Jun 25, 2019 in Health

Stress and Panic

Literature Review

To speak about reasons of sudden panic attacks, the following statement should be outlined. Kearnye and Trull suggest that panic attacks are a symptom of social phobia (2015). The disorder can be characterized by an anxiety of embarrassment in public. Social phobia is usually accompanied by frequent stresses and possible substance abuses. Besides that, social phobia includes such symptoms as trembling, sweating, shortage of breath, dizziness, etc. Intensification of the phobia lasts within 6 months so that an individual may not demonstrate specific signs of social phobia at the moment of diagnosis. However, the authors consider the symptoms to be the result of panic disorder, which is developed by social phobia. Hence, the diagnosis of panic disorder presupposes a subsequent diagnosis of social phobia since this disorder includes a wider spectrum of symptoms. Regardless the complexity of the disorder, the treatment consists of simple steps, which are the following.


The treatment includes cognitive behavior therapy that consists of specific activities aimed at detection and neutralization of patient’s fears. The therapeutic objective is addressing the basics on which certain fears of a patient occur as long as the elimination of symptoms does not guarantee absence of relapse panic attacks and stresses. That therapy is usually combined with exercises directly designed for a reduction of non-adaptive behavior. Such course of psychological treatment usually includes 8 to 12 sessions and is conducted by a clinical psychologist. Rachman and de Silva consider group sessions to be extremely effective since patients are able to interact with each other so that their adaptation to a normal social life takes place during clinical intervention (2010). Additionally, any required medication is supposed to follow a slow build-up pattern. Thus, the obtaining of the fullest effects may take between 2 and 8 weeks per course of psychological treatment.

In regard to family psychology, the causes of various disorders are usually detected via quantitative analysis. The analysis processes a correlation between Axis I and Axis II as certain features of any individual may be reflected on his/her family partner. That also includes the appliance of GARF as long as Bray and Stanton assume that behaviors within family should be analyzed without context consideration (2012). That can be explained by neurobiological causes of conflicts. Needless to say, such process of diagnosis is applied to cases that do not include a distinctly deviant behavior of a particular family member. Still, the quantitative analysis of behavior strives for such objectives as indication of dominant behaviors, contrasting them to standard/usual behaviors within family, and quantitative detection of factors that render specific behaviors. Therefore, the independent analysis of any individual is also possible as some special behaviors can be spotted in the isolation from his/her relatives.

The treatment of family-related disorders includes group medication and exercises aimed at reduction of non-adaptive behaviors. Besides that, Salmon and Shackelfold argue that families with children or those planning to have a child are recommended to focus on child investment because a child is regarded as a common goal for both partners (2011). Moreover, common interaction with a child leads to establishment of a new communication plan between partners. The appliance of specific behavior utilized for interacting with a child can be easily embedded in a current model of relationships between partners. The investment in children does not have to be limited to factual spending money on them, but simple communication with them is able to normalize relationships within family. Provided that family is only planning to have a child, common preparations for giving birth and post-birth concerns are favorable circumstances for the regulation of family relationships as both partners express extremely total dependence on each other during that period.

Eventually, Bruth Carruth argues that any kind of addiction of different levels makes its negative impact on neuropsychological state of an individual via influencing stress responses (2011). In other words, the state of drug or alcohol abuse presupposes ignorance of any external factors. Thus, human sympathetic neural system attempts to boost homeostasis for adjusting organism to a stress-free state. As long as substance abuse provides such a state, the organism sends signals of a need for a new substance intake since subsequent stress-free condition will be obtained. Hence, Carruth considers stresses to be the main cause of moderate and medium substance abuse (2011). Such levels of substance addiction can be easily treated throughout a complex of methods of the primary prevention.

