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Panic Attack Case Study With Soap Note

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  • Sue, 30 years old, recently left the RAN after ten years of active service

    I remember my first panic attack like it was yesterday. I guess I’d always been an anxious type, but this was like nothing I’d ever experienced. I was at a football game about six years ago, big crowd, St Kilda getting hammered by the Pies. I think I was a bit edgy – I’ve never liked being hemmed in, stuck somewhere I couldn’t get out of easily. Then suddenly this thing just took me over. I got these pains in my chest and I couldn’t breathe. I was sure I was having a heart attack and was going to die. I was thinking about my daughter – she was two at the time – and thinking it can’t end like this, I’ve got to see her again. I was sweating, heart racing, trembling….I had to get out of there. I managed to push my way through the crowd and I saw a St John’s ambo. What a relief. He helped me to the ambulance and they took me straight to hospital, wired me up to all sorts of machines and then…..they told me there was nothing wrong, that it was all in my head. All in my head? Those pains were real, I can tell you. All they said was that I’d had a panic attack, and I was so happy to be alive, I didn’t ask them more about it. I just wanted to get home. But since then, my life has changed. I only went back to sea once (my skills are needed more on shore than at sea, thank God) but that was terrifying. I spent the whole time worrying about whether I’d have an attack while we were far from land and I avoided being below decks whenever I could. Since the first time, I’ve had about a dozen attacks and each one was terrifying. I’ve stopped going anywhere that I can’t get out of easily in case I have another one. No shopping centres. No cinemas. No football games. No public transport. No crowded places. I left the navy because I couldn’t face going to sea again.

    Taking action

    A month ago it came to a head, my daughter’s 8th birthday. She wanted me to take her and a couple of friends into the city on the train to see a movie. I told her I couldn’t and got angry with her – poor kid. Then I had a big fight with my husband. After we’d all had a bit of a cry I decided I had to do something about it. I went along to see our GP – he told me I had panic disorder (which I guess I already knew) and something called agoraphobia. That’s the part where I won’t go anywhere in case I have an attack. He gave me a script for some tablets and a referral to see a psychologist. I managed to get in to see her and the first thing she told me was to only take the tablets when I absolutely had to. That annoyed me – one doctor tells you one thing, another tells you something else. But the more she explained what was happening, the more it made sense. The tablets help to stop the attacks when they’re happening, but they don’t do anything to prevent another one. She says I can only learn how to control them if I let myself risk having one.

    I think we’re on the right track. We’ve spent a lot of time talking about my breathing. She says I’m “hyperventilating”, that my body is getting ready for fight or flight when there’s no danger there. I’ve been practicing the exercises she gave me and I really do feel more in control. The next step is to start getting back to do the things I’ve been avoiding. That’s very scary, but she says I can do it in small steps. And she’s started to talk about how my thoughts play a part.

    I’m a long way from being cured, but I feel much more confident now. My husband says I’m much better. And I’m going to take my daughter to the city on her 9th birthday for sure.

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