In this article, you will learn what a panic attack is, learn about the causes of anxiety, find out what processes trigger its onset, how a therapist can help, and finally, how you can manage the symptoms yourself.
What is anxiety and how to deal with it?
You’ve certainly heard many times about what anxiety is, but what exactly does it mean when you hear that someone or yourself is experiencing severe anxiety that hinders daily functioning? Anxiety is a common problem we experience, it refers to insecurity and insecurity. Everyone worries from time to time about various things, such as preparing for a job interview, meeting a partner’s family for the first time, or the behavior of a child. That is, anxiety is an emotion, and in this state we often experience a sense of danger coming from outside or coming from inside the body, accompanied by many symptoms of mental, motor and autonomic arousal. It lasts until the source of our anxiety disappears. Experiencing anxiety can be potentially harmful to you especially when you experience it in excess or inadequate to the stimulus that triggers it. Anxiety expands into more and more areas, hindering our functioning. If your experience of anxiety is having a debilitating effect on your daily life, it’s a sign to reach out for help. Anxiety symptoms create feelings of dissatisfaction, lack of control and suffering. Let’s look at an example: “If I don’t get the job – I’ll break down.” Such negative predictions about the future, called catastrophizing, have their genesis in distorted thinking and “writing” negative scenarios. The sense of catastrophism is often expressed by the phrase “What will happen if …? E.g. “What will happen if, while driving my car, I get a heart attack, lose control of the car and cause an accident?”. Such thoughts scare us a lot, we focus all our attention on them, analyze them and develop various strategies to combat them.
So, when you recognize in yourself the symptoms of an anxiety attack in the area:
- cognitive, anxious thoughts, e.g. “I’m losing control.”, anxious thoughts about the future: e.g. “It’s over, I can’t stand it.”, anxious beliefs, e.g. “Only weak people can be afraid.”;.
- physical, when you experience excessive physical activation of your body in relation to the situation, physical symptoms e.g. elevated heart rate and rapid heartbeat as a response to the vision of shopping at the mall. Symptoms in this category of symptoms can often be mistaken for a belief that a heart attack is imminent;.
- behaviors, when you notice that you begin to avoid anxious situations (e.g., driving), also situations similar to the underlying one that causes anxiety (e.g., exercise), protect yourself just in case the situation is difficult for you (e.g., always have a phone in your hand, just in case, to call for help).
Panic attack – symptoms
There are many different anxiety disorders. One of the most common is anxiety disorder with panic attacks, the first panic attack, usually begins in the third decade of life (Morrison, 2015) .
Panic anxiety is characterized by recurrent unexpected panic attacks that are not limited to specific stimuli or situations. Panic attacks are often distinctive episodes of intense anxiety or discomfort that begin suddenly, reach maximum intensity within a short period of time and last from a few to several tens of minutes. Occasionally, panic attacks occur at specific times for no apparent reason, such as panic attacks at night. In addition, the occurrence of panic attacks, is characterized by a persistent fear of recurrence or anxiety about the risk of experiencing further panic attacks and their consequences (e.g., loss of control, or the sensation of having a heart attack). A person experiencing anxiety, fears for his life. In addition, at any time he may experience again an unpleasant experience, which increases his alertness and heightens his anxiety. Can panic attacks cause heart problems? The answer is no, experiencing severe anxiety can result in a very unpleasant state and a feeling of being out of control. However, it does not lead to serious medical consequences. Of course, the long-term experience of medication, affects our well-being and our body in general negatively.
This leads to significant impairment in personal, family, social, educational, occupational or other important areas of functioning. These symptoms are not a manifestation of another medical condition and are not caused by the effects of a substance or drug on the central nervous system. What exactly can a person who struggles with unexpected panic attacks experience ? Referring to the International Statistical Classification of Diseases and Health Problems ICD-11, panic anxiety will manifest itself in somatic symptoms (body symptoms):
- palpitations or accelerated heart rate,
- sweating,
- trembling of the body,
- sensation of shortness of breath,
- tightness in the chest,
- a sense of unreality of the environment, depersonalization, derealization
- nausea or abdominal pain,
- a feeling of dizziness, headache
- chills or hot flashes,
- tingling or lack of sensation in the extremities (i.e., paresthesias),
- fear of loss of control or derangement
- anxiety of anxiety, anticipatory anxiety
- fear of imminent death (ICD 11, ver.2/2022).