The treatment starts with information dissemination because an individual has to realize that substance abuse damages his/her psyche and organism heavily. In other words, the increase of knowledge regarding consequences and peculiarities of addiction should result in a high patient’s awareness. Personal growth of a patient is also important as high self-esteem, self-reliance, and reduction of boredom create unfavorable circumstances for a further substance intake. By the same token, alternative activities such as sports, hobbies, or attending cultural places are particularly aimed at the raise of interest to the world around. Addicts usually lose interest to the objective reality as it is mainly associated with stressful conditions and their direct causes. Moss and Dyer admit that the appliance of resistance skills will be needed; thus, a patient needs to cope with addictive signals on his/her own (2010). Positive peer influence is especially effective so that the group treatment is also desirable for that phase of therapy course. In such a way, an addict can be directed towards quitting substance abuse and comply with standards of public health.

All in all, the literature review has demonstrated the fact that panic disorder is usually the result of stresses, complications in private life, and substance abuse. These factors are sequentially connected so the basic causes of panic disorder should be eliminated. Subsequently, substance abuse and problems in a family can be addressed as soon as the main source of stress is already neutralized. Such strategy is recommended for the following case study where some specific insights should be outlined.

Case Study

Theory Appliance

Appliance of the theories outlined in the literature review is quite appropriate as Jason is facing problem on all three levels: personal, social, and neurobiological. Consequently, he is recommended to undergo the treatment of panic disorder and social phobia in terms of an individual course. He may participate, however, in group sessions, but involving his wife in the process is not desired at that stage of treatment. As for family perspective, the outlined quantitative analysis should be conducted for distinguishing exact behaviors of the partners. Then, the investment in children is not the best reaction on the situation since it remains unclear and will possibly place a new stress on Jason (Clarkson, 2013). The patient is having certain financial problems; thus, a subject of money should not prevail in sessions within that period of treatment. Substance abuse treatment is also applicable to the case since Jason confessed about his relative addiction to alcohol and cannabis. Hence, the prevention of further abuses will improve his resistance to non-adaptive behaviors (Clarkson, 2013). Jason is experiencing a wide range of stressful situations so that he needs to make himself more resistant to external factors otherwise his state will surely worsen.

Further Assessment 

It is becoming increasingly apparent that the central issue of Jason’s problems is the worsening relationship with his wife. Consequently, both he and his wife should be interviewed independently. The interview will be focused on revealing background of the marriage and the entire history of Jason’s relationship with his wife. That will indicate specific details which may change results of quantitative analysis. Interviewing Jason has to be careful as additional circumstances for panic attacks are totally unacceptable for his current state. Thus, interviewing him needs to be combined with other activities in terms of a treatment session. Two weeks is not a long period, but Jason is capable of overcoming his anxieties because he used to face stressful situation at his job on a daily basis. Regarding that, Jason is advised to take a vacation for these two weeks as his life needs to be trouble-free for the period of treatment. In other words, Jason has to focus on his family problems. The attitude towards the problem can be changed throughout conversation based on the results of quantitative data. The main object at this phase is to motivate Jason to cope with his problems.

Unique Experience Appraisal

Speaking about the case in terms of Bloch’s biopsychosocial encompassing of factors, the biological factor in Jason’s case is one of the most prominent aspects of his psychological health. Substance addiction is producing its negative effect on Jason as he finds the avoidance of stresses in alcohol or drug abuse. In general, such addiction is likely to intensify so that the patient will be always dependent on drug/alcohol intake. Needless to say, such consequences should be prevented with a specific treatment. As for psychological factor, Jason needs to cope with his panic disorder because he seems to be quite resilient person owing to his job at the mine (Janowski & Steuden, 2009). In fact, this advantage is recommended for addressing during the treatment so that the entire complex of activities is built on the strength mechanism. Social factor leaves also much to be desired, but that perspective can be also addressed just after elimination of panic disorder (Janowski & Steuden, 2009). Jason confessed that he truly loves his wife and does not have anything to hide from her. That will boost a further medication course of the couple. As soon as the problem is solved, Jason will be able to pay attention to domestic issues such as paying mortgages and other issues.

