Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry
Abstract
:1. Introduction
2. Method
2.1. Study Design
2.2. Participant Selection
2.3. Research Team and Reflexivity
2.4. Measurement
2.5. Data Analysis
2.6. Authenticity and Trustworthiness
2.7. Compliance with Ethical Standards
3. Results
3.1. The Life and Pain of Patients with PD
3.1.1. Fear of Confined or Large Places
Especially in the elevator… outside, in the park … I feel anxious regardless of where I am…I am worried that the elevator won’t open … Sometime in the past, I don’t know if the elevator was new or not, but it was too quiet. I thought that it broke down. Panic came instantly …(C)
3.1.2. Anxiety about Somatization Symptoms and Avoidance
I’m afraid to go to supermarkets or coffee shops, the crowded places, so I order a lot of things online. It was so hard to go to the supermarkets… I went to a large market once, but it was so hard …(G)
I have a precursor before the panic attack comes… When the precursor comes, it’s okay if I take medicine as soon as possible… It gets a lot harder when I cannot do that … I always prepare for the precursor … for everything… Especially if the precursor comes out while driving… it’s very dangerous … so I try not to drive as much as possible… and not to go so far… my spouse usually drives a lot.(A)
3.1.3. Thoughts of Death and Fear
The doctors in the hospital always say everyday … that I’ll never die with this disease… But in my everyday life, this disease is always connected to death… Anxiety starts to come …for example, it’s called a panic attack, when I run into it, I just think I will die. I am always afraid of the fear of death… I feel I am going to die.(A)
3.1.4. Limitations of Living and Longing
Now coffee… it contains caffeine. So now, when I talked with the doctor, he told me to avoid having caffeine as well as stress, in my first visit to him… It’s been more than 5 years since I stopped having coffee. But although there are many coffee shops around, I don’t go there… I envy those who go to the coffee shop, and sometimes I want to have a cup of coffee there.(D)
3.1.5. Side Effects of Medication
I have the side effects that I want to do nothing and I just want to sleep… These are psychotropic…When I joined an online community for panic disorder and worked, I saw many people talk the same just as me. If I take medicine, I become lethargic, have little vitality, and go limp.(G)
I feel comfortable when I take medicine in the hospital… If I don’t have it, I feel anxious. People with panic disorder probably feel like me…
3.1.6. Longing That No One Knows
This photo was taken with the meaning that I was alone… there is loneliness in my mind. Because other people don’t know and I’m the only one who knows about the disease … When the arms are broken, they can be seen to others, but this disease cannot be seen, so if I don’t explain … I don’t make the opportunities to meet people as much as possible, so I don’t meet people and I feel a bit lonely and a little isolated.(E)
3.2. Difficulties of Physical Activity Perceived by Patients with Panic Disorder
3.2.1. Avoidance Due to Panic Attacks or Anticipatory Anxiety Experienced during Physical Activity
I don’t want to think about it, but if I do, I went to the emergency room because I thought I would die from hyperventilation while playing soccer… That’s why I don’t play soccer anymore…(E)
I played badminton… I was playing badminton, but my heart suddenly seemed to be beating fast and I couldn’t breathe well… I stopped playing and got help from others … I have been to the emergency room by calling 119.(B)
I haven’t exercised, but sometimes I’ve tried … Whenever I exercised … I felt like I was breathing with this straw in my mouth. This means that I am out of breath. Now I cannot overcome this, so it’s very difficult to exercise.(G)
3.2.2. Happy Memories, but Now I Can’t …
I took a picture of a tennis racket … It’s been a while since I had panic disorder … before that, I really liked playing sports. So, the happiest time for me is when I exercise, and I miss those times a little … and … I haven’t used the racket since I had panic disorder although I have it in my car … So, whenever I open the truck and look at the racket, I think it was really good time in the past, but why is it like this now?(F)
3.2.3. Anticipatory Anxiety about Places of Physical Activity
This is a photo of a shower room … After exercising, I must take a shower. Because it is hard for me to enter such a narrow place … I won’t do it… when I exercise, because I have to take a shower again, I have to go into a narrow space … that is continuously connected, to me …(B)
