Anxiety Help

Current, useful information about anxiety disorders and their treatment.

Panic Attacks: What They Are and How to Stop Them

What they are and how to stop them.

While most people have heard of panic attacks, those who have never had one may have a difficult time appreciating what terrifying experiences they can be. A full-blown panic attack is not just a strong feeling of anxiety but rather an explosion of terror that the brain reserves for only the most horrifying events. Panic attacks are also frequently associated with intense body sensations, and thus are often misinterpreted by those experiencing them as dangerous, physical reactions. Despite being relatively common, panic attacks are often not well understood, and as a result many people suffer needlessly because they are unaware that what they are experiencing is psychological in nature and has an effective treatment.

Panic Attack Basics

The first and most important thing to know about panic attacks is that they are not dangerous. Panic attacks feel dangerous because they engage our brain's emergency system which tells us we are in imminent danger. But like a fire alarm placed to close to a toaster, the emergency systems in the brains of people with panic attacks are issuing false alarms.

Secondly, panic attacks are very treatable and respond exceptionally well to the right type of therapy. Because panic attacks are so unpleasant and often seem like a physical medical problem, people often assume that some type of medication will be necessary for effective treatment. While panic attacks may occur in the course of a disorder for which medication is appropriate and useful, the treatment of panic attacks themselves generally does not require medication. In fact, some anxiety medications prescribed for panic attacks may end up hindering full recovery in the long run.

What is a Panic Attack?

A panic attack is a discrete episode of intense fear that usually peaks within ten minutes and occurs in the absence of any real danger. In contrast to anxiety, which is about bad things that might happen, panic typically involves a sense that something terrible is happening right now. The focus of panic can vary widely, but people experiencing a panic attack frequently fear they are dying, going crazy, or losing control.

Because panic involves the perception of current or imminent danger, the brain sets in motion our "escape" reflexes. These are the physiologic processes evolution endowed us with to help us get out of life-threatening situations. When these processes are engaged, they can result in the following set of symptoms, some or all of which may be experienced during a panic attack.

  • Increased heart rate or palpitations
  • Sweating
  • Trembling or shaking
  • Shortness of breath or a feeling of being smothered
  • Choking sensations
  • Chest pain or discomfort
  • Nausea
  • Dizziness or lightheadedness
  • Feelings of unreality or being detached from oneself
  • Numbness or tingling sensations, particularly in the extremities or around the lips
  • Chills or hot flashes

Even though panic attacks are harmless, given this list of physical sensations, it's not hard to understand why someone having a panic attack might believe something physically dangerous was happening to them.

What Causes Panic Attacks?

Panic attacks come in two general categories - situational and unexpected. Situational panic attacks are triggered by a particular scenario while unexpected panic attacks seem as though they come out of nowhere. For example, someone with a strong fear of public speaking might have a situational panic attack before having to give a speech to a large audience, while someone with unexpected panic attacks would have a difficult time identifying why the panic attack occurred.

For those with situational panic attacks, removing themselves from the feared situation usually will decrease the anxiety and bring the panic attack to an end. Unfortunately, avoidance of feared situations, while effective in the short term, can lead to longer-term problems as the number of avoided situations may grow larger and there is never an opportunity to learn that the situations are actually safe.

Unexpected panic attacks, while they seem like they happen spontaneously, are usually driven by a fear of certain bodily sensations that are misinterpreted as meaning the person is dying, going crazy, or losing control. Over time, people with unexpected panic attacks often develop a fear of panic attacks themselves and then misinterpret the bodily sensations caused by anxiety as meaning that another panic attack is imminent. These types of attacks can be understood as a type of positive-feedback loop between scary thoughts and anxiety-related sensations where a sensation, such as shortness of breath or a rapid heart rate, causes a scary thought, such as "Oh no, this feels like the beginning of a panic attack," which then causes even more shortness of breath and an even faster heart rate, which then leads to another thought such as "It's getting worse, I am definitely about to have another panic attack," which then leads to even more anxiety-related sensations, and so on until the panic attack reaches a peak.

How to Stop Panic Attacks

Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that has been shown to be very effective for the treatment of panic attacks and anxiety disorders in general. Unlike some other types of psychotherapy, CBT involves being taught specific techniques and can be done on your own with the help of a book. That being said, working with a CBT-trained therapist may provide better or more rapid results, particularly for those with more severe anxiety disorders.

In general, CBT takes a three-pronged approach to treating panic attacks and anxiety disorders by targeting the physical symptoms, the inaccurate thinking, and the problematic behaviors that are at the root of the problem.  

While a detailed description of CBT is beyond the scope of this article, there are several excellent CBT-based self-help books including Mastery of Your Anxiety and Panic, The Feeling Good Handbook, and Mind over Mood that are very effective for treating panic attacks and anxiety disorders in general. Additional information on anxiety disorders and their treatment can be found at http://www.anxiety.org/

 

 

Jason Eric Schiffman, MD, MA, MBA is the chief resident psychiatrist at the UCLA Anxiety Disorders Program and Editor in Chief of Anxiety.org.

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