A panic attack is a very brief episode of intense fear and discomfort that lasts on average approximately 20 minutes. The panic may occur abruptly, reach a peak within 10 minutes, and then begin to subside. A person may return to a reduced state of anxiety or to a state of calm.
It is not uncommon for a person to have multiple panic attacks throughout the day but may be shorter in length and will eventually stop.
The body naturally seeks to maintain equilibrium and as a result it will trigger the parasympathetic (rest and digest) system which will return the body to more of a state of calm.
What is a Panic Attack?
A panic attack is the body’s evolutionary response to a perceived external threat. The fight, flight, or freeze response is helpful if we encounter a wild animal poised to eat us.
The adrenaline that begins flowing through our bodies aids in our escape and survival.
When the external threat is defeated or evaded, the symptoms disappear.
For most people today, however, there is no wild animal. It’s a false alarm that signals an internal threat or danger. It’s a misperception of danger. After experiencing a first panic attack, the fear becomes about experiencing another one.
Panic attacks can be expected or unexpected. An example of an unexpected panic attack is called a nocturnal panic attack.
This is when a person wakes from sleeping in a state of panic. Expected panic attacks occur in specific situations that are either anxiety provoking or situations where a person experienced a panic attack and now avoids it for fear that it will trigger another one.
Specific phobias such as fear of flying and public speaking could also trigger a panic attack due to increased anxiety and fear of the event itself.
When panic attacks are expected, a person will begin to experience anticipatory anxiety that could eventually lead to a panic attack. This anticipatory anxiety may make it seem like the panic attack lasts longer.
Symptoms of A Panic Attack
The symptoms of a panic attack may include;
A pounding heart
Shortness of breath
Feeling of choking
Feelings of unreality
Feeling detached from your body
Fear of losing control
Fear of going crazy
Fear of dying
Numbness or tingling
Chills or hot flashes
What Causes A Panic Attack?
Stress and Anxiety
Chronic stress adds up overtime. If you don’t find a way to cope with the stress, your body will respond with anxiety. This leaves you vulnerable to panic attacks.
A buildup of stress from life events such as losing a job, death of a loved one, or divorce may cause symptoms of anxiety that could lead to a panic attack. Our bodies experience a physiological response to these stresses that could lead to symptoms of a panic attack.
This is when you feel anxious and tense. This anxiety is often caused from your fear of having future panic attacks. This “fear of fear” may occur frequently and can act as a trigger for having a panic attack.
Catastrophic thoughts turn on the body's fight or flight stress response that could lead to panic attacks.
Misinterpretation of bodily sensations is another common trigger for a panic attack. Two minutes after running up a flight of stairs, a pounding heart and shortness of breath is misinterpreted as an internal threat such as a heart attack or other cardiac event.
This misinterpretation causes fear of survival which turns on the flight or freeze response. This increases the heart rate and physical discomfort further and confirms the person’s misinterpretation of physical danger.
Behaviorally avoiding situations that are associated with panic attacks only temporarily relieves anxiety. Avoidance actually strengthens anxiety and panic.
When having a panic attack you most likely have been running away from the situation, avoiding situations you associate with panic attacks, or becoming over-controlled when feeling anxious.
Avoiding confirms and maintains the belief that the situation and/or the symptoms are dangerous. You might not have a panic attack by avoiding a particular place but you have also reinforced that whatever you just avoided is dangerous.
What are the Risks for Panic Disorder?
Anyone who experiences frequent panic attacks, worries about future panic attacks, and changes their behavior because of it, could be diagnosed with Panic Disorder if these symptoms persistent beyond one month.
Family history of anxiety: Some research indicates that first-degree relatives of patients with panic disorder have higher rates of panic disorder than relatives of patients with major depression and relatives of healthy controls (Goldstein et al 1994).
Respiratory illnesses: Conditions such as asthma can cause breathing issues that lead to shortness of breath and feeling dizzy. This could cause the fear of internal physical danger, triggering a panic attack.
Environment: Physical and psychological abuse, traumatic events, the death of a loved one, divorce, abandonment, and maladaptive behaviors learned from parents pose a greater risk for the development of an anxiety disorder such as panic disorder.
Those with an anxiety disorder may have inherited anxiety from their families as a result of stressful family and life circumstances.
Other anxieties: Other anxieties such as PTSD, social anxiety, and phobias all have the potential risk to trigger panic attacks.
What Are The Complications Of Panic Attacks?
Agoraphobia with Panic Disorder
The fear of public places can cause intense anxiety that often leads to panic attacks.
After experiencing a first panic attack, people fear experiencing the next one.
People will avoid situations that they believe will cause a panic attack. This can ultimately lead to Agoraphobia if you experience a panic attack in a public place, in a crowd, while using public transportation, or where escape seems difficult. The place is associated with extreme fear, anxiety, and the public place will be avoided.
Agoraphobia symptoms include fear and avoidance of:
Using public transportation (e.g., automobiles, buses, trains)
Being in open spaces (e.g., parking lots, marketplaces, bridges)
Being in enclosed places (e.g., shops, theaters, cinemas)
Standing in line or being in a crowd
Being outside of the home alone
These situations cause anxiety because you fear that there is no easy escape and you will not find help if you have a panic attack or other embarrassing symptoms.
Your fear and belief that these situations are dangerous is out of proportion to any actual danger that these situations may pose. You either actively avoid these situations, need to have a companion with you, or you endure intense fear and anxiety in these situations.
Treatment For Panic Attacks
If you believe you could have Panic Disorder it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
Treatment often consists of a combination of medication and psychotherapy. Medication helps take the edge off the physical symptoms of anxiety and psychotherapy helps to challenge irrational thinking and beliefs that lead to the panic attacks.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving. You learn different ways of responding to the symptoms of a panic attack.
Also known as prolonged exposure, exposure therapy is a form of CBT. As with most anxiety disorders, in order to learn how to overcome the symptoms of panic disorder, you need to have the experience of successfully managing the symptoms.
This often means exposing yourself to the thoughts, images, and the public places that trigger the panic attacks, and then applying the coping strategies until the thoughts, images, and public places no longer produce the same level of fear.
Please consult with your primary care physician or a psychiatrist regarding the use of any medication.
Medication can help reduce the symptoms of anxiety that occur in public situations that you have been avoiding such as school, work, and any other necessary public location.
Commonly prescribed medications include benzodiazepines, anti-depressants, and beta blockers.
Benzodiazepines are quick acting sedatives that are generally safe and effective for short term use.
Anti-depressant medications are also effective at reducing symptoms of anxiety on a daily basis. This helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.
Beta Blockers are used to treat high blood pressure, heart arrhythmias, and migraines. They are also prescribed for off-label use by physicians to help reduce the physical symptoms of anxiety.
Beta blockers have the ability to control rapid heartbeat, shaking, trembling, and blushing in response to a panic attack. Beta blockers do not interfere with cognitive performance and are by far my favorite for removing the jitters before a speech.
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