Panic attacks are frightening episodes of intense fear that trigger physiological reactions without apparent cause. They can develop into panic disorder. Fortunately, they are treatable through psychological treatment.
What is a Panic Attack?
A panic attack is a sudden episode of intense anxiety or fear that triggers severe and frightening physical reactions when there is no real danger or apparent cause. You might think you’re losing control, having a heart attack, or even dying. People who have recurrent, unexpected panic attacks and have fears of them happening again that limit their lives may have panic disorder.
Panic attacks may happen once, or you may experience repeat episodes. They can be triggered by a specific situation where you feel endangered. They trigger your fight-or-flight response. Additionally, they may occur as part of another disorder like panic disorder, social phobia, or depression. They are treatable, and there are strategies you can use to reduce or eliminate the symptoms of panic, regain your confidence, and take back control of your life.
What Symptoms May Be Involved?
Panic attacks start suddenly, and symptoms tend to peak within minutes. You may feel fatigued after it is over. Some of the signs and symptoms include:
- Sense of impending doom or danger
- Fear of dying, losing control or going crazy
- Rapid, pounding heart rate or heart palpitations
- Sweating
- Trembling or shaking
- Shortness of breath, hyperventilation, or tightness in your throat
- Chills
- Hot flashes
- Nausea or upset stomach
- Abdominal cramping
- Chest pain or discomfort
- Choking feeling
- Headache
- Dizziness, light-headedness or faintness
- Numbness or tingling sensation
- Feeling unreal or detached from your surroundings.
The signs and symptoms develop abruptly and usually reach their peak within 10 minutes. They rarely last more than an hour, most ending within 20 to 30 minutes. They can happen anywhere and at any time.
What Causes Panic Attacks?
It is not known what causes panic attacks, but these factors may play a role:
- Genetics (runs in families).
- Significant stress, including major life transitions.
- Personality, which is more sensitive to stress or prone to negative emotions
- Certain changes in the way parts of your brain function
Panic attacks share some of the same symptoms as when your body’s natural fight-or-flight response is activated. Therefore, some believe that they are the triggers of your fight-or-flight response when there is no apparent danger.
Medical conditions and other physical causes can also cause panic attacks. So, it’s important to see a doctor to rule out the following possibilities:
- Mitral valve prolapse is a minor cardiac problem when one of the heart’s valves doesn’t close correctly.
- Hyperthyroidism (overactive thyroid gland).
- Hypoglycemia (low blood sugar).
- Stimulant use (amphetamines, cocaine, caffeine).
- Medication withdrawal.
What is the Difference Between Panic Attacks and Panic Disorder?
Panic attacks are relatively common, and having one does not mean that you have a panic disorder. For example, if you are feeling very stressed or overtired or if you have been doing excessive exercise, you might have one. However, this does not mean that you have a panic disorder.
Panic attacks only become a significant problem if you are regularly worried about having more attacks or if you are afraid that something terrible will happen because of a panic attack. For example, people worry that they will faint, embarrass themselves, have a heart attack, go crazy, or die.
In panic disorder, the panic attacks are unexpected and unpredictable. It is common for people with other anxiety disorders to have them, but this is not panic disorder. For example, people with a phobia of dogs might have a panic attack whenever they are near a dog. But in this case, it is expected, and the person is afraid of the dog, not the panic attack.
Symptoms of panic disorder often start in the late teens or early adulthood and affect more women than men. However, it can occur with any age or gender.
Factors that may increase the risk of developing them include:
– Family history of panic attacks or panic disorder
– Major life stress, such as the death or severe illness of a loved one
– A traumatic event, such as sexual assault or a severe accident
– Major changes in your life, such as a divorce or the addition of a baby
– Smoking or excessive caffeine intake
– History of childhood physical or sexual abuse
When Does a Panic Attack become Panic Disorder?
While many people experience just one or two panic attacks without further episodes or complications—and there’s little reason to worry if that’s you—some people go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks combined with significant changes in behaviour or persistent anxiety over having further attacks.
You may have panic disorder if you:
– Experience frequent, unexpected panic attacks unrelated to a specific situation.
– Worry a lot about having another one.
– Are behaving differently because of them, such as avoiding places you’ve previously panicked.
While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause severe disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:
Anticipatory Anxiety
Anticipatory anxiety is when instead of feeling relaxed and like your usual self in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is often present and can be highly disabling.
Phobic Avoidance
Phobic avoidance is when you begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be harrowing or help would be unavailable if you had one. When taken to its extreme, phobic avoidance becomes agoraphobia.
Nocturnal Panic Attacks
During a nocturnal panic attack, you wake up while experiencing a sudden episode of fear and distress. These attacks occur while you’re in stage 2 or 3 of non-REM sleep and generally only last between two and eight minutes. However, the unpleasantness of the experience can make it difficult for you to go back to sleep or even lead you to try to avoid sleep.
Nocturnal panic attacks are common in people with panic disorder, affecting more than half of all patients. Some experts theorize that a fear of uncertainty or vulnerability causes these types of panic attacks. In other words, you feel anxious about your inability to react to threats while asleep.
