I Feel Panicked

Fear and anxiety are natural reactions to scary events or things. This fear or anxiety even has the potential to help us stay safe in dangerous situations.

When the fear and anxiety becomes overwhelming, though, you experience panic. The physical responses to panic are caused by a surge of adrenaline being released into your bloodstream, which is designed to help you stay and fight, or run away.

If you are experiencing the symptoms of panic without an obvious external reason for panic, you may be having a panic attack. If you are feeling panicked, and don’t understand why, you may benefit from reading this information on panic disorder and panic attacks.

WHAT IS PANIC DISORDER?

Panic disorder occurs when the person has recurrent panic attacks and either a fear of having another panic attack, of losing control, of having a heart attack, or of going crazy.

A panic attack is a sudden attack of fear or anxiety in a situation where others would not be afraid, accompanied by physical symptoms of arousal.

These attacks start suddenly, are extremely distressing, and last for minutes, never for hours. The attacks are often followed by persistent concern about having another panic attack, both because of the unpleasantness of the attack and because the person believes that the severity of the anxiety could lead to physical or mental harm.

Panic attacks may sometimes lead to agoraphobic avoidance of situations in which escape may be difficult or embarrassing, such as crowded places, movies, driving, etc., or in which help may not be available should a panic attack occur.

suffering-panic-attacks

About 35–50% of adults will experience at least one panic attack in their lifetime, and 6.8% of adults will experience panic attacks that are frequent enough to meet criteria for panic disorder at some point in their life.

Onset is usually in the mid-twenties, with the first panic attack generally occurring in the late teens, and panic disorder is more frequent in females. If untreated, panic attacks can occur several times a week or even daily. Recurrent attacks may continue for several weeks to several years. During this time there may be periods of full or partial remission (i.e., with no panic attacks or only mild attacks with few symptoms).

Panic disorder can be treated with educational and behavioural interventions and with medication, and the prognosis is good for people who are sufficiently motivated. A good outcome will depend on the person’s commitment to practicing the relevant cognitive behavioural therapy (CBT) techniques for gaining control over panic.

WHAT ARE THE SIGNS OF PANIC DISORDER?

Frequently recurring panic attacks indicate panic disorder.

Panic attacks are sudden periods of intense anxiety or fear, where four (or more) of the following symptoms, associated with the fight-or-flight response, develop abruptly and peak within 10 minutes:

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Pounding heart

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Sweating

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Trembling or shaking

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Shortness of breath

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Chest pain or discomfort

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Nausea, abdominal pain

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Feeling dizzy, unsteady, faint or lightheaded

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Numb or tingling feelings

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Feelings of unreality or of being detached from oneself

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Fear of losing control or going crazy

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Fear of dying

You will notice that the last two symptoms mentioned are different to all the others, in that they are fears rather than physical sensations. One of the most frightening things about a panic attack is that the person does not know why it’s happening. Because there doesn’t seem to be any reason for these sudden and intense physical symptoms, most people interpret them to mean that they are about to lose control, have a heart attack, die, or go crazy.

In other words, they take the symptoms as a sign that something dangerous and terrible is happening. This interpretation is problematic because it can inadvertently contribute to the cycle of panic.

WHAT CAUSES PANIC DISORDER?

A lot of different processes in the human body take place automatically, without us having to think about them, like breathing. When we exercise, the muscles in our body need more oxygen so we start to breathe more quickly, but we don’t choose to do this, it just happens automatically.

Another automatic process in the human body is called the fight or flight response. This is an in-built safety device, which allows us to respond very quickly whenever we are threatened, or in danger. Since most of the threats to our survival as human beings were once physical threats, this response is designed to help us move quickly to fight off a predator, or escape from a dangerous situation.

When our fight or flight response goes off, our bodies release adrenaline, which causes various changes throughout the body. These changes include increased heart rate and breathing rate, and the tensing of muscles, as if ready for action. We also start to sweat and have a strong urge to flee.

Another automatic process in the human body is called the fight or flight response. This is an in-built safety device, which allows us to respond very quickly whenever we are threatened, or in danger. Since most of the threats to our survival as human beings were once physical threats, this response is designed to help us move quickly to fight off a predator, or escape from a dangerous situation.

