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Anxiety

What Causes Your Panic Attacks?

Identifying your triggers is important for overcoming panic attacks.

Key points

  • A panic attack can be particularly frightening when you don't know what caused it.
  • You can identify your unique triggers (body sensations, thoughts, and feelings) by examining patterns with your panic attacks.
  • Knowing your triggers can help you come up with strategies to overcome panic attacks.
Tero Vesalainen/Shutterstock
Source: Tero Vesalainen/Shutterstock

You are sitting at home, watching a suspenseful movie. Out of the blue, your heart starts pounding. You feel like you can't breathe, your face gets hot, and your fingers start tingling. You've had these sensations before, and your mind goes back to a familiar thought:

I'm having a heart attack, and I'm dying!

However, you are still alive, and you are reading this article. It turns out it was another panic attack.

Panic attacks can be frightening, especially when they are unexpected. Suppose you have a panic attack before a test or before giving a speech or when you see police lights flashing in the car behind you. It still can be scary and extremely uncomfortable. However, the fear can reach epic proportions when the attacks seemingly come from nowhere.

Knowing more about your triggers can help defuse some of your anxiety during a panic attack and ultimately lead to overcoming them.

The fight-or-flight response

The fight-or-flight response is your body's reaction to danger. Having a powerful anxiety response can be helpful. If you were crossing the street, and a motorcycle came barreling towards you, you would need to have a quick reaction to get out of the way.

However, some people are prone to having an extreme stress response in situations that don't warrant it. When there is no outside stressor, people try to figure out the reason for their intense body sensations. They often think there is something physically (or mentally) wrong with them.

Why do people have panic attacks?

Biological and genetic factors make more people more prone to experiencing repeated panic attacks. Here are some other risk factors:

Sensations: High anxiety sensitivity: Research has shown that people with recurring panic attacks tend to have high anxiety sensitivity (fear of anxiety sensations). They pay too much attention to their bodies to ensure everything is OK.

It's normal to experience changes in body sensations throughout the day, and most people don't notice them. However, those with high anxiety sensitivity can misinterpret harmless body symptoms as dangerous and set off a panic attack.

Thoughts: Beliefs about the risk of physical and mental problems: Some people think they are at significant risk of physical or mental issues. For example, maybe they had a history of physical illness in childhood or lost a loved one to a heart attack. Or perhaps they have a relative with schizophrenia and worry that they might develop the disorder at some point. Or maybe they fainted and then became fearful of fainting.

Thus, someone feeling vulnerable in these ways might misinterpret anxiety or panic symptoms as a sign of having a heart attack, "going crazy," or fainting. People with these types of fears also tend to have high levels of anxiety sensitivity.

Situations: Fear of situations where previous attacks occurred: For those with recurring panic attacks, certain situations become associated with panic attacks. For example, someone might have been driving on the freeway on the way to a job interview, got anxious, and then had a panic attack. As a result, they might associate freeway driving with panic attacks and worry about losing control of the car and causing an accident. This fear might cause them to avoid driving on the freeway altogether.

How to identify your triggers:

  1. Think about your first panic attack. Where were you? What was going on? What stressful things were going on in your life? What symptoms did you have? What interpretation did you make about the attack—did you think you were dying, losing control, going "crazy," about to faint?
  2. Think about more recent panic attacks and apply those same questions above as your first panic attack. Notice if there are any patterns. Also, note any situations you are currently avoiding for fear of having another panic attack.
  3. Now, write down specific triggers in terms of sensations, anxiety-producing thoughts, and situations. Here are some examples:

Whenever I notice my heart beating fast or hear about someone having a heart attack, I think I'm going to have a heart attack.

When I can't concentrate on something, I worry that I'm losing my mind, which causes me to panic.

When I am in a situation where I feel like I cannot escape, like in the dentist's chair or a crowd, it causes me to have a panic attack.

Put your knowledge of triggers to use.

Now that you have identified your triggers, here's how to use this information:

Sensations: If you notice uncomfortable body sensations, even if they seemingly come from out of nowhere, remind yourself that it is normal for this to occur. Also, tell yourself that you are likely to be hyper-aware of body sensations because you are vulnerable to panic attacks. You can also refer to a previous post I wrote for additional steps to reduce body awareness.

Thoughts: Remind yourself of other times you have panicked, and your feared outcome didn't occur. For example, if you fear dying during an attack, ask yourself how many times you have had that thought and how many times you actually died. Panic attacks are not dangerous, even though they feel that way. If you have a health concern that you are worried about (e.g., heart attacks), talk to your doctor about it to alleviate your concerns.

Situations: If you are going into a situation that you associate with panic attacks, remind yourself in advance that you might get anxious and possibly panic. However, all panic attacks are temporary and not dangerous, and you will be OK. If you are tempted to avoid a situation that you associate with panic attacks, try to resist the urge. Avoidance only makes situations scarier. Coach yourself through the situation by telling yourself that panic attacks are not dangerous and every panic attack will end.

In sum, panic attacks feel scary and uncontrollable. However, the more you learn about your specific triggers, the more you will feel in control, which is an important step in conquering panic attacks.

References

Norton, P.J., & Sears Edwards, K. (2017). Anxiety sensitivity or interceptive sensitivity: An analysis of feared bodily sensations. European Journal of Psychological Assessment, 33(1), 30-37.

Ohst, B., Tuschen-Caffier, B. (2020) Are Catastrophic Misinterpretations of Bodily Sensations Typical for Patients with Panic Disorder? An Experimental Study of Patients with Panic Disorder or Other Anxiety Disorders and Healthy Controls. Cognitive Therapy Research, 44(6), 1106–1115.

Van Diest, I. (2019) Interoception, conditioning, and fear: The panic threesome. Psychophysiology, 56(8), 1-27.

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