basic calming: Restore rhythm, disconnect the alarm, and create a verbal
representation of what is happening. This is a form of external control,
because you are the one doing the calming, not the fearful person. If there
is such a person in your life, especially one with panic disorder, you’ll go
through the sequence many times, but hopefully not forever.
The overall goal of psychotherapy is to foster internal control of fear.
External control is a necessary precursor: the beginning, not the end.
Treatment for fear disorders is usually begun by primary care physi-
cians. After making a differential diagnosis, they attempt to alleviate
symptoms, usually with medication. This medication can be a blessed
relief, but the blessing is mixed. If the medication works, there’s no problem.
Treatment begins and ends right there. Nothing else is needed but pre-
scription refills.
If the medication doesn’t work, however, if it doesn’t cause the
symptoms to go away, fearful people may be left with some confusion as
to who or what is responsible for making them feel better.
For panic disorder, the usual regimen is a serotonergic, usually a
reuptake inhibitor like Prozac, Zoloft, or Paxil, but sometimes a tricyclic
like Imiprimine, with a limited course of benzodiazepines until it takes
effect. As I said in the previous chapter, benzodiazepines have to be
watched carefully because they work too well. Addiction is less of a problem
than fostering unrealistic expectations.
On the night Jane awoke in panic, her terrified husband rushed
her to the hospital, where they calmed her with a shot of Valium
and told her to call her doctor in the morning. The clearest
memory Jane had of that night was the immediate relief she felt
when the Valium took hold. That feeling became imprinted below
her awareness as the way a panic attack should end, with the fear
melting away into a pleasant haze that she mistook for normalcy.
The next day, Jane’s doctor, after diagnosing her condition
as panic disorder rather than physical demise, prescribed Xanax
three times daily for two weeks, until Prozac could take effect.
In Jane’s opinion, the Prozac never took effect because it
didn’t make the panic go away as well as Xanax.100 ❧Explosions into Fear