Panic Disorder Need Not Be Chronic, Says Nashville Therapist

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Panic disorder is a debilitating and chronic condition. Yet it need not remain chronic. And resolving it need not take long, says psychotherapist Bonnie Lenihan.

"If I had panic disorder, I wouldn't want my symptoms less severe. I'd want them gone. And the sooner the better."

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Psychotherapist Bonnie Lenihan now offers a new and brief therapy to end panic disorder, a debilitating and chronic condition. The hallmarks of panic disorder are recurrent panic attacks that seem to come from out of the blue and persistent worry over future ones. The condition need not remain chronic, says Lenihan, and resolving it need not take long.

Lenihan is a licensed clinical social worker with a doctorate in economics. She had no particular interest in panic disorder until one day during a therapy session she stumbled over a way to resolve it. She discovered that the client had been triggering his panic attacks with a thought pattern of which he was completely unaware. Upon replacing the thought pattern with a more helpful one, the man stopped having panic attacks and stopped worrying over future ones.

Intrigued, Lenihan led subsequent clients with recurrent panic attacks through the same process and observed the same results.

The two widely accepted treatments for panic disorder are medication (antidepressants and/or benzodiazepines) and cognitive behavioral therapy. The first rests upon the premise that the condition is due to some unidentified brain dysregulation. The second posits that panic attacks are triggered by the person's catastrophic misinterpretations of normal bodily sensations that accompany anxiety.

Both of those treatments are affirmed everywhere in the literature as effective for panic disorder. They reportedly reduce or eliminate panic attacks in 70-90% of cases. Yet panic disorder typically remains chronic even with treatment. A 2005 study by Peter Roy-Byrne and colleagues reported the following rates of remission among primary care patients at the end of one year of treatment for panic disorder: 16% among those who received usual treatment with medication, and 29% among those treated with both medication and cognitive behavioral therapy.

Upon examining the research, Lenihan found that the 70-90% figure comes from a 1991 consensus conference on panic disorder convened by the National Institute of Mental Health. It reflects the research available at the time. Conference participants noted that symptoms tended to re-emerge following successful short-term treatment. The conference articulated new standards to correct a host of recurring methodological problems in the research.

The better-designed studies brought disappointing news. The treatments did not clearly outperform placebos in eliminating panic attacks or worry over future ones. Researchers then shifted their attention to how well the treatments reduce the severity of a variety of symptoms.

In recent years, randomized controlled trials have found medication and cognitive behavioral therapy efficacious for panic disorder on the basis of their reducing the severity of symptoms at least marginally better--enough to achieve statistical significance--than the sugar pills. Studies on adapted versions of the treatments (e.g., cognitive behavioral therapy via phone or Internet) report similar efficacy.

"If I had panic disorder," muses Lenihan, "I wouldn't want my symptoms less severe. I'd want them gone. And the sooner the better."

With that in mind, Lenihan devised a brief cognitive therapy reflecting her understanding of what causes panic disorder and what resolves it. The format is three structured sessions, in person or by phone. She will check with each client at three months, and again at six months, following the third session to see if the panic disorder is resolved--if the person's panic attacks and worries over future ones have gone to zero.

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About Bonnie Lenihan:
Bonnie Lenihan PhD LCSW ( practices psychotherapy in Nashville, Tennessee. She earned her masters degree in social work from the University of Chicago and her doctorate in economics from the University of Tennessee. She believes it is possible to eliminate the needless human suffering and considerable health care costs related to panic disorder.


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Bonnie Lenihan PhD LCSW

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