therefore, the continuous researches on this particular contagion clearly show the changing view of psychotherapists’ and general public views about PD.
In addition to changing the general public’s, psychologists’, and medical practitioners’ view treatment models have changed too. For instance, PD was considered to be part of human living, and little attention was accorded to treat the condition (Kupfer, 2015). Furthermore, the society was harsher on women, and on any form of mental disorder, they were placed in a facility which was ruled by a man, and any form of disobedience attracted severe punishment (Kupfer, 2015). Currently, this has changed to a great extent, and a modern woman with mental problems such as panic attacks might get treatments tailored to suit her gender and elementary theories. As well, people who had mental conditions such as anxiety disorders were placed in facilities that were similar to the present-day jails (Kupfer, 2015). As time went on, due to extensive research and innovations in the field of psychology, cognitive-behavioral therapies were introduced as methods of treatment.
Causes of Panic Disorder
Although there is no specific causative agent to panic disorder, various incitants can be associated with the mental ailment. For some individuals, panic attacks are precipitated by specific incidents and circumstances. A good case in study is of someone who experiences panic attacks when forced into a certain social situation (Hofmann & Hinton, 2014). Significant transitions in the social life form part of the causes of PD. Graduating from college to start a new life, changing from bachelorhood to marriage life, or even getting the first child can be stressful developments that can lead to PD. In most cases, panic attacks occur in particular situations and not all times. Certainly, trauma and stress, which some circumstances expose different individuals to, are known to be factors for the cause of PD.
In addition to traumatic experiences and stressful circumstances, family history is also a factor in determining the cause of PD. Research has revealed that panic attacks may be genetically linked. Family history and twin studies postulate that the chances of inheriting genes that are linked with panic occurrences stand at 43% and 48%, respectively (Na et al., 2011). Ever since psychoanalysts recognized PD as a family ailment, six controlled family studies have recorded an accelerated PD risk (5.7%-17.3%) among affected person’s relatives (Mendlewicz et al., 1993, as cited in Na et al., 2011). Further, there was a 17-fold heightened PD risk in the first-degree kindred of PD probands when their onset ages were lower than 20 years, while six times for first-degree relatives of those whose onset ages were greater than 20 years (Goldstein et al., 1997, as cited in Na et al., 2011). With the outcomes of such analysis, psychologists have been convinced that there is an increased likelihood of people within the same family having the symptoms of PD. Nevertheless, no particular genes have been established as causing PD.
Treatment Approaches to Panic Disorder
Effective treatment methods that are known to reduce the impacts of PD are cognitive behavioral therapy and medication. The medicament can be applied to control or minimize some of the signs of PD (Ebert, Cuijpers, Muñoz, & Baumeister, 2017). Even so, medication neither treats nor solves the problem. Medicinal treatment can be helpful in grievous cases, but it should not be applied as the sole therapy. The main medicines normally used are antidepressants and benzodiazepines, which are drugs for PD management (Ebert et al., 2017). Equally important, there are various benefits that are attached to the use of medicinal treatment. Antidepressant drugs have been found to lessen panic intensity (Ebert et al., 2017). Another advantage linked with medication includes the eradication of panic attacks (Ebert et al., 2017). In addition, antidepressants improve the condition of the quality-of-life course of the PD victim. Be that as it may, medication should be used under the strict guidance of a registered clinician.
The most important treatment model is the use of cognitive-behavioral therapy (CBT). The treatment paradigm involves various methodologies, such as applied composure, subjection in vivo, breathing retraining, and behavioral restructuring (Ebert et al., 2017). For long terms trials in treatment, CBT is the most efficient compared to medication. In CBT research, 73% of treated victims were panic-free at ninety to one hundred and twenty days (Ebert et al., 2017). Interestingly, it is never comprehensible as to which aspect of CBT is more important: cognitive therapy or behavior therapy.
The use of CBT in alleviating the effects of PD is advantageous to the patient. Most importantly, the application of the treatment methodology does not cause any side effects to the PD valetudinarian. Secondly, utilization of the CBT model ameliorates panic signs and overall disability (Ebert et al., 2017). An individual suffering from PD is also able to control his emotions and feelings when CBT is used as the treatment method (Vorkapic & Rangé, 2014). Through the experience, the patient becomes less afraid of future internal bodily disturbance.
Prevention
Psychologists and medical researchers have not found a way to completely prevent PD. For a long time, there have been methods of preventing mental health disorders, but due to scientific research and innovation, new methods have emerged. In fact, social prevention measures have been in practice for quite a long time. A methodology as prevention of the use of stimulants is one such example in preventing PD, yet more sophisticated methods have been overlooked. Currently, sporting activities, not all, but specifically yoga sports, are of great benefit to PD prevention. Orme-Johnson and Barnes (2003), as cited in Vorkapic and Range (2014), assert that “yoga practitioners are less predisposed to developing anxiety disorders and respond better to negative emotions when they appear” (p. 5). However, it should be noted that yoga only prevents future recurrence of panic attacks from PD patients and does not necessarily discourage the condition from manifesting itself from the yoga practitioners.
Similarly, internet and mobile-based (IMIs) interventions are presently used to help in PD prevention. Mobile-based software is nowadays used in monitoring the wellbeing of individuals and also to provide health information before onset of a mental condition such as PD. Ebert et al. (2017) record that the basic element of mobile-based interventions “is that emotional, cognitive, and behavioral processes are modified and their generalizations to users’ daily lives promoted using established psychological techniques” (p. 2). Further, the authors outline how IMIs can be implemented in the prevention of PD. Ebert et al. (2017) argue that the IMI techniques range “from the provision of evidence-based strategies as interactive self-help lessons; e-mail, chat, or video-based sessions; virtual reality for exposure interventions; serious-games, in which psychological strategies are trained in the context of a computer game” (p. 2). Therefore, IMIs are best suited for effecting changes in thoughts and behaviors of PD patients.
