Panic Attacks (Disorder)

Table of Contents

This article is to help you

  1. understand your panic attacks better, and
  2. show you how to stop them by choosing the proper treatment or self-help.

 

What are panic attacks?

What is the cause?

Panic attacks can be caused by;

 

  • your amygdala
  • anticipatory anxiety
  • underlying medical conditions.

 

It is important to rule out medical reasons for panic attacks before commencing psychological therapy.

Many people experience panic attacks out of the blue or similar situations that do not necessarily involve anticipatory anxiety. If this is you, it is probably your amygdala. 

 

Example of amygdala based panic

Let’s say you keep having panic attacks in the car (or in a lift, or plane; the same places.)  If this happens to you, your amygdala is activating your fight or flight response as it thinks you are in a threatening situation. Your amygdala learns from experience. If you keep having panic attacks and do nothing about it, your amygdala will keep activating your stress response in situations you do not need it; you will keep having panic attacks.

 

With the proper treatment however, you teach your brain that you are not in danger and stop your stress response from getting activated.

You can think yourself into a panic attack.

If you are worried about something that may or may not occur in the future, i.e. you are anticipating something bad, you can experience what is called anticipatory anxiety.

 

For example, if you keep thinking that you shall panic on a train, you can experience real anxiety while just thinking about this.

 

Unfortunately your brain starts to expect this anxiety, and when you are preparing to get on a train in real life, you have unwittingly primed yourself to feel anxiety.

How do I know if I am having a panic attack?

If this is your first panic attack, you probably will not recognise it as an attack. Rather you may think you are dying and end up in hospital.

 

 

It is different for everyone, but all panic attacks have one thing in common in that it feels like something dire is happening.

 

 

I have a more detailed list of symptoms relating to anxiety here., but the following list is more specific to panic attacks

 

  • gulping for air; each in-breath can feel like a gulp, and your chest expands too much
  • feeling like your breathing is not correct; you are very aware of your breath, and it is not regular
  • feeling like you are dying or having a heart attack
  • terror
  • feeling like you are suffocating
 

These symptoms are due to your fight or flight response getting activated in a situation where it is not needed. 

What does it feel like?

You might also find it helpful to read my account of what my first panic attack was like. Please read it, and then come back to this page.

 

One minute you are going about your business, and the next, you might break into a sweat, your heart is pounding out of your chest, it’s getting hard to breathe.

 

This is a panic attack, but it can be different.

 

You might feel like someone has placed a cushion over your mouth and nose, where it feels like you are getting smothered or suffocated, even though there is nothing over your face. I experienced this each time I had a panic, so I feel for you if you get this. It does go away; I have not experienced this for years.

You are terrified and convinced that you are not breathing; there’s not enough air getting into your lungs. ( I used to put my finger beneath my nostrils to get reassurance that there was still air going in and out!)

 

You check your pulse, and it may be rapid, or you might not be able to feel it at all.

 

You are shaking, sweating and feeling complete and utter terror as you might be having the thought (maybe for the first time in your life) that you are dying. You could also feel pins and needles, numbness and tingling anywhere in your body (this used to bother me a lot in my arms and legs.)

 

You may have had different symptoms, but if you have had a panic attack, you will be able to relate to what I have just said.

 

You could very well end up in the hospital and get a series of tests, to be told

“It’s okay; there’s nothing wrong with you. You just had a panic attack.”

If you are very accepting of this information, or if it gives you some relief or explanation regarding what has just happened to you, you may never experience an attack again or as severe.

 

More than likely, though, it is tough for your brain to understand that what you have just experienced is “just a panic attack.”

 

When I had panic attacks, I felt like my life was spiralling out of control. I was physically and emotionally exhausted as my panic attacks would wake me from my sleep. At work, I couldn’t concentrate as all my attention was focused on helping me to breathe. I took time off work and flew home; I can still remember standing in the queue at the airport, trying to look normal and sneakily taking my pulse, which made it worse.

 

After one month out of work, feeling a good bit better, I flew back, and once I arrived back into my apartment, bang, it all started again. That was 12 years ago, and during those 12 years, I have studied panic attacks; for myself, I am a psychologist, but the knowledge I acquired through training wasn’t helping me in the long term, so I took time out (years) to study it myself in depth. Now I can hopefully help you.

Early warning signs

Even though it may seem like panic attacks come out of the blue, there are usually early warning signs that, with practice, you can learn how to stop a panic attack.

Start to monitor your attacks and note your early warning signs.

Possible early warning signs include,

 

  • feeling a tightness in your chest
  • noticing a change in your breathing
  • feeling your heart beat faster
 

When you have developed a list of early warning signs, you are in a better position to stop your anxiety from developing.

What to do when you spot early warning signs of panic

Remind yourself that you are simply experiencing the effects of anxiety and will not harm you.

Start a mindfulness exercise such as the following one

Start by simply noticing your breath.

This may be not easy at first, but it is called a mindfulness practice.

It does not have to be perfect each time you try it: you practice.

You can read more on Mindfulness by clicking here.

If your breathing feels laboured or fast or uncomfortable, just notice it, and try not to engage your thought process, as anxiety-related thoughts may increase your anxiety.


Start to count each out-breath
breathe in, breathe out 1
breathe in, breathe out 2
breathe in, breathe out 3
breathe in, breathe out 4
breathe in, breathe out 5


Repeat this until the number 10 and start again with the number 1 through 10.


