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against the feared (and therefore avoided) events. Generally, we notice that clients change
their behavior or act it out spontaneously, without having it assigned as homework (Faretta,
2001). For instance, they may start taking short walks on their own or spontaneously face
the feared situation. The intervention also focuses on the bodily component of panic, to
address the anticipatory fear. This helps the client to restore a more appropriate contact with
reality, by starting to recognize the different opportunities and potential (inner resources)
to achieve new adaptive conditions and to enact appropriate behaviors.
An important consideration in the treatment of panic disorders, and the one illustrated
nicely in this case example, is secondary gain. For instance, clients may somehow believe
that without their panic disorder and the consequent avoidance, they shall have to face the
world and could fail. They then tend to maintain the symptoms to postpone or avoid this
responsibility. Other blocking beliefs, such as “I don’t deserve to overcome this and feel
good” or the dependence on an individual because of an unbalanced attachment relation-
ship, may also be considered indirect gains of the disorder. Therefore, these issues must be
identified and targeted within the EMDR standard protocol. All steps of the phobia proto-
col should be initiated that include a sufficient preparation phase and then the processing
of targets related to each symptoms: (a) events that set the foundation for the pathology;
(b) first experience of fear, anxiety, or panic; (c) worst experience; (d) most recent experience;
(e) current triggers; and (f) future templates.
In addition to processing the events directly related to the obvious symptoms (e.g., fear
of driving), effective therapeutic work focuses also on the dynamics created by the disor-
der, the attachment bonds, the factors contributing to distress maintenance, and the possi-
ble skills and behaviors useful for suitable future actions. Only the sole and unique
individual history of each person can explain the existence of this disorder. EMDR support
in psychotherapy may ascribe a sense and a meaning to the symptoms through an analysis
of the dynamic relationships between the participant, the others, and the environment.
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60 Clinical Case Studies