Use of cognitive therapy for management of nocturnal panic
National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
National Institute of Psychology, Quaid-i-Azam University, Islamabad
|How to cite this article:|
Aslam N. Use of cognitive therapy for management of nocturnal panic.J Postgrad Med 2014;60:206-207
|How to cite this URL:|
Aslam N. Use of cognitive therapy for management of nocturnal panic. J Postgrad Med [serial online] 2014 [cited 2020 Sep 23 ];60:206-207
Available from: http://www.jpgmonline.com/text.asp?2014/60/2/206/132353
We present in this paper, a case of a 40-year-old male patient who reported that he was under the influence of black magic (Kala Jadu). He reported that, during sleep he suddenly gets up with a lot of terror and with intense symptoms (i.e., palpitations, pounding heart, and accelerated heart rate, sweating, trembling/shaking, feelings of choking, chest pain, and fear of losing control). Although the episodes typically last only a few minutes, he is unable to endure this and feels as if he must get some fresh air. Treatment by faith healers (FHs) 'Amils' did not help. Patient was diagnosed with nocturnal panic (NP) and was given psychoeducation about the nature of the disorder and the role of fearful thoughts in the secretion of adrenaline and subsequently development of panic attacks. After six sessions client recovered.
NP, waking from sleep in a state of panic, is distinct from nightmares, dream-induced arousals, and sleep terrors. It is a relatively common phenomenon, and occurs in 18-45% of patients with the panic disorder (PD).  NP represents a more severe form of PD or is a manifestation of heightened vulnerability to sleep disturbance. NP is a specific version of PD characterized by fearful associations with sleep and sleep-like states. A greater proportion of the NP subjects reported chest pain during diurnal panic attacks and a trend toward greater fear of dying. Almost 85% of those with NP reported a history of traumatic events in comparison to only 28% without NP. Fear of loss of vigilance is considered as a potential mediator of the relationship between NP and traumatic events.  There are substantial differences between PD and control subjects in autonomic regulation and that there are small differences between patients with daytime panic attacks and those with sleep-related panic attacks.  Cognitive behavioral model helps in understanding and managing the NP. Psychological treatment, cognitive behavioral therapy (CBT) targets misappraisals of anxiety sensations, hyperventilatory response, and conditioned reactions to internal, physical cues. Current studies indicate that both pharmacological treatment and CBT are effective for PD with or without NP. Guidelines suggest CBT, pharmacotherapy or CBT plus pharmacotherapy in the treatment of PD. CBT may also be used in patients who do not respond or have a poor response to pharmacotherapy.  FHs usually evoke supernatural powers in the etiology of mental disorders and mostly offer unorthodox treatments to their clients who present with an array of physical and psychological symptoms suggestive of the evil eye, magic, and jinn possession.  Therefore, scientific knowledge about the nature and etiology of NP facilitates the treatment outcome, whereas the supernatural explanations and/or magical interpretation about NP may produce the feelings of helplessness among patients and it adversely affects the treatment outcome.
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