When our fight or flight response goes off, our bodies release adrenaline, which causes various changes throughout the body. These changes include increased heart rate and breathing rate, and the tensing of muscles, as if ready for action. We also start to sweat and have a strong urge to flee.

 

These reactions would be useful if we had to run or fight, but in most situations nowadays, it is not appropriate to run or fight. As a result, all the extra oxygen inhaled and carbon dioxide exhaled can start to make you feel dizzy and light-headed, even nauseous. Your arms and legs may start to shake, and you may get muscle cramps from being tense for too long. Do these symptoms sound familiar?

If you think this sounds like the symptoms of a panic attack, you’re right! A panic attack happens when your fight or flight response goes off and you breathe more than you need. These feelings cannot hurt you. They occur because your body is trying to protect itself from danger.

A routine medical assessment can determine whether organic or physical disease is causing the anxiety symptoms (e.g., hyperthyroidism). Typically, people with panic disorder will already have consulted with a general medical practitioner who is likely to have ruled out an underlying organic disorder.

Panic attacks may also occur in relation to other phobic disorders such as social phobia (e.g., when speaking to a group of people) or a specific phobia (e.g. in the presence of a spider). In these disorders, the panic attacks are predictable and occur in response to specific feared stimuli or situations.

HOW TO DEAL WITH PANIC DISORDER

Management strategies for panic disorder will vary from one person to the next depending on the person’s particular problems. The management of panic disorder usually involves CBT, either face to face with an experienced therapist or via the internet from organisations such as This Way Up. Generally, the management plan includes:

1. Ongoing assessment
2. Education about panic disorder
3. Cognitive interventions
4. Behavioral interventions

In some cases, antidepressant medication can be useful in the control of severe panic attacks, but sedative medication should be avoided.

Referral or specialist consultation may be necessary if panic attacks continue despite the above measures.

1. Assessment

Assessment should occur at the beginning of treatment, and should be repeated at appropriate points during and after treatment. During treatment, a person should keep a record of how frequently they experience panic attacks, which will help assess progress and the effectiveness of the program.

2. Education

Some of the physical changes caused by the fight or flight response will result in symptoms of panic disorder, such as:

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Blood is redirected from gut to muscles = nausea

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Sweating increases – cold sweat

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Heart rate increases – palpitations

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Muscle tension increases – shaking and trembling

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Pupils dilate – things look unreal

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Mental arousal – selective attention

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Respiration increase – shortness of breath

As seen above, the fight-or-flight response leads to an increase in the rate of respiration. This increased respiration rate, or hyperventilation, has been strongly implicated in causing or worsening symptoms of anxiety and panic attacks.

Hyperventilation can cause anxiety and worsen panic attacks. It results in dizziness, light-headedness, breathlessness, palpitations, and tingling in the hands and feet. The good news is that learning to sit with and neutrally observe the sensations will reduce the unpleasant symptoms of hyperventilation over time as people cease to respond to the experience with fear.

Hyperventilation is often not obvious to the observer or even to sufferers themselves. In many cases, hyperventilation can be very subtle. This is especially true if the person has been slightly overbreathing for a long period of time. Mild hyperventilation can cause an person to remain in a state of perpetual apprehension and anxiety. In this case, there can be a marked drop in carbon dioxide, but because the body is able to compensate for this drop, symptoms may not be produced. Many sufferers report that they don’t feel as if they’re hyperventilating. However, because carbon dioxide levels are kept low, the body is less able to cope with further decreases, and even a slight change of breathing (e.g., a sigh or yawn) can be enough to trigger symptoms.

3. Cognitive Interventions

Anxious thoughts are a major part of the panic cycle. They often trigger the fight-or-flight response that causes the physical symptoms of panic attacks, which result in avoidance behaviours to reduce anxiety. Avoidance, however, confirms the anxious thoughts, leading to a vicious cycle.

When panic attacks occur without any obvious explanation, people can misinterpret these symptoms as indicating a serious physical or mental problem. Hence, the symptoms themselves become threatening and can trigger the whole anxiety response again. People with panic disorder believe that symptoms of the flight-or-fight response may lead to losing control, going mad, having a heart attack, collapsing, or dying. The role of cognitive behavioural therapy is to encourage the person to recognise the symptoms as part of the flight-or-fight response, or of hyperventilation, and not presume that they are indicators of a serious outcome.