Treatment Interventions

To return to the subject of treatment, complex of exercises designed for resistance to non-adaptive behaviors and preliminary prevention of substance abuse are the most appropriate interventions concerning the Jason’s case. Addiction should be prevented initially as long as it is the main barrier in terms of the patient’s treatment (Bruce & Jongsma 2010). Jason will not improve his state until he consumes alcohol and smokes cannabis. Simultaneously, exercises regarding social adaptation should be practiced as Jason has to learn how to cease his panic attacks in order to proceed to medication together with his wife. A certain difficulty, however, should be mentioned. Jason’s readiness to continue the medication course does not guarantee positive outcomes so that a probability of a divorce though still remains. The treatment does not need to limit itself to extents of panic disorder treatment (Bruce & Jongsma 2010). Quantitative analysis and related solutions are expected to play a substantial role in this case as Jason’s wellness depends heavily upon the outcomes of conflicts with the wife. Jason needs to be psychologically ready for the worst scenario since the appliance of multiple solutions is needed on the basis of quantitative analysis of Axis I and Axis II (Bruce & Jongsma 2010).

Most Prominent Insights of the Case

Psychological treatment of the patient is conducted not only in terms of clinical intervention but also from the perspective of counselling. Jason seems to be deeply in love with his wife; hence, the conflict is especially stressful for him. Additionally, their daughter, as a result of their relationship, is of the greatest value for Jason so that losing the connection with her depresses him. Financial hardships intensify stressful state as the lack of money implies a loss of the last way to support his daughter. Jason is especially anxious about the divorce because the girl will probably have a step-father. Likewise, Jason works at quite stressful job so that problems in a private life exceeded his threshold of resistance to stresses. All these factors confuse the patient so that his psyche recalled a state of substance abuse that renders stress-free experience. Jason needs to solve all his problems one-by-one as they are interconnected. Simultaneously, the presence of all these problems makes Jason think that he is not sufficiently successful and lucky. That feeling results in his panic disorder as Jason associates his problems with being surrounded by the society that is more successful and luckier than he could have been.

Counselling Responses

Counselling response to the patient’s case should be based on a cooperative approach because Jason is loaded with multiple problems that are obviously hard to face with alone. Hence, the suggestion of simple help will be the basis for building trust and rapport. Jason will surely accept the offer to help as it can be explained by the fact that he already consulted a clinical psychologist. Also, the patient’s psyche is weakened now so that any external support will be subconsciously accepted. Regarding that, the case presupposes just a collaborative approach without modifying any specific agenda (Feltham & Horton, 2012). One may argue that addressing to all levels of biopsychosocial state of the patient implies the design of a custom model. It is certainly not true as every single perspective is addressed to independently. The main reason for such approach is the fact that the patient is experiencing excessive stresses so that he has to undergo plain means of treatment (Feltham & Horton, 2012). Overall, the establishment of cooperation with the patient is not expected to be hard since his decision to undergo specific course of treatment was made voluntarily. That will boost the treatment and help the psychologist assess the progress (Feltham & Horton, 2012).


It is appropriate to make a general comment on the fact that the case of Jason is relatively complicated, but the means of addressing the entire complex of biopsychosocial problems are standard. The patient needs to reduce his non-adaptive behaviors of panic disorder so that he will be able to face a challenge of an encounter with his wife. Besides, the prevention of substance addiction is also pivotal. In regard to the literature review, the treatment should consist of three independent stages as all problems are mutually related. Consequently, Jason has to undergo a social therapy for learning skills how to resist panic disorder, undergo a complex of sessions designed on the basis of quantitative analysis of Axis I and Axis II, and eliminate his habit of substance abuse. The latter problem is especially dangerous since it blocks the patient from overcoming the rest of his stresses and anxieties. Consumption of alcohol and drugs creates a trouble-free condition so that the patient avoids the objective reality by substance abuse. Counselling approach should rely on cooperation with Jason as he is definitely willing to solve all his problems.


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