Cross-Cultural Issues Pertaining To Panic Disorder
Many issues are considered when analyzing cross-cultural aspects pertaining to anxiety disorders such as PD. The issues are innumerable, and that is why they are grouped into two broad categories of ethnopsychology or ethnophysiology and contextual factors. By definition, aspects that arise from notions about bodily systems or physical signs of diseases and psychological symptoms of illnesses form the ethnopsychological or ethnophysiological factors (Hofmann & Hinton, 2014). Undeniably, different cultures offer specific meanings to panic attacks depending on their customary beliefs and their own understanding of mental disorders. In Africa, for instance, palpitations, which is a sign of PD, is associated with someone being mentioned somewhere in a bad light. In America, most people know that the use of stimulants predisposes individuals to heart attacks (Hofmann & Hinton, 2014). Consequently, these beliefs hamper any positive intervention that PD patient might be given. The examples given are not unique because any culture is most likely to color-wash the scientifically proven symptoms of any anxiety disorder, PD included.
While ethnopsychological and ethnophysiological factors determine the expression of PD based on an individual’s understanding of own body, contextual issues influence the impression of PD based on social context and rules. Of all the cross-cultural issues studied under social context, collectivism and individualism have received the greatest attention (Hofmann & Hinton, 2014). Collectivism in itself cites the association between members of the social institutions that stresses the interdependence of its members. Accordingly, this affects an individual’s view about a disorder like PD, in the sense that a particular social institution establishes norms and practices regarding a certain disorder, and they become binding to all members. In individualistic societies, personal achievements are held in high regard while being diagnosed with certain mental sicknesses such as PD is berated (Hofmann & Hinton, 2014). In the end, individuals are motivated to restrict their behavior towards PD in accordance with the appropriateness of their societal norms.
Biblical Worldview of Panic Disorder
The scriptures do not mention panic by name but rather speak of fear as a form of panic. Through scrutiny of the scriptures, fear is viewed as a major cause of panic (Tan, 2011). As further evidenced by different verses of the Bible, people of God who at one point panicked because they were overwhelmed with fear. For instance, King Hezekiah panicked when the prophet Isaiah told him that he would not recover from his sickness but would succumb to it (King James Bible, 1769/2017, 2 Kings 20:1-2). In comparison to today’s analysis of PD, fear of dying is clearly evident from Hezekiah’s situation. The second Biblical character who panicked was Prophet Elijah when he received death threats from Queen Jezebel. The Bible speaks of how Elijah ran for his life till he became exhausted (King James Bible, 1769/2017, 1 Kings 19:3). Interestingly, Elijah did not panic because he lacked faith in God, but he failed to trust in God’s plan that He could deliver him from the hand of Jezebel. Therefore, the Bible gives fear as the major cause of panic and anxiety.
As a threat to a strong relationship with God, anxiety which results in PD should be treated as a spiritual issue. Current theologians recommend the assistance of three professionals to a Christian who is hit by the disorder: a doctor, a counselor, and a pastor (Tan, 2011). The presence of a medical practitioner, together with a counselor, shows that the Bible approves of cognitive behavioral therapy based on Biblical Christian values and understanding. While several scriptures are given as a shield to anxiety effects, the Bible also agrees that PD that may result from anxiety is a great manifestation of spiritual decay and lack of faith in God’s work (Tan, 2011). In essence, Christianity’s view on PD’s treatment and prevention has strong foundations on the scriptures and the Bible.
Conclusion
In summary, the soaring prevalence of PD in the current society is making the understanding of its causes, treatment, and cross-cultural issues are of great importance. A great understanding of the condition can be attributed to research and innovations that have made the disorder to be included in the DSM-3 of 1980 by the American Psychologists Association. With the continuing research on anxiety disorders, the main incitants can be given as stress, trauma, and family history. However, great importance should be placed on cognitive behavioral therapy as the main intervention to treat the anxiety disorder of PD because it is also a method approved by Christianity and many theologians. As well, IMI and yoga sports should be heavily supported as they help in preventing the occurrence of PD among individuals. Lastly, issues of ethnophysiology, ethnopsychology, and social contexts of individualism or collectivism should be given great consideration in future researches to ensure that decisions made with regard to treatment models in individuals are not affected by the societal views about the PD. Essentially, the management of PD is an initiative of all members of the society.
References
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Hofmann, S., & Hinton, D. (2014). Cross-cultural aspects of anxiety disorders.Current Psychiatry Reports, 16(6), 450-458. Web.
King James Bible. (2017). King James Bible Online. Web.
Kupfer D. (2015). Anxiety and DSM-5.Dialogues in Clinical Neuroscience, 17(3), 245–246. Web.
Na, H., Kang, E., Lee, J., & Yu, B. (2011). The genetic basis of panic disorder.Journal of Korean Medical Science, 26(6), 701-710. Web.
Tan, S. (2011). Mindfulness and acceptance-based cognitive behavioral therapies: Empirical evidence and clinical applications from a Christian perspective.Journal of Psychology and Christianity, 30(3), 243-249. Web.
Vorkapic, C., & Rangé, B. (2014). Reducing the symptomatology of panic disorder: the effects of a yoga program alone and in combination with cognitive-behavioral therapy.Frontiers in Psychiatry, 5(177), 1-7. Web.