Complications of Panic Attacks and Panic Disorder
Panic attacks and panic disorders can end up affecting almost every area of your life if left untreated due to your fear of having another panic attack.
They can lead to more negative effects in your life, including:
- Development of specific phobias, such as fear of leaving home, driving or doing certain activities.
- Frequent medical care visits for health concerns and other medical conditions
- Avoidance of social situations
- Problems at work or school
- Depression, anxiety disorders and other psychiatric disorders
- Increased risk of suicide or suicidal thoughts
- Alcohol or other substance misuse
- Financial problems
Agoraphobia
For some people, panic disorder may include agoraphobia — avoiding places or situations that cause you anxiety because you fear being unable to escape or get help if you have a panic attack. Or you may become reliant on others to be with you to leave your home.
Although it can develop at any point, agoraphobia usually appears within a year of your first recurrent panic attacks.
If you’re agoraphobic, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be fearful of having one where you wouldn’t be able to get help. Because of these fears, you start avoiding more and more situations.
For example, you may begin to avoid:
- Crowded places such as shopping malls or sports arenas.
- Cars, airplanes, subways, and other forms of travel.
- Social gatherings, restaurants, or different situations where it would be embarrassing to have a panic attack.
- Physical exercise in case it triggers panic.
- Certain foods or drinks that could provoke panic, such as alcohol, caffeine, sugar, or specific medications.
- Going anywhere without the company of someone who makes you feel safe. In more severe cases, you might only feel safe at home.
What Can You Do?
No matter how powerless or out of control you may feel about your panic attacks, it’s important to know that there are many things you can do to help yourself. The following self-help techniques can make a big difference in helping you overcome panic:
Psychoeducation
Educating yourself about panic attacks and anxiety can normalize them and make them feel less frightening. Your knowledge can help you gain a more grounded perspective.
Grounding and Relaxation Skills
Practicing forms of relaxation, such as yoga, mindfulness, meditation, and progressive muscle relaxation, can strengthen your body’s relaxation response. Learning deep breathing skills that can relax you can benefit you if you notice the sensations leading up to a panic attack, as relaxation is the opposite of the feelings of a panic attack.
Grounding skills can be used during a panic attack to reassure yourself and ground you in the present moment.
Reframing Your Experiences
Reframing your thoughts around the sensations of a panic attack can lower the intensity and distress of the experience.
Self-Care
Self-care can lower anxiety levels, which can reduce your chances of experiencing panic attacks. Some of the most helpful forms of self-care are the following:
- Exercise regularly.
- Get enough restful sleep.
- Avoid smoking, alcohol, and caffeine.
Get Support
Connect with family and friends, as anxiety can get worse if you feel isolated.
Support groups with other people who experience panic attacks can create connections around shared experiences and include sharing strategies and coping techniques that may help you.
Attending psychotherapy can support your emotional distress while working on preventing future panic attacks.
Treatment for Panic Attacks
Psychotherapy
The most effective form of professional treatment for tackling panic attacks, panic disorder, and agoraphobia is therapy. Even a short course of treatment can help.
Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy focuses on the thinking patterns, beliefs, and behaviours that are triggering your panic attacks sustaining panic disorder, and helps you look at your fears in a more realistic light.
Exposure Therapy
Exposure therapy for panic disorder allows you to experience the physical sensations of panic in a safe and controlled environment. It allows you to slowly gain confidence in dealing with panic and its sensations.
Exposure therapy for panic disorder with agoraphobia includes exposure to the situations you fear and avoid is also included in treatment. It helps you learn that the situation isn’t harmful and that you control your emotions.
Medication
Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, medication only relieves the symptoms, so it needs to be combined with other treatments that address the underlying causes of panic attacks. Medications used may include:
- Antidepressants. They must be taken for several weeks before they begin to work, so you must take them continuously.
- Benzodiazepines. Taking these anti-anxiety drugs during a panic attack can provide rapid relief of symptoms since they act very quickly (usually within 30 minutes to an hour).
Xanax
Alprazolam (brand name Xanax) is the benzodiazepine that is prescribed the most. Xanax slows down the hyperactivity in your nervous system from panic attacks. It helps get you to a more relaxed state.
However, like other benzodiazepines, Xanax should only be used for the short term. You can develop an addiction if you take it too often.
Helping Others Experiencing a Panic Attack
Someone suffering a panic attack can be frightening. Simply telling them to calm down or minimizing their fear won’t help. When you help your loved one ride out one, you can help them feel less fearful of future ones.
- Stay calm yourself. Being calm, understanding, and non-judgmental will help your loved one’s panic subside quicker. Your relaxed state can bring calmness to the person suffering a panic attack.
- Focus your loved one on their breathing.
- Doing something physical can burn off some of the stress.
- Get the other person to do an active grounding skill, such as asking them to name five things around them.
- Encouraging them to seek help.
Conclusion
Panic attacks are frightening and distressing to experience. There may be multiple causes for them. However, you can do something about them, and there are ways to treat them so they don’t bother you as much or stop occurring.
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