Focusing on your breathing, with no judgement, and letting your thoughts come and go as they please will eventually calm your body and mind.
If you feel other anxiety symptoms while doing this, notice them and bring your attention back to your breathing.


If your heart is racing, notice it racing, and bring your attention back to counting your out-breaths.


At first, this may feel difficult, but you will lower your anxiety with practice.
This is an excellent exercise to do daily, not just when you feel your early warning signs of anxiety.


Developing a daily practice will help you lower your overall anxiety levels and make it less likely to experience a panic attack.

If it feels like you are gulping in air or notice that your belly expands when you breathe in, you are taking in too much air.


The uncomfortable feeling of panic breathing will naturally make you want to breathe more deeply but don’t.

 

Your over-breathing is the problem.
Breathe in, through your nose, slowly, do not gulp.
Breathe out slowly, through your mouth, as if you were blowing up a balloon. Make sure your exhale is longer than your inhale.


Each time you breathe out, relax your shoulders, let them drop.
Wait for the next breath to come. If you are gulping in air, you probably started to breathe in before you needed to.


Wait
Wait for the next breath to come.

It is normal to have scary thoughts during a panic attack. In addition to taking control of your breathing, you need to ground yourself.

This will take your attention away from your thoughts.

 

Grounding Technique
Focus on something else. I would recommend focusing on something else in your body, as your body is always with you!

Focus on the soles of your feet.

Shift them about a bit.

How do they feel on the ground?

Walk around and pay attention to your heel coming into contact with the ground, followed by the rest of your foot.

 

By doing this, you are taking your attention away from scary thoughts that add to your anxiety and focusing on something neutral – something real. Your feet on the floor.

 

All of this sound too simple for you?

 

It may sound simple but bear in mind. You experience a panic attack due to activation of your sympathetic nervous system; your stress response. Your brain controls this; you did not choose to activate it.

 

Controlling your breathing IS your choice. You are activating your parasympathetic nervous; your relaxation response, which will restore balance in your body.

 

Focus on your feet too simple for you?

If you continue to focus on thoughts that are fuelled by panic, you will most certainly spiral more into a panic.

 

Focusing on your feet is you choosing to focus on thoughts that are not adding to your panic.

 

Remind yourself that you are only feeling this because you are hyperventilating and will be okay, or by using coping statements.

This will pass.

I have felt this before, and it goes away.

 

The sensations are because I am over-breathing, nothing else.

If my thoughts are scary, I know that they are not real. My thinking is irrational when I have a panic attack.

 

Pay no attention to my thoughts – I choose to focus on something else.

So what if I have a panic attack. It will pass.

 

You can add some coping statements of your own.

 

Accept your feelings.

Don’t run away from panic, but do not fight it either – accept it.

Accept it for what it is – your nervous system is overstimulated.

Accept your feelings of panic without your spin on what is happening. By this, I mean thoughts such as “I am going to die, I can’t handle this”, etc.

Accepting your feelings is just describing them; for example,

 

My heart is beating fast – as opposed to – I am going to have a heart attack

My breathing is fast as opposed to – I am suffocating

My heart is beating fast

I feel pins and needles

I am sweating

This way, you accept what is happening without adding fuel to the fire.

Do not smoke

If you are a smoker, you might reach for a cigarette to help you relax. Smoking will stimulate your nervous system, causing your heart to beat faster, and may make you more anxious than you were.

 

Do not misinterpret your symptoms.

If you have had panic attacks before, you will know that any of your anxious thoughts about what may “really be happening” do not come true.

If your mind focuses on some other scary reason for your symptoms, this will create more anxiety.

 

Talk yourself through it and know that whatever symptoms you feel directly result from your sympathetic nervous system.

 

Do not run away from whatever you are doing.

It is a natural reaction to leave wherever you are when you have a panic attack. If you are in a shop, you will want to go, to get outside for fresh air.

It is not the shop or the air in the shop resulting in the difficulties you have breathing.

 

It is your sympathetic nervous system.

If you leave whatever you are doing, you are sending a signal that you are not safe where you are.

 

If you can manage to talk yourself through it and stay where you are, your body and brain will thank you for it.

With panic attacks, it is all too easy to avoid places that you believe may cause you to have an attack.

It is not the place that is causing your panic.

Your body gives you a stress response in situations where you do not need it.

 

Do not fight it.

With practice, you can learn to accept that what you are feeling results from anxiety. This acceptance lessens the fear. Having less fear means that the attack will pass quicker.

 

Learning not to do these things will take away some of the fear.

Without fear, there is no panic.

Stopping panic attacks

If you want to overcome panic attacks, it will be helpful for you to find out what caused you to panic in the first place. Understanding the cause will help you to select the proper treatment.

 

At the start of this article, I introduced you to different reasons for panic, such as amygdala based panic. 

Understanding your type of panic helps you to choose the most effective treatment.

Treatment and self-help.

Retrain your brain

If you would like my help, I have an online course to help you recover from panic attacks, based on my work in private practice.
Self-help

The recommended treatment for panic attacks is Cognitive Behavioural Therapy, CBT. CBT is an excellent model for addressing the thought processes that occur with panic attacks, and also is extremely useful in helping you change behaviours that may keep your panic attacks going.

 

However, many people, and this could be you, have panic attacks that just come out of the blue, and I would personally recommend having an understanding of your brain, in addition to CBT. I say this because there are different routes in your brain that can result in panic attacks.

References

Further reading