What Triggers Panic Attacks?
The triggers for panic attacks or what causes a panic attack could be many and varied but causes are usually either internal or external.
Causes for a panic attack tend to be related to:
1. Stress and Anxiety
2. Misinterpretation of physical symptoms
3. Trying to relax
Panic attacks can also 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.
People will often avoid situations that either trigger panic attacks, situations that just become associated with panic attacks, or places where escape to safety may be difficult.
In extreme cases people stop leaving their homes and become agoraphobic or fearful of a wide range of situations that feel unsafe.
What does a Panic Attack Feel Like?
My patients describe a panic attack as feeling like they are going to die or lose their mind. Their heart begins to pound, they feel light headed, and they have tunnel vision. They are terrified and fear what might come next.
Symptoms of a Panic Attack
The symptoms of a panic attack may include; a pounding heart, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, feeling dizzy, faintness, feelings of unreality, feeling detached from your body, fear of losing control, fear of going crazy, fear of dying, numbness or tingling, and chills or hot flashes.
What Triggers Panic Attacks?
Beyond other anxiety disorders, fears, and worry there are physical and mental processes responsible for panic attacks and anxiety.
They are evolutionary biological processes that are meant to help us in times of danger but often become a nuisance when there is no danger.
1. Stress and Anxiety
Tension and stress from daily life events and activities has a way of building up and overwhelming our perceived ability to cope with them.
Relationships, school performance, work performance, financial difficulties, and physical health issues start to pile up on each other.
This can overwhelm a person’s psyche and cause feelings of helplessness and feeling like there is no way to cope with these life stressors.
Apprehension about future events, phobic situations, and a perception of not being able to cope further leads to feelings of helplessness and feeling out of control.
Other anxiety disorders such as PTSD, social anxiety, and phobias all have the potential risk to trigger panic attacks.
To protect its’ self, the body’s sympathetic nervous system turns on the flight, fight, or freeze mechanism.
Now the person feels a sense of internal danger and experiences symptoms of a panic attack.
2. Misinterpretation of Physical Symptoms
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.
The cycle of panic is then triggered and the person experiences a panic attack.
Catastrophic thinking causes the amygdala to turn on the body's fight or flight or freeze stress response and triggers the vicious cycle of panic.
The Vicious Cycle of Panic
The Trigger can be a thought or a situation
You then Perceive Danger. The thought or situation can be of an internal (Physical) or external (Phobic) threat. An example of an unhelpful thought for an internal threat is “My heart feels like it is beating fast. I must be having a heart attack.” An example of an unhelpful thought for an external threat is, “This plane that I’m on could crash.”
This sends a message to your amygdala to sound the alarm and causes more Fear and apprehension of the perceived danger.
The sympathetic nervous system automatically kicks in and increases physical Body Sensations (pounding heart, sweating, shaking).
You Label the Sensations as Catastrophic, you have a panic attack, and this confirms the danger.
Your Perceived Danger increases and the cycle continues. This becomes a vicious cycle of panic. Avoiding the situation or running away also falsely confirms that the danger is real and gives more power to future panic attacks.
Sympathetic nervous system
The sympathetic nervous system is responsible for the “Stress Response” also called the “Fight or Flight or Freeze Response” in order to provide us with the internal resources to deal with a real threat or danger.
Just remember that the sympathetic nervous system "Sympathizes" with you in times of danger.
It is fast, automatic, and is activated mostly without your conscious control. It is responsible for the physical sensations of panic or the fight, flight, and freeze stress response.
During times of stress or danger, your senses send messages to your amygdala in the brain.
The small almond shaped amygdala is your emotional center and is responsible for causing the emotional feeling of fear.
When your amygdala gets the message that there is danger, it sounds the alarm for your sympathetic nervous system to release adrenaline to help you react to the danger. This causes the symptoms you feel during a panic attack.
The thinking part of your brain also gets this message so that you can determine if the danger is real or not. If you have the thought or belief that the danger is real, then your amygdala will get that message from your thoughts and it will continue to sound the alarm which will cause your hypothalamus to dump more hormones into your blood stream, further fueling a panic attack.
3. Trying To Relax
Many of my patients will explain having a panic attack triggered while trying to relax.
This could be while getting a massage, laying down for bed, or just sitting and watching TV.
It seems that the body and sympathetic nervous system are saying, "It's not time to relax! You are still in danger!"
Yes, panic attacks can be triggered by simply letting your guard down, especially if you don't usually do this and you are continually under stress.
If you are on guard constantly for any sign of danger your body will have a tough time turning that off when it's time to relax and this could trigger a panic attack.
What is the 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. CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring your automatic thinking.
CBT sessions also provide education on the symptoms of panic disorder.
Cognitive restructuring is used to identify and dispute unhelpful, automatic, and irrational thinking so that you can create highly effective thoughts with the power to alter your emotions and behavior.
An example of an irrational thought is “What if I can’t escape from that place. I’ll have a panic attack and lose control.”
We develop beliefs about ourselves, other people, and the world. These beliefs influence how we think. If you believe that the world is basically a dangerous place, then your thoughts will follow. If you believe that you are defective and not a capable person, then your thoughts will reflect those beliefs.
It is not the public place that causes the anxiety, it’s your thinking and beliefs that cause the fear and anxiety.
Exposure therapy, also known as prolonged exposure, 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 and anti-depressants.
Benzodiazepines are quick acting sedatives that are generally safe and effective for short term use.
However, the long term use of benzodiazepines is associated with the risk of developing tolerance, dependence, and possible other adverse effects.
Commonly prescribed benzodiazepines are:
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.
Commonly prescribed anti-depressants are:
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.
Commonly prescribed Beta Blockers:
Metoprolol (Lopressor, Toprol-XL)
More On How To Stop Panic Attacks:
How to Stop A Panic Attack: 7 Steps
What To Do In A Panic Attack: 4 Great Ways to Cope