CBT provides ways of challenging negative anxious thoughts, such as those detailed below:

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Fear of having a heart attack

Some of the symptoms of a panic attack are also those of a heart attack (e.g., chest pain), and therefore a person who is having a panic attack may think that he or she is having a heart attack. If chest pain is recurrent or long-lasting, a thorough medical investigation to rule out the presence of heart disease is recommended. If heart disease is not present, then subsequent chest pain caused by a heart attack is unlikely. The information below may be helpful for distinguishing between symptoms of panic and symptoms of a heart attack.

  • Ischemic heart disease is very, very rare in young women, the group most likely to experience panic disorder.
  • Generally, if a person who is prone to panic attacks experiences another similar attack, sitting quietly and neutrally observing feelings for about five to ten minutes is recommended. The person can also ask himself or herself, “Did I die or have a heart attack last time I experienced these symptoms?”
  • However, if chest pain is still present after ten minutes of practicing mindfulness, the person should seek medical advice.

 

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Fear of losing control

Some people believe that they will lose control when they have a panic attack.

Usually, they mean that they will become paralysed and be unable to move, will collapse, or will not know what they are doing. They fear that this may lead them to run around wildly, hurting people or yelling out obscenities, and embarrassing themselves.

During the anxiety response, the entire body is ready for action, and there is often an overwhelming desire to get away from any potential danger. However, there has never been a documented case of anybody doing anything wild, out of control, or against his or her wishes while experiencing a panic attack.

It may also be helpful for the person to ask themselves, “Have I done anything wild or out of control when I’ve had a panic attack before?” Chances are that the person behaved appropriately under the circumstances and will behave the same way if another panic attack occurs.

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Fear of going mad

Many people fear that when they experience the physical sensations of anxiety or panic, they are going mad.

If people hold these fears, differentiating between anxiety symptoms and other mental disorders such as schizophrenia is important.

By providing education about the nature of panic, CBT can reassure people that they do not suffer from these other disorders.

Furthermore, showing that these symptoms are not unique and are in fact shared by many other people can be reassuring.

4. Behavioural Interventions

When people are afraid of something, they usually try to avoid it as much as possible. This makes sense when the thing you fear is truly dangerous, but if there is no danger then avoidance only makes your fears worse. Although you may feel better when you avoid a situation that makes you anxious, leaving strengthens the idea that if you’d stayed, something awful might have happened. As a result, you’ll be more afraid to go back next time. Avoiding situations in case of panic stops you from learning that you will cope and survive, even if you have a panic attack. To get better, you have to start confronting your fears.

Graded Exposure

Graded exposure is a way of gradually confronting any situation where you are afraid of having a panic attack. The first step is to write down places you would like to go, and things you would like to do, if you weren’t afraid of having a panic attack. Some examples are listed below.

Exposure Goals

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To catch a train by myself into the city and return in rush hour.

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To shop alone in the local supermarket and buy the weekly groceries.

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To go to the cinema with friends on a busy Saturday night.

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To go away for a weekend in the countryside.

Now, imagine you decided that you wanted to get fit, but you haven’t done any exercise for years. Let’s say you set yourself the goal of running in the local 10km fun run in three months time. On the first day of training, would you set out to run 10km? Of course not! The most sensible way to reach your goal would be to start with a brisk walk or a short jog, then gradually increase the distance you run every week until you reach your goal. It’s the same process that works best when confronting your fears. Once you have written down your goals, break them into smaller steps, so you can work up to them gradually.

We will use the train journey as an example. Train travel may be difficult, as you can’t escape if a panic attack occurs. Your goal, then, may be to catch a train by yourself into the city and back. Try breaking it down into 10 steps as follows:

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Travel one stop and return on the train with a friend

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Travel one stop on the train by yourself at a quiet time, and have someone meet you at the other end

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Travel one stop and return by yourself at a quiet time

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Travel two stops and return by yourself at a quiet time

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Travel two stops and return by yourself at a busy time

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Travel five stops and return by yourself at a quiet time

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Travel five stops and return by yourself at a busy time

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Travel to the city by yourself and have a friend meet you there

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Travel to the city and return by yourself at a quiet time

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Travel to the city and return by yourself in rush hour

The first step should be something that you think you could do, even though you would be anxious. Each step is repeated, until you can do it with confidence. The first time is usually the hardest, so it is important to keep confronting a step until your anxiety subsides. If a step is too easy then go to the next one. If a step is too hard, try to think of something easier, but that is harder than what you’ve already done. It is best to keep a diary, so you have a record of what you have done, and what steps were easy or difficult.

