Supporting patients through panic – the vital role of GPs in managing panic disorder

GP Connect feature by Amber MacLeod, Clinical Psychologist Registrar, Centre for Clinical Interventions (CCI)

Understanding panic disorder

Panic disorder is a challenging condition characterised by recurrent panic attacks. The cycle of panic is self-perpetuating, as patients with panic disorder are acutely attuned to bodily sensations that could be perceived as threatening. The experience of such symptoms (e.g. palpitations and breathlessness) triggers anxiety, further amplifying these sensations and often culminating in a full-blown panic attack. Such episodes reinforce the perception that certain bodily sensations are dangerous, fuelling anticipatory anxiety about future attacks and sustaining hypervigilance for physical symptoms. Panic disorder profoundly impairs physical, social, and occupational functioning, as individuals alter their behaviour to avoid feared bodily sensations and panic attacks.

The role of GPs in identifying and responding to panic disorder

GPs play a vital role in identifying and managing panic disorder, as patients often mistake their panic symptoms for medical emergencies, prompting them to seek medical attention.

Recognising panic disorder can be challenging. However, some key signs to look out for include:

  • Recurrent panic attacks: Frequent and sudden episodes of extreme anxiety or panic, characterised by physical symptoms such as rapid heart rate, sweating, trembling, and shortness of breath.
  • Fear of future attacks: Persistent concern about experiencing additional panic attacks.
  • Behavioural changes: Avoidance of situations or places which may trigger panic attacks.
  • Impact on daily life: Significant disruption of daily functioning and overall quality of life.

The assessment of panic requires perception and empathy in communication with patients. GPs should carefully rule out any genuine medical conditions, while simultaneously providing reassurance. A GPs confidence in excluding organic causes enhances their capacity to provide effective reassurance. Once panic disorder has been identified as a potential cause, GPs can employ three key reassurance strategies:

  • Validation: Listen to patients’ fears and concerns. Let them express their worries and acknowledge that their symptoms are real and uncomfortable.
  • Normalisation: Explain the body’s ‘fight-or-flight response’ to help them understand that the physical sensations they experience during panic attacks are their body’s natural response to stress. Clarify that these symptoms are temporary and not dangerous.
  • Instil hope for recovery: Let patients know that evidence-based treatment options exist. Provide referrals to appropriate mental health services.

Psychological therapy for panic disorder

Cognitive behavioural therapy (CBT) is the foremost treatment for panic disorder. CBT helps individuals to identify and challenge negative thought patterns and to gradually expose themselves to feared situations or sensations. CBT has excellent treatment efficacy, with around 80 per cent of clients being panic-free at the end of treatment. Its effects are longer lasting than medication. Group interventions for panic disorder also have compelling evidence and are as effective as individual therapy.

The Centre for Clinical Interventions (CCI) is a state-wide specialised clinical psychology service dedicated to developing and providing free effective evidence-based psychological interventions. One of CCI’s recent innovations is a group CBT program for panic disorder.

CCI’s panic disorder group includes:

  • Learning about symptoms and maintaining factors of panic disorder.
  • Cognitive strategies for challenging unhelpful thoughts.
  • Exposure-based strategies to assist clients in learning to tolerate the physical sensations associated with panic and face situations where they fear they might have a panic attack.

Group program criteria

  • Aged 18 and over
  • Primary diagnosis of panic disorder
  • Current Medicare card
  • Able to attend clinic in Northbridge (rural patients may be eligible for individual telehealth treatment).

Program structure

  • Six, two-hour sessions, held weekly
  • Follow-up session one month after completion
  • Six-eight clients per group.

How to refer

Complete the referral form found on the CCI website. For inquiries or to discuss potential referrals, call 9227 4399.