When Words Alone Were Not Enough

Luca, 41, a chef in Rome, has had panic attacks for three years. His heart pounds, his chest tightens and he fears he will die. He avoids lifts, trains and even busy kitchens. He tried a few sessions of therapy and learn…

Luca, 41, a chef in Rome, has had panic attacks for three years. His heart pounds, his chest tightens and he fears he will die. He avoids lifts, trains and even busy kitchens. He tried a few sessions of therapy and learned breathing and thought-testing, but the attacks kept coming, and his low mood deepened.

His therapist, who was honest rather than defensive, said that therapy works best when matched to the problem, and that sometimes a doctor's review is needed too. She suggested he see a psychiatrist while continuing therapy, and said that medicine and talk therapy often work well together.

Luca's mother was against it, saying only faith and strong will could help. Luca explained he was not giving up his faith, but adding a medical check. The doctor looked at his health, his sleep and his history, and discussed options with him, including how long help may take and what side effects to watch for.

Therapy continued with graded steps: he rode the lift for one floor, then three. Over several months the panic eased and his confidence returned. He later told a colleague, "Therapy taught me what to do, and treatment gave me the room to do it."

How to recognise it

• Repeated panic attacks with avoidance of places.

• Low mood or hopelessness alongside anxiety.

• Little change after several weeks of therapy.

• Daily life and work affected.

• Family disagreement about how to get help.

What this story explains

Therapy is not always enough alone; combining it with medical care, and choosing the approach to fit the problem, can help. It also shows how faith and family views can be respected.

Probable root causes

• Anxiety that builds through fear of fear and avoidance.

• Stress and sleep loss.

• Possible medical or physical factors.

• Family beliefs that delay treatment.

What to do

1. Keep attending therapy and report honestly what is and is not helping.

2. Ask the therapist or doctor whether a medical review would help.

3. Have a check-up to exclude physical causes.

4. Discuss medicine options and concerns openly with a doctor.

5. Practise gradual exposure to avoided situations as agreed.

6. Involve family by explaining the plan calmly.

Whom to consult

• Psychiatrist when symptoms are severe or not improving with therapy.

• Family doctor for a first physical check.

• Clinical psychologist for graded exposure and CBT, the thought-and-behaviour approach.

Do and don’t

How to behave and communicate

• Explain to family: "This is a health condition, like diabetes; I need proper care."

• Be honest with the therapist: "This is not helping enough."

• Listen to family worries before replying.

• Stay calm and respectful in disagreement.