When breaking your goals into steps, think about the following things:

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How far will you go away from home?

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Whether it is a quiet or busy time of day.

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How long will you stay there?

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How many things will you do while you are there?

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Whether you go alone or with a friend.

Grading exposure exercises can take practice and skill, so if you’re not sure how to go about it, seek advice from a CBT professional who is familiar with this technique.

COPING WITH SYMPTOMS OF PANIC DISORDER

Because panic attacks can be so frightening, people who suffer from panic attacks often start to notice little changes in their body that most people don’t notice.

For instance, you might notice your heart beating faster as you climb the stairs, or that you feel a little dizzy when you stand up too quickly. Even though these changes are harmless, you may avoid these activities just in case they trigger a panic attack. This avoidance makes your fear worse, as it encourages the idea that bodily changes are dangerous, and it stops you from learning to overcome your fear of panic sensations.

By practicing exercises that give you the same physical feelings as a panic attack, you can collect evidence that these feelings are not dangerous.

You will probably never like these feelings, but the idea is to prove to yourself that they are harmless.

As a result, you will get used to them, and they won’t be as frightening next time you have a panic attack.

Remember, noticing harmless physical changes will only set off a panic attack if you believe that they are dangerous.

 

Coping with Panic
Coping with Panic
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Breathe as deeply and as quickly as you can for one minute.

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Shake your head from side to side for 30 seconds.

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Run up and down on the spot as fast as you can for one minute.

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Hold your breath for 30 seconds

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Stand up and turn around in circles as quickly as you can for 30 seconds to make yourself dizzy.

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Breathe through a thin straw for one minute while holding your nose.

None of these exercises are fun. For a person afraid of panic, they can be scary and confronting, so do them systematically and carefully. If you need help seek advice from a CBT professional who is familiar with these techniques.

TECHNIQUES TO REDUCE OVER-BREATHING & ANXIETY SYMPTOMS

Some people say that, during a panic attack, they feel like they are suffocating or that they can’t get enough air. This is because the human body needs a certain balance between carbon dioxide and the oxygen that’s being inhaled.

When you breathe too quickly, there is not enough carbon dioxide to balance all the oxygen you’re taking in, and so it feels like you can’t get enough air. In order to stop this process, though, you need to SLOW your breathing. This is why some doctors might recommend holding your breath or breathing into a paper bag. Doing so will increase the amount of carbon dioxide, so you can start using the oxygen you’re breathing in.

Breathing too much, too quickly, causes a lot of the symptoms of a panic attack, such as dizziness, light-headedness, chest tightness and pain, tingling fingers and feet, hot and cold flushes, etc. To prove the link between breathing and panic symptoms, try breathing as deeply and quickly as you can for one minute.

Slow Breathing

The following slow breathing technique will stop you from over-breathing during a panic attack. This technique is useful even if you don’t over-breathe during panic attacks, as it helps you to settle down, stop releasing adrenaline, and turn off the fight or flight response.

  •    – Hold your breath for 6 seconds (time it)
  •    – Breathe in and out every 6 seconds (10 breaths a minute)
  •    – Say relax under your breath as you breathe out
  •    – After a minute hold your breath again for 6 seconds
  •    – Breathe in and out every six seconds
  •    – Say relax under your breath as you breathe out
  •    – Stop when your anxiety drops.

To begin, you will need to practice when already relaxed. Then you can gradually practice in anxious situations. Like learning any new skill, slow breathing takes time and regular practice. You should practice this at least 4 times a day.

With assistance, the right treatment, and a solid understanding, you can overcome panic disorder.

Take our online Panic Disorder course

THIS WAY UP offers a highly effective internet delivered course for people with panic disorder.  Four out of five people improve, over half to the point of no longer being troubled by their disorder.

The course can be undertaken on the prescription of a GP or on a self-help basis, and costs just AUD$59 for 90 days access.

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