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ABSTRACT: Recently there has been an emphasis on biomedical and behavioral aspects of the treatment panic disorder. The symptom-based nature of these treatments may cause elements of the life context, such as systems of meaningfulness and symbolism, to be overlooked in some cases. In this paper, the successful treatment of a case of panic disorder of three years duration is presented, in which complete remission of symptoms occurred within the third week of existential psychotherapy. Prior to this therapy, the client had exhibited a deteriorating course while following a purely psychopharmacological treatment plan. Implications are discussed.
KEY WORDS: existential therapy; panic disorders; single system design.
It is estimated that panic disorder may affect about 1.5% of the population at a given time (Eaton, Kessler, Wittchen, & Magee, 1994). Much of the treatment sought by this large group of patients is based on a medical model. Patients with panic disorder, who often mistake their symptoms for those of acute cardiac distress and fear they are about to die, are particularly likely to consult family or emergency room physicians for relief(Sperry & Carlson, 1996). Concentrating primarily on the physiological aspects of the problem, these physicians generally prescribe medications such as anxiolytics or antidepressants (Mavissakalian & Ryan, 1997), while the life context which gave rise to the disorder may go almost entirely unexplored.
Among mental health professionals, cognitive-behavioral treatment is favored for panic disorder. According to Craske and Barlow (1993), the combination of a cognitive-behavioral model with adjunctive psychopharmacologic treatment was "recommended as the treatment of choice" (p. 1) in a consensus conference sponsored by the National Institute of Mental Health. However, these techniques are generally quite localized, and tend to focus only on the symptomatic and physiological aspects of the disorder.
Existential therapy, a modality concerned with conflicts arising from the "the individual's confrontation with givens of existence" (Yalom, 1980, p. 8), has been little used in the treatment of panic disorder. Yet death anxiety is a crucial issue in existential therapy, and in its most acute form (fear of imminent demise) this dread is often the very symptom that troubles patients with panic disorder the most. This paper presents the case of a man with a crippling panic disorder who became ever more functionally incapacitated,...