In a recent study (spotlight, 2013) two therapeutic approaches were compared in treatment of panic disorder: the Cognitive behavioral therapy (CBT) and theEye Movement Dessensitization and reprioxing (EMDR).
According to the cognitive behavioral model, the panic attacks They derive from erroneous and catastrophic interpretations of sensations by Arousal Corporeo Inocue (Taylor, 2006).
That is, when these sensations are experienced (such as palpitations, tight or pain in the chest, sweating, sensations of breathing difficulties) the person (and in particular the person who has a high sensitivity to anxiety) can erroneously interpret them in a catastrophic way (e.g. as a sign of imminent death, madness, loss of control).
This causes an increase inanxietythus increasing the intensity of feared sensations (e.g. stronger palpitations).
This carries the person, convinced more and more than an imminent catastrophe, to alarmed further, in turn increasing the intensity of the sensations of anxiety, up to triggering a vicious circle that culminates in the panic attack.
There CBT for panic attacks Use strategies aimed at deconditioning (entertainive exposures, in vivo and relaxation training) and to promote more adequate cognitive functioning in the interpretation of physical symptoms (through cognitive renovation).
The CBT, therefore, combines psychoeducative interventions (on nature and the physiological aspects of anxiety and panic), cognitive techniques (which aim to modify the tendency to interpret the corporate sensations) and behavioral techniques (such as exposure to physical sensations and feared situations and the promotions of adequate coping skills with respect to physical symptoms).
Numerous meta-analysis studies have recognized the CBT as One of the most effective treatments for panic disorderwith the maintenance of the improvements in long -term follow -up (Taylor, 2006).
Since EMDR is an evidence-based therapy for the trauma treatment (Bisson et al., 2007), it was hypothesized that it could also have an effect on panic attackswhich are often perceived as traumatic experiences in themselves, where the person is so terrified of an uncontrollable fear that he believes he is about to die.
Basically, in the approach EMDRaccording to the model of the adaptive processing of information (AIP), it is believed that early experiences in the life of the person, elaborated in an incomparable way, can contribute to a deficit development or to a deterioration of the person’s resilience skills and can contribute to the formation of incorrect perceptions of stressful events, which occur later in the course of life, which can culminate in the experience of the experience panic.
Early experiences of negative life are in fact a possible risk factor for the emergence of psychopathological problems and for vulnerability to trauma (Liotti and Farina, 2011).
According to this model, theEMDR it could be effective in Treatment for panic disorder To intervene at a neurophysiological level, facilitating the reprocessation of elements stored in a dysfunctional way in memory (with early traumatic experiences that act as predisposing factors and that contribute to the emergence of symptoms in moments of subsequent stress, to the traumatic memories of panic attacks such as the first, the worst, the last).
In the same way, current Triggers related to panic experiences are also addressed and prepared the person to face future situations.
In this study, therefore, the EMDR treatment Follows the 8-phase protocol described by Shapiro (2001) with some additional elements.
In phase 2 (psychoeducation) a specific part on panic is introduced; In phase 3 (reprocession of targets) the events passed to be reprooked start from the Stressors immediately preceding the first panic attackthen the first panic attack, the worst and the most recent; Subsequently memories of childhood experiences of perception of abandonment, humiliation, fear, early reversal of parent-child roles are developed.
The protocol then provides for the elaboration of the stimuli in the present, where then those internal and external signals are addressed that are associated with the current ones panic attacks And subsequently the processing is used to facilitate in the person the comparison with these stimuli in the future in order to strengthen the person’s resources and create models in front of more functional faces.
In this study, the differences in the application of the two approaches are therefore basically two.
Change the Treatment focus: EMDR focuses on the intervention on the elaboration of the memories of the antecedents in the history of the person who contribute to the current disorder, as well as on the triggers related in the present to the experience of panic; The CBT is instead focused on the change of behaviors and cognitions in the present.
Patients followed with CBT is asked to perform between one session and another of the weekly tasks (AP diary, relaxation, exposure exercises) while in the EMDR group to patients there are no tasks at home and each one spontaneously responds to their internal changes of attitude compared to those situations that caused anxiety.
The results show how after 12 treatment sessions both the EMDR and the CBT are effective in the treatment of panic disorderboth with and without agoraphobia.
The treatment with EMDR appears to have the same effectiveness of the treatment with CBT and the results are also maintained in the follow -up at a year later.
Bibliography:
- Bisson, Ji, Brayne, M., Ochberg, FM, & Everly, GS (2007). Early Psychosocial Interventions Following Traumatic Events. American Journal of Psychiatry, 1641016-1019.
- Spotlight, E. (2013). EMDR and Cognitive Behavoral Therapy in the Treatment of Panic Disorder: A Comparison. Journal of Emdr Practice and Research, 7 121-133.
- Goldstein Aj, & feske, U. (1994). Eye Movement Desensitization and Reprocessing for Panic Disorder: A Case Series. Journal of Anxiety Disorders, 8351 – 362.
- Liotti, G., & Farina, B. (2011). Traumatic developments. Etiopathogenesis, clinic to the therapy of the dissociative dimension. Milan, Italy: Cortina.
- Shapiro, F. (2001). Eye Movement Dessensitization and Reprocessing: Basic Principles, Protocols, and Procedures. New York: Guilford Press.
- Taylor, S. (2006). Panic disorders. Bologna: Monduzzi Editore.