Panic anxiety with agoraphobia
A type of anxiety disorder singled out in the ICD-11 is panic anxiety with agoraphobia. Agoraphobia is characterized by pronounced and excessive fear or anxiety that occurs in response to a number of situations from which escape may be difficult or help may not be available, such as using public transportation, being in crowds, being alone outside the home (e.g., in a store such as standing in line) (ICD-11, ver. 2/2022). As a result, recurrent panic attacks can become the norm. People experiencing panic attacks often try to cope by avoidance – a fight-or-flight strategy, placing a myriad of restrictions on themselves, such as avoiding the places or circumstances in which the panic attack occurred.
Causes of panic attacks
Anxiety disorder is the most common mental health problem in the world. The World Health Organization (WHO) indicates that 1 in 14 people suffer from an anxiety disorder (Tracz-Dral, 2019). So if you are experiencing this problem – you are not alone. Anxiety disorder is more common in women and ranks first in the category of mental health problems, in men it is second only to addiction. Research shows that this difference between men and women may be due to the role played by female sex hormones, menstrual cycles, other physiological differences as well as differences in the structure of the brain structures responsible for anxiety (Jalnapurkar, 2018).
Causes of panic anxiety and risk factors include:
- a previous family history of the disorder,
- severe life stress,
- major changes in your life, such as divorce or the birth of a child (Milne, 2020).
Panic attack-mechanisms of onset
There are several models by which the onset and persistence of panic attack disorder can be diagnosed. The model proposed by Clark (1986) is one of the most useful models to describe the symptoms and treatment of this prevalent problem. At its heart is the assumption that panic attacks are led by a certain sequence of events that occur suddenly. The attacks themselves result from a “misguided, catastrophic” interpretation of physical and psychological sensations (e.g., dizziness leads to fainting, or an accelerated heartbeat leads to a heart attack). Because the sequence is circular in nature, the model has become known as the“vicious circle model.” The vicious circle, culminating in a panic attack, consists of a sequence of thoughts, emotions and sensations that can begin with any of the elements. The former have their genesis in certain ideas about ourselves, others, people and the world. They are so deep that they may be unconscious and we do not even articulate them to ourselves. We accept these truths as self-evident, absolute are crucial. They can be triggered in a lowered mood state or be active most of the time. When this happens, a person interprets through this prism the current situations he or she is experiencing, even when, from a rational point of view, a given interpretation may be manifestly invalid. Panic anxiety exacerbates somatic symptoms that we over-interpret, e.g. “surely it’s a heart attack,” “I’m going to die already.” A person focuses only on information that confirms the truth of a key belief, omitting information that contradicts it (Beck, 2012).
In contrast, once panic anxiety has set in, three other factors contribute to its maintenance: selective directing of attention to somatic symptoms, ad hoc protective behaviors, and avoidance (Wells, 2010).
Figure 1: Clark ‘s cognitive model of panic (Wells, 2010).
Let’s see it using the example of Ms. Annie, who tells the story:
“I was just on the bus, going to work, as I do every day, I left my gaze on the window in front of me, when I realized that there were a lot of people inside and the window was closed, I felt danger. Of course, I’ve known for a long time that this bus is sometimes crowded, I’ve already ridden it more than once, along the same route, however, a feeling of anxiety overwhelmed me. It was more like this irrational fear that I would pass out, I could feel people almost pushing against me and less and less air left. It was awful. I felt that there was less and less of it, and it was getting harder and harder to breathe by the minute, I don’t know why myself. I started to panic a lot, breathing very fast, I held on tightly to the holding handle, I couldn’t do anything, because it scared me a lot. I had to leave at the nearest stop but I still didn’t calm down, I was very scared, this feeling of being out of breath accompanied me for some more time. I don’t know when it passed, I don’t remember now.”
Ms. Anna was traveling on a bus, she stopped her gaze on the glass and felt danger being in this situation.
Figure 2: Cognitive model of panic, using Ms. Ania as an example. Own elaboration.
