Employers and plans need new approaches to treating COVID-related panic attacks
Even before the pandemic, panic attacks affected some 27 million Americans—nearly as many as have diabetes.
It’s well known that COVID-19 has dramatically impacted the mental health of Americans. But just how many of us have been impacted is stunning.
Before the pandemic, one in five adults were affected by a mental health condition, driving U.S. health costs of $225 billion. During COVID-19, the percentage of people reporting anxiety and depressive disorders skyrocketed from 11 percent to 40 percent in just one year. Employers are paying attention. Forty-four percent of human resources decision-makers and 27% of health plan leaders stated increased access to mental health services will become a long-term solution for their organization, according to a March 2021 report from Evernorth, the health services arm of Cigna.
Related: Employers: We need to do more than just talk about mental health
Employers may be particularly worried about the impact of COVID-19 on people suffering from panic attacks, one of the most common anxiety disorders. Even before the pandemic, panic attacks affected some 27 million Americans—nearly as many as have diabetes. A World Health Organization analysis ranked panic disorder as the No. 1 most impairing health condition among high-income nations, responsible for an average of 45.6 days per year “out of role,” a term meaning the total inability to work or carry out normal activities. By comparison, employees with cancer averaged 31.5 days out of role; those with migraine headaches, 32.3 days.
Even if they don’t miss work entirely, one of the most significant impacts on people suffering from panic attacks in the workplace is missed deadlines. Deadlines can induce panic attacks in those with the disorder, which might even contribute to missing them altogether. People experiencing panic attacks also are more likely to avoid their colleagues at work hoping to avoid interpersonal conflict, and in the process impairing a collaborative environment.
All of this has a cost. Health care costs alone average $6,812 per year for patients with panic disorder, compared with $1,287 for an average patient in a medically matched control group, according to Health Lumen. And that’s not including the indirect costs of workplace disruption. Unfortunately, current treatments for panic attacks are often ineffective or unavailable for many people. Psychotherapy is useful for some patients with panic attacks but the long duration of treatment can pose obstacles for access, affordability, and adherence over time.
High dropout rates are reported for talk therapy, particularly the exposure-based therapies commonly used to address panic. Commonly used medications, particularly antidepressants, often produce unwelcome side effects that lead to adherence problems and high dropout rates. Benzodiazepines are not recommended for extended use and carry risk for abuse and dependence.
Most people are familiar with the symptoms of a panic attack, even if their own panic is as short-lived as an onstage walk to a microphone. Symptoms include shortness of breath, racing heart, chest tightness, dizziness, and lightheadedness. In extreme cases the panic is recurring and accompanied by intense fear of impending death and feelings of losing control or ‘going crazy. These symptoms can be misinterpreted as a medical emergency, only to be later ruled out as a cardiac or neurological event. Patients are often told their symptoms are ‘all in your head,’ or are referred out to a primary care or medical specialist for testing or follow up.
Faced with increasing rates of recurrent panic attacks, employers and health plans need new approaches to help their employees and members with treatments that are safe, effective, and produce minimal side effects. Amid pandemic limits on in-person care, they also need treatments that can be delivered remotely.
Fortunately, new treatment approaches now exist, based on multiple published studies addressing an important underlying physiological factor in panic attacks. Surprisingly, this emerging science reveals an unexpected contributor to panic attacks – hypersensitivity to carbon dioxide (CO2). In experimental lab settings, most panic sufferers react with pronounced fear and physiological distress when exposed to a single breath of air with high CO2 concentration. Subsequent research has shown that treatments aimed at normalizing respiratory rates are effective in minimizing or eliminating symptoms, and they are now available in clinical practice.
Highmark Health, the nation’s fourth-largest Blue Cross Blue Shield plan, has made one such treatment available to its 5.6 million members in Pennsylvania, Delaware and Virginia. The FDA-cleared non-medication digital therapeutic targets the symptoms of both panic disorder and its cousin, Post Traumatic Stress Disorder (PTSD). During twice-a-day 17-minute sessions that are conducted at home, the patient inhales and exhales in sync with rising and falling audio tones and adjusts their respiratory volume to keep their exhaled CO2 in the normal zone, guided by a graphical display on a tablet. Weekly telehealth coaching provides support, encouragement and guidance to help patients achieve their breathing targets.
Several peer-reviewed studies have confirmed the regimen can reduce or eliminate symptoms of panic disorder in just 28 days. The most recent study, which was funded by Highmark Health and conducted at Alleghany Health Network in Pittsburgh, found that 68% of treated patients were in remission one year post-treatment and 91% had significant symptom reduction as long as one year after treatment. Research on panic disorder and PTSD at the VA Palo Alto Health Care System measured significant improvement in over 80% of participants who used the regimen, and remission in 50% of participants.
Coincidentally, the Highmark study also found the treatment significantly lowered health care costs. Following a claims analysis that documented sharply higher medical costs for individuals with panic disorder compared to matched controls, the study found a 35% reduction in any-reason medical costs for the year after treatment with the device. Pharmaceutical costs were slashed by 68%, and Emergency Department costs fell by 65%.
Until we have brought Covid-19 completely under control, it is good to know that employers and health plans have options for helping their employees, members, and patients deal with the most acute mental health impacts of the pandemic. Just as the transmission of the virus can be prevented by the adoption of new habits like mask-wearing, we are learning that the acute symptoms of panic attacks can be prevented with new self-management skills.
All we needed was to take a fresh look at the problem.
Robert Cuyler, PhD, is chief clinical officer of Freespira, Inc.
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