Case study. panic disorder with agoraphobia

Consider the case of 'Carlos,' a 42-year-old man who began experiencing unexpected panic attacks six months ago.

Since then, he has lived with an intense fear of having another attack and has begun avoiding situations such as going to the supermarket alone or using public transportation, fearing that he will not be able to escape or receive help if an attack occurs.

Assessment and Case Conceptualization

Carlos describes classic symptoms of panic attacks (palpitations, feeling of suffocation, dizziness, fear of dying).

His main concern is the "fear of fear," that is, anticipatory anxiety about future attacks.

His avoidance of multiple situations suggests the development of agoraphobia.

Carlos is identified as catastrophically interpreting his physical sensations ("If I feel palpitations, I'm going to have a heart attack") and has developed safety behaviors (always carrying a bottle of water, checking the location of nearby hospitals).

CBT-Based Treatment Plan

Carlos' treatment would focus on:

• Psychoeducation: Explaining in detail the nature of panic attacks as a "false alarm" from the fight-or-flight system, the fear-fear cycle, and how avoidance and safety behaviors maintain the problem.

• Breath Management Training: He would be taught diaphragmatic breathing to help him regulate his physiological arousal during times of anxiety or at the onset of an attack.

• Cognitive Restructuring: Identifying and challenging his catastrophic interpretations about physical sensations and the likelihood of feared consequences ("dying," "losing control") occurring. Alternative and more realistic explanations would be sought.

• Interoceptive Exposure: Perform in-session exercises to deliberately induce the feared physical sensations (e.g. hyperventilating to cause dizziness, climbing stairs to cause tachycardia) and teach the patient that these sensations are not dangerous and can be tolerated.

• Gradual In Vivo Exposure: Develop a hierarchy of feared agoraphobic situations and begin to