What is a panic attack?
Imagine you are walking along the street or you are in the middle of a busy supermarket and you are suddenly overwhelmed by feelings of panic. You begin to perspire, your heart beats loudly, your chest tightens and you struggle to breathe…you are unsteady on your feet, perhaps wanting to run, but feeling unable to do so. Your whole body trembles and you experience dizziness; hands and feet tingle as you gasp for air; you feel a choking or smothering feeling, and with thoughts racing and feeling faint, you worry about losing control, or worst still dying…This is what a typical panic attack might feel like.
Of course, not everyone who experiences a “panic attack” will have all these symptoms, but they can be extremely frightening, and to those who have them regularly, they can be so disabling to the point where sufferers avoid situations and places which they associate with these attacks. Often agoraphobia and panic attacks go hand in hand. For some people, so-called “phobic panic attacks” are associated with a deep rooted fear, such as seeing a spider or being in shops or crowded places where they feel unable to escape. Some people have panic attacks with no obvious external cause and these are known as spontaneous panic attacks. These can be brought about by stressful situations or events; running upstairs or even laughter may trigger attacks in people who are prone to them.
Panic attacks usually start with one or two symptoms, perhaps awareness of heart beating or a hot flush rising to a crescendo, peaking in a few seconds; sometimes they can last for a few minutes but seldom for long.
The actual cause of panic attacks can vary, but in essence it could be described as a surge of intense anxiety. This often leads to the individual taking deep breaths in order to try to overcome anxious thoughts and heightened bodily awareness. Over-breathing in this way leads to an excess of oxygen in the body which gives rise to physical discomfort and causes a vicious circle leading to heightened awareness of symptoms and further panic. Panic. Panic attacks are extremely common with many people experiencing one or more at some stage in their lives.
Recognising panic symptoms
The first step in overcoming panic attacks is recognising the symptoms:
- Rapid heartbeat
- Feeling flushed (or cold)
- Tightness or pain in chest
- Feeling dizzy
- Tingling in hands/arms or numbness
- Feeling nauseous or sick
- Choking sensations
- Shortness of breath
- Worry over loss of control
- Fear of death
- Fear of fainting
- Fear of going crazy
- Feeling unreal
Panic attacks from a CBT perspective
From a CBT perspective we look at dividing the symptoms into three broad areas:
Physical Symptoms – As we can see from the list above, physical symptoms are plentiful. Things like rapid heartbeat, shortness of breath and tightness or pain in the chest make this a very real and frightening experience.
Cognitive symptoms – This is to do with our thoughts (cognitive = thoughts). While the physical symptoms are hard to miss, it is the cognitive component that gives rise to anxiety. For example, we experience pain in the chest, shortness of breath with tingling in the hands and arm region. Our thoughts turn to the possibility of us having a “heart attack.” Images of us lying on the floor, clutching chest with a crowd of onlookers and a paramedic in attendance. Our anxiety levels rise and when we focus on our symptoms they seem to magnify. Our sense of panic and fear rises as a vicious cycle is created, In our mind thoughts are racing.
Behavioural symptoms – This is where you quite simply want to ditch the shopping trolley and escape. This is where you worry that you will have a panic attack if you enter certain places (particularly if you experienced a panic attack there before) or where you avoid people or crowded places. (Avoidance can also be cognitive, such as when you use distraction). Likewise, certain behaviours such as drinking water, reaching for the mobile phone, taking rescue remedy or medication are what we call “safety behaviours.”
The vicious panic cycle
Although you might think that panic attacks simply happens, this is not the case. There is a distinct pattern that can be clearly seen when we look closely at the experience. You will see that various things happen in a sequence of events –
- The trigger – This might be a sudden thought, perhaps brought on by an image in our mind or perhaps by a bodily sensation. It might be as a result of a frightening experience we are involved in.
- Automatic thought – “I’m in danger,” or “Oh no, not a panic attack,” or “What’s happening?”
- Emotional response – Usually fear or raised anxiety.
- Bodily reaction – A feeling of breathlessness, of chest tightening, light headedness, heart begins to race, feeling increasingly hot and uncomfortable.
- Focus on sensation – We zoom in on our bodily reaction, scanning for symptoms.
- Sensations increase – With all our attention on focused on our bodily symptoms they magnify as adrenalin and noradrenalin race through our body. Our brain sends messages to the heart to beat faster in order to send more oxygen rich blood to our major muscles, our blood pressure rises and our body prepares to fight off the imagined predator about to attack us.
- Imagine the worst – “Is it a heart attack, will I faint, am I going to lose control, will I make a fool of myself, will others notice”… The list of possible negative outcomes increases Our natural urge tells us to avoid, escape or engage in some kind of safety behaviour in order to save ourselves.
- Panic – The cycle is complete and we in our mind we are back at point 2 and so 2 to 8 are repeated, sometimes several times over and panic escalates.
Your seven step plan to managing panic attacks.
- The first thing to remember is that while panic attacks do not feel pleasant they will pass and they are not dangerous. If it will help, write this down on a piece of paper, laminate it and carry it with you to remind yourself.
- Stay calm – turn your attention to your breathing. Take slow gentle breaths into your tummy, place your hand above your tummy button and focus on the gentle rise and fall of your diaphragm.
- Try to reduce your anxiety by saying to yourself, “everything will be alright” or “calm.” Try to let the fear go moment by moment.
- Shift your attention to your muscles, gently stretch and tense them, then relax them and allow tension to slip away.
- Accept what is happening, don’t try to fight it. The feelings will pass, be patient, stay with them and watch them as they gradually fade away.
- Stay in the situation, no need to escape. Simply focus on relaxed breathing and calming down,
- Pa attention to reducing your discomfort by using your breathing as your friend. Stay in the present and rest assured that your panic will pass.
There are a number of very good websites and organisations you can turn to for advice and support. These include:
The voluntary charity – No Panic – www.nopanic.org.uk
The information and resource service – Centre for Clinical Interventions – www.cci.health.wa.gov.au
Cognitive Behaviour Therapy (CBT) resources – GET.gg – www.getselfhelp.co.uk
Remember, panic attacks are very straightforward to treat and a good therapist will be able to help you to overcome them in no time at all. To find a CBT therapist near you look up BABCP – www.babcp.com or contact BPS – www.bps.org.uk to find a psychologist trained in CBT. Alternatively you may contact me at – www.stevecliffordcbt.com
Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist
Please post a comment if you have a good tip to help overcome panic attacks?