Abnormal Psychology

Anxiety Disorders 275

Targeting Social Factors: Group and Couples Therapy

Therapy groups (either self-help or conducted by a therapist) that focus specifi cally

on panic disorder and agoraphobia can be a helpful addition to a treatment pro-

gram (Galassi et al., 2007). Meeting with others who have similar diffi culties and

sharing experiences can help to decrease a patient’s sense of isolation and shame.

Moreover, couples or family therapy may be appropriate when a partner or other

family member has been the safe person; as the patient gets better, he or she may

rely less on that person, which can affect their relationship. In some cases, the pa-

tient’s increasing independence is satisfying for everyone; but if the safe person has

found satisfaction in tending to the patient, the patient’s increased independence

can be a stressful transition for that person. For Shirley B. (see Case 7.3), her rela-

tionship with her daughter Nadeen would undoubtedly change as her agoraphobia

diminishes, because she will no longer need Nadeen to accompany her on excur-

sions out of the house. The particular ways their relationship changes will depend

on how each of them views Shirley’s new independence.

Family members and friends can also be great sources of support, as Campbell

noted: “When I’m traveling, my schedule frequently becomes so hectic that I get a

bit run-down. Then, I can usually feel the panic sneaking up on me, and I’ll pick up

the phone right away to call Reuna. Just as it does at home, on the road it tends to

attack me in the middle of the night” (Campbell & Ruane, 1999, p. 120). Reuna

reminds him to take deep breaths and helps him get through it. He also remembered

that, “I’d made one of my biggest steps towards recovery the day I called Janice [his

assistant] into my offi ce and exposed my illness to her. I strongly encourage anyone

suffering from panic or anxiety to do the same. Start with a close friend you can

trust completely, tell that person about your condition, and ask for support. Then

do the same with a coworker. Next, approach a friend within your social network.

Start small and work your way up” (Campbell & Ruane, 1999, p. 132).

Exercise

Duration

(seconds)

Sensation

intensity (0–8) Anxiety (0–8) Similarity (0–8)

Shake head from side

to side

30

Place head between

legs and then lift

30

Run on spot 60

Hold breath 30, or as long

as possible

Completely tense body

muscles

60, or as long

as possible

Spin in swivel chair 60

Hyperventilate 60

Breathe through narrow

straw

120

Stare at spot on wall or

own mirror image

90

Source: Craske & Barlow, 1993, Table 1.4, p. 36. Copyright 1993 by Guilford Publications, Inc. For more information see the

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Table 7.7 • Interoceptive Exposure Exercises for Treatment of Panic Disorder

People receiving interoceptive exposure

perform each of the exercises listed in

this table for the indicated duration; such

exercises are likely to elicit sensations

typically associated with panic. After each

exercise, they rate how intense the sensations

were, their level of anxiety while doing the

exercise, and how similar the sensations were

to panic symptoms.