Treating panic attacks and panic disorder in a public hospital respiratory ward

The respiratory ward and clinic at Prince of Wales Hospital provide treatment for people suffering from chronic respiratory diseases. The bulk of both inpatients and outpatients have chronic obstructive pulmonary disease (COPD), a condition caused primarily by cigarette smoking and one of the major causes of disability and death worldwide. In COPD, panic disorder is up to ten times more prevalent than in the general population, and panic attacks and anxiety symptoms are common (Divo et al., 2012).

There are various challenges to be considered in treating panic spectrum psychopathology in COPD – for example, the problem of “controlled breathing” being a “safety seeking behaviour” in CBT for panic disorder, while COPD’s cardinal symptom – worsening shortness of breath on physical exertion (in the context of an eventually fatal illness) – necessitates attention to managing breathing. Modifications need to be made to standard CBT for panic attacks and panic disorder as a result of the nature of respiratory diseases.

A clear cognitive theme emerging from therapy sessions is of catastrophic interpretations about breathing difficulty, as conceptualised in Clark’s (1986) cognitive model of panic e.g. “It feels like I'm going to run out of air and suffocate on the spot”. As a clinical psychologist working in a respiratory ward, it is necessary to, on the one hand, validate people’s suffering in living with an illness that makes “getting a good breath” a distant memory, while on the other hand encourage them to consider that self-management of their breathing could make a difference – that catastrophic interpretations, and panic attacks, are understandable, but not inevitable.

Psychology’s role with COPD patients at Prince of Wales Hospital

A four session CBT program for the treatment of anxiety and panic attacks in COPD, and the prevention of panic disorder, has been developed and evaluated at Prince of Wales Hospital. The program specifically addresses catastrophic interpretations about breathing difficulty. In a randomised controlled trial including 41 people with moderate to severe COPD, the four, one hour CBT sessions were effective in treating existing panic attacks, and preventing the development of panic attacks and panic disorder over an 18 month follow up period (Livermore, Sharpe & McKenzie, 2010).

The program was also associated with a lower number of hospital admissions between the six and 12 month follow-ups in the CBT group compared with the routine care group, and a significant 17% decrease in ratings of shortness of breath (mediated by a change in catastrophic interpretations) when baseline psychophysiological testing was repeated at six month follow up. The latter results have provided the first evidence that a psychological intervention aimed at helping people with COPD to reduce anxiety and manage their breathing could reduce the intensity of shortness of breath as measured by psychophysiological testing (Livermore et al., 2015).

Further innovations and developments in psychological treatment keep on coming, with the multidisciplinary hospital environment creating a fertile milieu for such developments.

The author can be contacted at [email protected]