Patients experiencing panic attacks develop various protective behaviors as a result of threat assessment. This is a classic psychological mechanism. They are based on the use of evasion, distraction, unwanted decisions, withdrawal from public life , camouflage, analysis of any situation aimed at “getting rid” of unwanted emotions, sensations and thoughts. The common protective behavior of running away is a consequence of beliefs about oneself and the surrounding reality. Other protective behaviors, such as walking along walls and leaning against something, are seen in people who interpret the feeling of “soft legs” as an impending fall. On the other hand, those who perceive shallow breathing as a sign of suffocation may breathe deeper and faster, leading themselves to hyperventilation symptoms. Often during a panic attack, you may breathe too fast, which was the case with Ms. Annie. The accelerated and deepened breathing caused by the anxiety situation, and therefore hyperventilation, resulted in a reduced concentration of carbon dioxide in the body, causing Ms. Ani’s body to go into a state of heightened alertness and mobilization. Protective behaviors sustain panic anxiety in two ways. First and foremost, they prevent people from questioning their belief in misinterpretations and recognizing that the non-occurrence of a disaster is the result of using a protective behavior. Ms. Anne thought she was about to pass out, so she kept breathing faster and faster. Second, some of these behaviors can exacerbate somatic symptoms, which in turn increases belief in the occurrence of a disaster (Wojtas, 2010). Ms. Anne squeezed the handrail the more her hands became sweaty, the more she believed she was about to pass out.
Treatment of panic attacks
How is the treatment of panic attacks carried out? The recommended therapeutic stream that is effective in treating this type of difficulty is cognitive-behavioral interactions. Cognitive-behavioral therapy for panic anxiety, based on Clark’s model described above, is a combination of cognitive and behavioral techniques designed to help understand and modify distorted, and dysfunctional, thoughts and beliefs related to anxiety. Cognitive-behavioral therapy is one of the most effective forms of treatment for panic attacks.
Panic anxiety therapy involves about 10-15 sessions held on average once a week. At the beginning of the therapeutic process, in addition to making a diagnosis, the therapist educates on what cognitive therapy is, the role of the person in treatment, what anxiety is, what its causes are, why it occurs, what it manifests itself as and/or what elements influence its maintenance. In addition, the therapist tries to introduce the basic tenets of cognitive-behavioral therapy, namely the relationship between thoughts, emotions and behaviors. Helpful at this stage is the use of reading (bibliotherapy), which will help to experience panic attacks in a safer way.
Another task of therapy is a joint analysis of the last anxiety attack, taking into account the accompanying somatic sensations, emotional reactions and misinterpretations of these sensations. The therapist constructs a specific version of the vicious circle (as in the case of Ms. Annie).
The following typical elements are then identified and incorporated into the model: triggers for unexpected attacks, protective behavior and avoidance. It can be helpful to use panic attack diaries, which should be kept daily as part of personal work. Once the cognitive model of the panic attack is developed together, the catastrophic mindset is gradually verified using verbal techniques and behavioral experiments (Wojas, 2010). The therapist can use psychoeducational experiments, such as those based on pairwise associations, with the goal of observing how thinking affects anxiety and accompanying somatic sensations. Other methods of work may include the technique of cognitive reattribution, the aim of which is to look for evidence of the validity of the judgment, to thoroughly understand the alleged catastrophe, as well as the evidence on which this interpretation is based. Subsequently, behavioral experiments can be introduced into the therapy program, which can help challenge belief in misinterpretations (Wells, 2010). They introduce active induction of panic sensations in a safe therapeutic care setting. Therapeutic interventions can effectively treat panic attacks.
Equally important to the work is the focus on reversing avoidance and reducing protective behavior. Such an exposure experiment can allow the person to experience anxiety and discover that it does not lead to disaster. It is carried out in a balanced manner, from the easiest to the most difficult, with the full consent and support of the person.
The last sessions in cognitive-behavioral therapy are devoted to working on relapse prevention. Together, a “contingency plan” is established for recurrent panic attacks. Once therapy is completed, you can become your own therapist.
The good news is that panic anxiety can be cured in a relatively short period of time, thanks to therapeutic interactions.
What to do if a panic attack happens to someone close to you, how to help?
If you accompany a person experiencing a panic attack, encourage her to breathe consciously and, above all, breathe calmly with her. If possible, put her hand on your chest so she can “feel” your calm breathing and thus calm her own. While doing so, speak in a calm voice, for example, “Can I touch you?”. Assure the other person that everything is fine and you will be there for them as long as they need you. However, throw out from your vocabulary such terms as “don’t dramatize” or “stop panicking.”
- Together, try not to resist a panic or anxiety attack. When experiencing a panic attack, our first reaction is to try to control it. Often, when experiencing this unpleasant state, we try to seek help, which can create a feeling that something very dangerous is happening. Try not to do this, because the less control you have over yourself in anxiety, the easier it is to deal with it.
