• Coping with Panic Attacks

    Many people experience panic attacks over their lifetime. For some it is a one-off experience, whilst for others it is something that occurs regularly. For whomever it is, it can be a terrifying experience, characterised by intense anxiety symptoms, fear and often significant physiological changes such as racing pulse or tightness in the chest. For many people their first panic attack can feel like a heart attack, even prompting a visit to the emergency department of the hospital. It can be very confusing, even invalidating to be told that it was “just” a panic attack.

    Panic attacks may happen in response to a specific, obviously identified trigger, such as speaking in public, seeing a spider or being in a crowded place. Confusingly however, some panic attacks seem to arise when there is no easily identified trigger. *

    Everyone experiences panic differently. However common symptoms of a panic attack include:

    • Increased heart rate
    • Rapid breathing or shortness of breath
    • Dizziness
    • Feeling of tightness in the chest or even down one arm
    • Weakness
    • Shaking
    • Pupil dilation
    • Sweating
    • Nausea
    • Faintness
    • Numbness or tingling
    • Difficulty swallowing/feeling that you might choke
    • Hot and cold flushes

    Looking at the list above it’s no wonder some people feel like they’re having a heart attack!

    In addition to the physical symptoms, panic attacks are often characterised by:

    • Feelings of terror or intense fear about dying
    • Intense fear about not being able to manage the situation or regain control
    • A strong desire to “escape” the situation
    • Feeling of being completely overwhelmed
    • Feeling that you are going “crazy”

    The intense physical nature of panic attacks is linked to a strong and often over sensitive “Fight/Flight/Fright” response and many of the physical symptoms of panic (listed above) can be linked to the actions of adrenaline on the body.

    All humans have an inbuilt threat-response system that has developed since our earliest days in order to keep us alive. The Fight/flight/fright response originates in the oldest “reptilian” part of our brain and it’s action is overseen by our limbic system. Both of these areas are very quick acting but not driven by “logic” or reason. In response to a situation that our brain perceives as life-threatening, we have a surge of adrenaline, and then cortisol, which increases our heart rate, blood pressure and rate of breathing and sends blood where it is needed in the body in order to mobilise us for action. Logical thought is temporarily overridden whilst we attend to the threat. All of these responses are very helpful if we are actually facing a life threatening situation, such as a wild animal or a fire. However for people suffering from panic attacks, these responses are triggered more frequently, over non-life-threatening events. It can be intensely uncomfortable and exhausting having such strong responses to everyday events.

    It is possible to have one or two panic attacks in your life. However many people have them regularly and this, combined with the ongoing fear of having them and routine avoidance of situations that may trigger them is called a “Panic Disorder”. In addition, many people have panic attacks in conjunction with other issues such as a generalised anxiety disorder, depression or phobias.

    There are various factors that may contribute to panic attacks developing:
    Biology: Some research has shown that the chemicals in our brain that regulate feelings and physiological sensations can become imbalanced, affecting the way we think, feel, and act, often resulting in conditions such as anxiety or depression. There are differing points of view on this in the research community as to how or why this happens. Certainly some people are more “sensitised” than others to the fight/flight/fright response, whether this is related to neurotransmitter release, over-sensitive response of the limbic system or impaired self-soothing systems.

    Lifestyle Factors: Many people report that their anxiety and panic symptoms worsen with reduced sleep, poor eating or the use of alcohol, drugs or other stimulants such as caffeine. In particular stimulants can mirror the effects of a fight/flight/fright response and are not helpful in someone working to reduce their anxiety. Equally some people report that they are more likely to have panic attacks the day after using alcohol.

    Environment/Family History: You are much more likely to develop panic disorder if someone in your family has had it as well. Family history can relate to both genetic predisposition (“nature”) and also how you were raised (“nurture”): whether you regularly watched someone close to you experience panic and whether you were taught skills for managing anxiety well.

    Trauma: Traumatic life experiences that caused intense fear, may be replayed by someone when they feel scared or anxious. When the individual thinks about the traumatic event or if they are reminded of it, they may begin to feel similar physiological responses to those they felt during the original traumatic experience. These physiological responses can trigger a panic attack.

    A person can also experience a delayed form of panic due to the suppression of emotions over many years. Ongoing suppression of emotions can lead to a physiological build-up which can eventually result in panic attacks.

    How is panic treated?

    Medical Treatment and Review: The first step is to see your Doctor to ensure you are not experiencing any physical health problems. As mentioned, often the symptoms of panic can be similar to those of a heart attack or other serious medical conditions. If your doctor clears you of medical complications, then it would be wise to approach a psychologist, counsellor or psychotherapist to assist you with treating your panic. Anti-anxiety or anti-depressant medications are sometimes prescribed to treat panic disorder. These medications can be helpful in the short term and work best in combination with psychotherapeutic intervention, described below.

    Cognitive-behavioural therapy: is the most commonly used method to treat panic disorder. This form of therapy assists the person to recognise and alter patterns of thinking and behaviour that trigger their anxiety.

    Mindfulness: is the ability to be fully engaged with the present moment; to be conscious of your thoughts and feelings and to accept things the way they are, without judgement. Mindfulness is an ancient practice that has been found to be effective in the treatment of panic and anxiety. It is a way for us to observe ourselves, our thoughts, our feelings and our place in the world without criticism or negative self-talk. It teaches us how to calm and centre ourselves when we are fearful that our anxiety may develop into a panic attack. Therapies that incorporate mindfulness include Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy and Gestalt Therapy.

    Gestalt Therapy: is a form of psychotherapy that, similar to mindfulness, focuses on the here and now experience of the individual. It is through relationship with the therapist that the client develops awareness about how they live their life, form relationships and deal with issues such as stress, anxiety, panic and depression. The focus of Gestalt therapy is more on what is happening throughout the therapy process, rather than what is being discussed (the actual content). The emphasis remains on what is being done, thought and felt during the session rather than on what has been, might be, could be, or should be. This process of ‘being in the present moment’ helps resolve anxious feelings and panic.

    Lifestyle Modification: It is important with any mental health issues to also address any physical health problems and work to improve sleep, diet and exercise if this is an issue. It is also important to reduce or cease use of licit and illicit substances in order to help your body and mind find a better equilibrium.

    What to do when having an attack:

    • Breathe – slow deep breaths all the way to your stomach. Inhale and exhale deeply and slowly.
    • Remind yourself you are not dying, and that you have been cleared of any medical ailments by your Doctor. This is an attack that will be for a brief period of time. This is just one moment in time that will pass.
    • Do not resist the panic. Telling yourself to stop, get over it, or trying to distract yourself can often exacerbate the panic. Accept that it is a panic attack and continue to breathe deeply.
    • Be aware of your thoughts. Pay attention to what you are thinking. Remember that your negative or unhelpful thoughts are just ‘thoughts’ that come and go, they are not ‘facts’.
    • Sit or lay in a comfortable position and allow the panic to pass in it’s own time, remembering to breath all the way to your stomach. Advise those around you of what is happening if you are at work or in a public situation and ask for assistance if you feel you need it.

     

    If you or someone you know are experiencing panic attacks and you would like support in managing them, please call Eliza on 0417910911.

     

    *It is possible that the person is over responding to small, natural changes in their body state (ie diurnal variations in adrenaline or cortisol levels) or there has been a trigger but it was imperceptible. Either way the treatment is often the same and is still helpful.

    References

     

    DSMIV, American Psychiatric Association, 1995

     

     

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