3.2.4. Lack of Desire to Exercise
It seems that not only the desire for exercise but also the desire for diverse lifestyle often disappears. I feel like I am drowsy and thoughtless …(D)
3.2.5. Nevertheless, Physical Activity Is a Challenge
I bought a smart watch … because the heart rate can be checked with it … because I keep looking at the heart rate. Now I check the watch when I feel a little breathless and anxious … if my heart rate is normal, I think I feel relieved. I have a habit of always wearing the watch and checking it whenever I move.(C)
When I exercise, there must always be a lot of people … if there is no one, I don’t exercise. I need a partner for any other reason… well… I need people around me … if I’m in an emergency, they can take me to the emergency room or treat me … and yes … so actually I cannot exercise often.(F)
It means that I check a location of a hospital in order to go there quickly when I have a panic attack. Of course, I know the hospital on the way I always go, and if I go a different route for the first time, I always check the nearby hospital first before I start to go. It is the same with exercise. Even if I cannot participate in sports sometimes, if I go with my friends, I think that I can do it because I like playing sports and I am good at it … I check the location of a hospital that I can get to as soon as possible and then I go to watch the sports.(A)
4. Discussion
4.1. To See the World through Their Eyes
4.2. Patients with PD and Barriers to Physical Activity
4.3. Phyical Activity for Patients with Panice Disorder
4.4. Symptoms in People with Panic Disorder Vary Widely, Making It Very Difficult for Doctors to Recommend Certain Physical Activities. I. Neuropsychiatrist
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Participant | Gender | Age | Marital Status | Family/ Inmate | Monthly Income (USD) | Education Level | Regular PA Participation | Remarks |
---|---|---|---|---|---|---|---|---|
A | Male | 52 | Single | Alone | 1500 or over | College graduation | NO | |
B | Male | 42 | Married | Children | 1500 or over | College graduation | NO | |
C | Male | 54 | Married | Spouse | 1500 or over | High school graduation | NO | |
D | Female | 38 | Single | Relative | 500 or over | Grad school graduation | NO | |
E | Male | 42 | Married | Spouse | 1500 or over | College graduation | NO | |
F | Male | 46 | Married | Spouse | 1500 or over | College graduation | NO | |
G | Female | 42 | Married | Spouse | 1500 or over | College graduation | NO | |
H | Female | 34 | Married | Single | 500 or over | High school graduation | NO | Drop-out |
I | Male | 47 | Married | - | - | Neuropsychiatrist | - | Medical Advice |
Stage | Details | Operator |
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1 | Finding significant statements with photographs | All researchers |
2 | Integration, organizing and collecting significant statements with photographs | Kim, Buttler, Gritzmacher |
3 | Classifying categories (e.g., pain and physical activity) through the classification of important statements | Kim, Buttler, Gritzmacher |
4 | Finding main themes and sub-themes in separated categories | All researchers |
5 | a) Repeated discussion and reflection of the research team to determine the final theme b) Holistic analysis based on overall statement, descrption, theme, and interpretation c) Sharing data with research participants for theme confirmation | All researchers & participants |
6 | Creating report | Kim |
Main Theme | Sub-Themes | Title of Photos |
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The life and pain of patients with PD |
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Longing that no one knows |
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Difficulties of physical activity perceived by patients with panic disorder |
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Kim, K.-O.; Ryu, J.-H.; Chung, H.-R.; Butler, M.K.; Gritzmacher, D. Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry. Int. J. Environ. Res. Public Health 2021, 18, 8140. https://doi.org/10.3390/ijerph18158140
Kim K-O, Ryu J-H, Chung H-R, Butler MK, Gritzmacher D. Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry. International Journal of Environmental Research and Public Health. 2021; 18(15):8140. https://doi.org/10.3390/ijerph18158140
Chicago/Turabian StyleKim, Kyung-O, Jae-Hyeong Ryu, Hae-Ryong Chung, Marcia K. Butler, and Deborah Gritzmacher. 2021. "Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry" International Journal of Environmental Research and Public Health 18, no. 15: 8140. https://doi.org/10.3390/ijerph18158140