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This article, condensed from Chapter 14 of A Guide to the Standard EMDR Protocols for Clinicians, Supervisors, and Consultants (Leeds, 2009), examines applying eye movement desensitization and reprocessing (EMDR) to treating individuals with panic disorder (PD) and PD with agoraphobia (PDA). The literature on effective treatments for PD and PDA is reviewed focusing on cognitive and behavioral therapies, pharmacotherapy, and EMDR. Case reports and controlled studies of EMDR treatment of PD and PDA are examined for lessons to guide EMDR clinicians. Two model EMDR treatment plans are presented: one for cases of simple PD without agoraphobia or other co-occurring disorders and the other for cases of PDA or PD with co-occurring anxiety or Axis II disorders. A more extensive literature discussion, detailed treatment guidelines, and client education resources can be found in the original chapter.
Keywords: agoraphobia; CBT; EMDR; panic; pharmacotherapy; review
Individuals with panic disorder (PD) experience periods of extreme anxiety accompanied by intense somatic and cognitive distress. These episodes can be as brief as 1 to 5 minutes, but more commonly increase over a period of about 10 minutes. Some individuals experience episodes of panic that can wax and wane over an hour or longer. The symptoms of panic include palpitations, sweating, trembling or shaking, sensations of shortness of breath, sensations of choking, chest pain or discomfort, nausea or abdominal distress, dizziness or lightheadedness, derealization or depersonalization, fear of losing control or "going crazy," fear of dying, tingling, and chills or hot flushes. Initial episodes of panic are frequently perceived as just as life- threatening as other experiences that meet Criterion A for posttraumatic stress disorder (PTSD; American Psychiatric Association [APA], 2000).
To meet criteria for PD, panic attacks must recur and initially be unexpected rather than being linked to a specific situation as in specific phobia or social phobia. Subsequently, individuals may come to expect panic attacks in settings where they have occurred previously. This expectation may lead to avoidance of those settings and thus is associated with the development of agoraphobia-the fear of having panic in situations from which escape may be difficult. These settings include bridges, public transportation, crowds, and lines of people. In extreme agoraphobia, individuals become unwilling to leave their place of residence. PD is experienced...