CASE JURNAL PANIC OF ATTACK

COGNITIVE-BEHAVIORAL TREATMENT  PANIC OF ATTACK

Abstract: 

Anxiety affects approximately 30million Americans at some point in their lives. The most common treatment modalities used to treat the continuum are the administration of psychotropic medications and the application of behavioral therapy. The following case details an adult female who suffered from severe panic attacks for a period of 10 years wherein numerous interventions, including psychotropic medications, had failed to ameliorate her suffering. The patient was treated using the Mastery of Your Anxiety and Panic protocol. Prior to treatment, the patient reported that she experienced an average of seven panic attacks per week, her Beck Anxiety Inventory score was 58, and her Beck Depression Inventory was 23. At the completion of treatment, the patient reported that the number of panic attacks was reduced to one per week. At 4-week, 6-week, and 16-week follow-up, the patient had not experienced any panic attacks.

Keywords: panic disorder, cognitive-behavioral therapy, behavioral therapy, cognitive restructuring, exposure therapy, relaxation therapy.

 Jane reported that she had daily panic attacks with physiological reactions that included chest pain, shortness of breath, dizziness, nose burn, sudden perspiration, and numbing in the hands. The panic attacks occurred at work, at home, and in public places. She reported that the panic attacks were becomingproblematic at her workplace, and her employer had commented on her condition. Jane stated that she had experienced panic attacks for more than 10 years. She sought out help from seven previous therapists. She terminated these professional relationships prematurely, because “they weren’t helping me.” The predominant treatment approaches employed by the previous therapists involved a psychodynamic paradigm and treatment by PCP, whose treatment of choice was anxiolytic medications.

HISTORY

Jane was born in a western state in theUnited States, and spent her childhood years there. She stated that she has two older brothers and two older sisters. Jane reported that she thought her childhood was “good until she was 17 [years old].” She stated that she changed her opinion once she started visiting the families of her friends and noticed the disparity with her family.

Jane reported that her mother was diagnosed with schizoaffective disorder and had been receiving medical treatment for her disorder for many years. She noted that herfather was twice divorced and that he was an alcoholic. She described situations where her father would come home inebriated and report that he had given his paycheck away, would “beat my mom,” and would proceed to “trash the house.” Jane reported that during these tirades, her father would “beat on the oldest,” and when she tried to protect her brother, her father would “hit me upside the head.” During these situations, Jane’s mother would shirk away in fear for herself.

ANALISIS CASE

Pada jurnal ini disajiakan Kasus yang terjadi pada seorang wanita yang mengalami gangguan kecemasan atau Panic Attack yang sangat parah dan sudah dialaminya sekitar 10 tahun. Dalam waktu tersebut dirinya sudah banyak menerima berbagai interfensi, pengobatan psikotropika yang juga tidak banyak membantu keluar dari penderitaanya. Berikut ini beberapa ciri-ciri yang dialami oleh pasien yang bernama Jane penderita Panic Attack Disorder :

a.         mengalami rata-rata tujuh serangan panik/ minggu.

b.         Ketika serangan panic muncul, juga diikuti dengan reaksi fisiologis seperti nyeri dada, sesak nafas, pusing, luka bakar pada hidung, keringat tiba-tiba dan mati rasa pada seluruh badan.

c.         Serangan panic seringkali muncul ketika dirinya berada di rumah, tempat kerja maupun tempat umum lainnya.

d.         Gangguan ini sudah dialaminya selama lebih dari 10 tahun terakhir.

e.         Mengalami ketakutan pada situasi yang kondisional

f.          Jane mengalami luka batin pada kehidupan keluarganya terutama pada orang tuanya saat dia masa kecil.

Kriteriautama bagi diagnosis gangguan panik tanpa agoraphobia menurut Diagnostik dan Statistik Manual, Edisi Keempat (DSM-IV) (American Psychiatric Association, 1994 ):

 Kriteria A.1 : sejarah berulang serangan panik yang tak terduga dengan setidaknyasalah satu serangan panik telah diikuti oleh 1 bulan 

, seperti :

(a) kekhawatiran terus-menerus
(b) khawatir tentang dampak atau implikasi dari setiap serangan panik
(c) signifikan perubahan perilaku karena serangan panik. 


Kriteria B : Presentasi tidak harus menyertakan agoraphobia 
Kriteria C : Serangan panik bukan karena penggunaan zat atau kondisi medis umum
Kriteria D : Gangguan kejiwaan . Dan  Kondisi Jane memenuhi kriteria ini.

Pendekatan Penyembuhan ( Treatment)

Model penyambuhan secara behavioral dan cognitive Behavioral ini berpendapat bahwa gangguan kecemasan panic terjadi sebagai hasil dari mekanisme psikologis yang terjadi dimana rangsangan lingkungan menyebabkan reaktivitas bersyarat, yang mungkin dimediasi oleh respon yang diakibatkan oleh kondisi yang menyebabkan ketakutan atau distorsi kognitif. (Klerman et all, 1994). Treatment ini dianggap cocok bagi Jane yang pernah mengalami trauma masa kecil pada permasalahan rumah tangga ibu dan ayahnya yang membuat Jane merasa panik dan ketakutan yang berlebihan di kondisi yang tertentu.