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a car accident when Adriana was 10 years old and subsequently avoided driving for 2 years,
instead delegating this task to his wife. Adriana’s mother was described as an apprehensive
person, although without a diagnosable pathology.
When Adriana was a few months old, her parents took her to live with her grandparents
for practical reasons (they had to wake up early to go to work). They used to visit her after
work on their way home. The family was finally reunited after they purchased a home near
the grandparents when Adriana’s mother was pregnant with her brother. The birth of this
brother also involved a traumatic experience. The day he was born, Adriana (then 8 years
old) was trapped in the elevator, and her distress was intensified by the fact that her mother
was not there to help and comfort her.
Shortly after her brother’s birth, another traumatic event occurred. When Adriana was
9 years of age, some burglars entered the property, after presuming that nobody was home.
The family heard noises in the garden and saw some men wearing balaclavas. The men
immediately ran away. Adriana recalled her mother exclaiming, “Who knows what they
would have done to us had they entered and found us here!” Consequently, Adriana expe-
rienced nightmares for years and was afraid to remain home alone.
Prior to the onset of Adriana’s panic attacks, two particular events appeared significant,
in terms of the development of her panic disorder. The first, a cannabis intoxication,
appeared to precipitate the first anxiety attack. After smoking marijuana, Adriana experi-
enced intense perspiration, visual disturbances, and a strong feeling of anguish while dri-
ving her car. A month after this episode, she underwent an appendectomy. Another month
later, she suffered her first real panic attack while she was driving.
Adriana reported several unsuccessful psychotherapy cycles over the years. She had also
received pharmacological treatment because the onset of the disorder and the specific med-
ications had been changed several times. Pharmacological treatment did not appear to ame-
liorate her panic symptoms.
5 Assessment
Adriana recorded her panic symptoms in a weekly diary for the first 2 weeks to assess
her behavioral, physiological, cognitive, and emotional responses. She was asked to write
the date, the situation, the trigger, the intensity (from 0 to 10), the duration, who was with
her at the time of the attack, and the symptoms. The diary was also kept for 2 weeks at the
posttreatment and at the follow-up after 1 year. Recovery was tracked by monitoring the
following baseline symptoms:
Panic Attacks at a 7 to 8 SUD Level
Pervasive tension, worry, and fear three to four times a week before leaving the home
and before leaving the office with an intensity of SUD of about 5.
Physical symptoms were “need for air,” dizziness, heart rate acceleration, weakness at
the legs, and internal shaking. The trigger was the fear of fear.
Avoidance of situations that could provoke panic attacks (e.g., driving by herself, going
to the supermarket, staying at home alone, and so on).
48 Clinical Case Studies