- If the panic attack is just beginning or the person experiencing the attack is able to take a relatively calm breath, you can also help by talking. Engage the person in conversation on any topic, and you can also talk to yourself.
- Panic attack exercises. Try the “5-4-3-2-1” technique, which involves distraction. Try to divert the person’s attention while experiencing strong tension. Gently ask the person to first look around and try to name five things he sees around him. Then, she listened to name four things she hears. Later, she turned her attention to three things she is able to touch. The next step is to engage the sense of smell – she pointed out and named two smells she can smell. The last step is to engage taste. To do this, she can drink water or at least taste her own mouth.”
- You can ask a person and together with her count out loud to ten. This is an easy task, but one that at the same time requires focus and distraction from overpowering anxiety.
- If, you are helping, remember that catastrophic thoughts of “What will happen if…” are a person’s premonitions that don’t necessarily come true. Try to work on making the person you are helping feel safe. Breathing exercises can regulate emotions. Relaxing in a comfortable chair sounds trivial, but it is effective. Keeping the feet comfortably on the floor, the person should focus on breathing in and out slowly and how he or she is feeling (Bemis, 2022).
- It happens (although very rarely) that a panic attack is severe enough to lead to serious events like loss of consciousness. In such a situation, emergency services should be called as soon as possible.
Panic anxiety-how to deal with it
Below are selected concepts on your own ways to cope with the problem.
- How we talk to ourselves is largely responsible for our anxiety and panic. Continuing inappropriate internal dialogues based on shame and putting prohibitions on ourselves can intensify the problem and prolong the feeling of anxiety. Ms. Anna from our story often encountered a key belief in her own incompetence, and interpreted it in a negative and self-critical way. Meanwhile, you can deal with panic anxiety by having the right internal conversations. A good place to start is by developing the belief that we have the right to feel anxiety.
- When you give yourself the right to feel panic anxiety, reduce your demands, let go of perfectionism, and explore the world of relaxation. It’s a state of consciously losing control and letting go of trying to wrestle with fear. Each of us is capable of learning how to relax. The forms of relaxation can be very individual, and we need to be very forgiving of ourselves if we don’t succeed in fully relaxing right away.
- Diaphragmatic breathing can be an effective calming method for panic disorder. Lie down on the floor, keep your feet apart. Place your hands (or a book) on your stomach, directly under your chest. Breathe slowly, through your nose. With each breath, your hands (or book) will rise, fall, as your diaphragm muscles move. As you inhale, imagine shuffling the air from your toes to the top of your head. As you let the air out, hold it for a moment, then let it out, relaxing at the same time. Feel how the floor supports the weight of your body. Repeat this exercise several times. The most appropriate time to use this exercise is when you are relaxing, not when panic is at its peak. After doing a certain number of exercises, you can apply the technique when you find yourself in a drug-inducing situation.
- Start working with your body. One of the more proven methods is Jacobson Training is a relaxation workout that regulates emotions in our body.
- A proper diet is essential for maintaining good mental health. You don’t have to follow a specific diet, but you may discover that some foods are empowering and some increase your feelings of anxiety. This is the case with sugar. When we become anxious, our blood sugar levels rise anyway, so any additional portion of it supplied with food, intensifies the stress we feel. It is worth remembering that caffeine adversely affects the mood of people experiencing panic attacks. Also, alcohol and panic attacks have adverse effects and can result in the amplification of anxiety. World dietary guidelines for prevention recommend a Mediterranean diet, consuming adequate amounts of omega-3 fatty acids. A diet rich in fiber, based mainly on plant-based products rich in vitamin B (e.g., almonds, avocados) and magnesium (e.g., nuts, seeds, spinach) and replacing white bread and flour with whole-grain products are increasingly recommended (Naidoo, 2019).
In panic anxiety, the most important thing is to take care of ourselves. Whether we try to manage the symptoms ourselves or get help from specialists.
If, after reading this article, you feel that you have been experiencing “panic anxiety,” i.e., irreversible and unexpected anxiety attacks followed by persistent anxiety about the occurrence of another one, I believe you want to and know how you can help yourself. The good news is that panic anxiety treats well and the symptoms go away relatively quickly.
If you are struggling with panic anxiety, schedule an appointment – online psychotherapy.
Guest post:
iwona Izbicka, MA
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