When we find ourselves in an anxiety provoking situation or facing a threat to our safety, it’s normal to experience sensations of panic. When we panic we have a fight or flight response, meaning our body gears up to defend itself or to flee. This involves a release of adrenaline, increased heart rate, rapid breathing and a number of other physiological changes designed to provide us with a boost in energy so that we can survive in a life-threatening situation. However, many people (around 11% annually in the US) experience episodes of panic in the absence of any tangible threat. This is known as a panic attack and can often occur completely out of the blue. Whilst it’s very helpful for the body to go into fight or flight mode when faced with a would-be assailant, when standing in line at the grocery store it can be extremely distressing!
Due to the physiological changes that occur when we panic, attacks are often experienced by the sufferer as indicative of a heart attack or other serious physical health problem. It is common for sufferers to feel that they may be dying – indeed, a sense of impending doom is one of the symptoms of an attack – resulting in trips to the emergency room. If the psychological cause of the episode is not identified, it can leave a sufferer searching for a physiological answer for their experiences and convinced that they are seriously ill.
Whilst panic disorder refers to regular and recurrent experiences of panic attacks, attacks can also be present within other emotional and mental health problems such as anxiety disorders, phobias and depression. As such, panic attacks are not a diagnostic category in themselves, but rather a feature of other diagnostic categories depending upon the particular contexts in which they manifest. It is often the case that a panic attack can be an isolated or rare event associated with a period of stress or a particularly anxiety provoking situation and not necessarily indicative of a mental health disorder.
The diagnostic criteria for a panic attack (see The Diagnostic and Statistical Manual of Mental Disorders, fifth edition) includes a period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly:
- Palpitations, and/or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or being smothered
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- De-realization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going insane
- Sense of impending death
- Paresthesias (numbness or tingling sensations)
- Chills or hot flashes
Panic attacks can also be a feature of, or mimic, some physical health conditions and therefore it is also worth investigating if there is a medical issue causing or contributing to your symptoms. Assuming you’re assured it’s a panic attack you’re having, here are some ways to help yourself:
Simply knowing that you are experiencing a symptom of anxiety rather than suffering a medical emergency can itself offer significant comfort. Learning about panic attacks, their causes and effects and in particular, the fact that they are not causing harm to you can help prevent escalation of panic and reduce anxiety between episodes.
It’s easy after a panic attack to avoid situations that are associated with the trigger for an episode or evoke similar physiological responses (such as avoiding exercise due to breathlessness). Although understandable, avoidance as a strategy is flawed in that it prevents us from learning that such situations are not in fact dangerous and that experiences of anxiety, whilst unpleasant, do not harm us. Whilst avoidance may minimize the regularity of panics, it doesn’t do anything to support us to learn to manage them. Instead, move towards the discomfort, and expose yourself slowly to the thing which you are afraid of.
Another helpful way of managing panic is by recognizing that it is just a feeling and a collection of sensations. Panic escalates when we ascribe meaning to these responses, such as by moving from the experiences of physical sensations to the interpretation that we are dying or having a heart attack. Learn instead to observe the feeling, without judging it, fighting it or interpreting it. Mindfulness exercises help with developing this capacity to observe and accept feelings.
Deep breathing has the effect of calming the parasympathetic nervous system. The simplest way of achieving this is through abdominal breathing. This means breathing into the abdomen, rather than high in your chest. To check you’re doing it correctly put one hand on your belly and one on your chest. The one on your belly should move up and down and the one on your chest stay still.
If you are experiencing panic attacks it’s likely there is something else going on that you need to pay attention to. While you are flooded with anxiety during the panic moment, it may be that you are disconnected at other times. It may be that you are under stress and not taking steps to address it, or you have developed a habit of excessive worrying. Ask yourself, what is this experience trying to tell me?
Even if you don’t know the exact cause of your panic attacks, undertaking stress reducing activities can help to minimize your overall anxiety levels and enhance your capacity for relaxation. Simple strategies such as exercising, getting plenty of sleep, avoiding excess alcohol and caffeine can all make a difference.
If you’re struggling to understand why you feel like you do, or find your anxiety attacks are impacting on your ability to feel comfortable and enjoy life, then it might be wise to seek help. This could be by talking to a trusted friend or family member or by seeking out a licensed professional who can work with you to help you understand why you feel like you do and teach you techniques to manage your anxiety more effectively. Most of all, don’t suffer in silence, panic attacks can be overcome and treated successfully. They can even be a useful opportunity to learn more about yourself and how to use your emotions to guide you rather than overwhelm you!
Medina, J. (2016). Panic Attack Symptoms. Psych Central. Retrieved on January 22, 2017, from https://psychcentral.com/disorders/panic-attack-symptoms/
American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 214–217, 938, ISBN 0890425558