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Adriana stated that because she always had an accompanying person in anxiety-provoking
situations, her diary was only partial and did not reflect all the symptoms caused by the
disorder.
In addition to the elimination of the panic attacks and the anticipatory anxiety, Adriana
articulated the treatment goals in four domains:
Behavioral
To be able to drive the car by herself (e.g., to work, to the supermarket, to the hairdresser) without
depending on someone else.
To be able to do pleasant things (e.g., window shopping, going out with a friend, and so on), enjoy-
ing them, and feeling free to do them.
Cognitive
To overcome and change the belief of not feeling well, to no longer perceive the car and her house
as a potential danger or threat.
To change the tendency of seeing and anticipating catastrophes.
Physiological
To eliminate and resolve accelerated heart rate, shaking, feeling of not being able to breathe, dizzi-
ness, and weakness at the legs.
To learn to relax to face these situations with no body disturbance.
Emotional
To learn to master her fear and manage her emotions (fear, tension, worry, blocks).
To overcome the feeling of tension in places where an accessible exit is not visible (e.g., tunnels,
movies, traffic jams, and so on).
6 Case Conceptualization
Many clinicians, regardless of their theoretical approach, believe that small and severe
traumas experienced in early childhood have a significant impact on the insurgence of psy-
chological distress. Raskin, Peeke, Dikman, and Pinker (1982) reviewed the antecedents of
anxiety disorders and found that 53% of the participants suffering from panic disorders had
experienced separation from their parents in childhood or adolescence, whether through
death, divorce, or other means. These findings also indicated that the impact of traumatic
life events depended on the age at which they occurred. Brown, Harris, and Eales (1993)
confirmed the impact of abandonment and separation on the development of panic disor-
ders, adding that exposure to unpredictable and uncontrollable stimuli in childhood may
also contribute to such symptoms. These results are consistent with the AIP theory
(Shapiro, 2001, 2002) described previously, in that these events may have created enough
distress to impair the information processing of the event, resulting in stored affects and
sensations that form the base of the pathology.
Fernandez, Faretta / Panic Disorder and EMDR Treatment
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