Panic Attacks!!!
Your heart pounds. You sweat. Your hands shake and you’re certain that this is it, you’re done for. You’ve come face-to-face with… nothing actually. That’s the nasty thing about panic disorder – it doesn’t have to be triggered by anything specific. You can be hit by the intense anxiety-attack anywhere, at any time.
You’ve probably wondered, if you know intellectually that there’s nothing threatening you, why are you so consumed by fear? And why does it feel so unbelievably powerful?
What are Panic Attacks?
Panic attacks are what most people know them as, the clinical term is Panic Disorder. The symptoms of panic disorder all revolve around one main emotion – fear. From that fear springs these physical manifestations:
Shortness of breath
Hyperventilation
Racing heart
Chest pain / discomfort
Trembling / shaking
Sweating
A choking feeling
Nausea or upset stomach
Feeling unreal and detached from your surroundings
The psychological burdens beyond the immense fear itself, bring on an overwhelming feeling that you are doomed, feeling like you have no control over yourself or your situation.
But it goes further than that. Fear of that fear can have a tremendous impact on your life as well. Aside from the fact that nobody wants to experience that much anxiety ever, never mind on a regular basis, you can end up curtailing your basic activities to avoid an attack.
This might mean that you start to avoid places where you’ve experienced an attack in the past. Maybe that means you stop socialising, skip school, skip work, or avoid basic chores like grocery shopping because you don’t want to face the embarrassment of having a panic attack when others can see you.
Panic disorder affects many people, it can start as early as your teenagers years, in adulthood, and also later in life.
What causes Panic Disorder?
There is no one definitive answer as to why you’re suffering from panic attacks. This is why it becomes so important to talk to a trained professional, like a clinical psychologist – you might find it difficult to get to work on the root causes without having a properly trained partner there to help guide you through the process. More commonly encountered causes include:
It can be inherited
Your development in social interactions was affected when you were young
Not being able to have control of your life because for other reasons
Major life events in your childhood or adult life
Traumatic events
Catastrophic thinking patterns
The Cognitive Behavioural Therapy Model
A plethora of studies have documented the efficacy and effectiveness of Cognitive Behavioural Therapy (CBT) for panic disorder.CBT usually has a quick and positive impact on sufferer’s lives and is often used for sufferer’s who have tried a drug treatment and have either relapsed or found it ineffective. CBT has also been found effective in helping sufferers wean themselves off drug treatments, and reclaim their life from panic disorder.
CBT is an important and extremely effective tool that your clinical psychologist will use to help you dig down to the root of your panic disorder. The heart of CBT is to help you shift from being swept up by the anxiety to being able to observe what’s going on.
Imagine a duck trying to cross a busy road – it’s so busy dodging traffic (and being scared by it) that it no longer has a clear picture of what it was trying to accomplish, never mind the brain faculties to actually make it to the other side of the road.
Now take a step back. Picture yourself walking along a safe street on an overhead pass. Since you have a clear view of the traffic patterns you’re able to shout down instructions to the duck about when it should move and when it should stay still, making crossing to the other side much easier and safer. CBT works in a similar way to shift you from the point of view of the duck, fearful and running purely on a reactional basis to that of the overhead observer. You will get a better handle on your panic attacks once you begin to recognise cognitive patterns in your own behaviour.
Using CBT, you’ll begin to see that the panic attacks are springing up from your snowballing of your symptoms. Let’s say you go out to a movie with your friends. You fear that you might have a panic attack which would humiliate you.
This fear of a panic attack causes exactly what you’re hoping to avoid – anxiety. Your panic disorder kicks in as symptoms start to rise – you get sweaty, or perhaps feel your heart racing a little. Your anxiety causes you to interpret these symptoms not as something in and of themselves but instead as the warning signs of a major incident – like a heart attack.
That snowball is now an avalanche and you fear for your life. These attacks don’t have to be self-centred either – you can snowball symptoms reported by friends in even the most offhanded manner and fear for them instead of yourself.
Because of the embarrassment of the panic attacks you do the one thing you know how to do on your own to avoid further attacks – you stop placing yourself in situations where they have occurred in the past. No more movies with friends, or going to dinner, or shopping for yourself, or even going to school or work.
Plus, the more attacks you have, the more sensitive you become to those minor triggering symptoms. Now, instead of noticing a racing heart, you’re on constant (and potentially exhausting) hypervigilance for the slightest tremor in your hand or a simple catch in your breath.
How does the treatment actually work?
There are a number of techniques that your clinical psychologist will guide you through in order to help you overcome your panic disorder.
Psychoeducation
Psycho-education focuses on breaking apart that snowball mentioned above before it really gets rolling. You’re going to work with your psychologist to figure out which symptoms are your specific triggers, how you think about them in the moment, how they make you feel, and from then what you’re currently doing to avoid both those symptoms and your thoughts about them (clinical psychology is big on identifying avoidance behaviours).
Controlling Bodily Symptoms
If you’ve suffered a panic attack, then you know that it’s not “all in your head.” You might hyperventilate. Or get dizzy. Feel like you’re suffocating. Or tense up, becoming rigid.
You can control these bodily events. Your psychologist will teach you diaphragmatic breathing and progressive muscle relaxation. These are not cures (they don’t dig down to your root causes), but these techniques do help you keep a lid on your growing physical sensations when you feel the onset of an attack.
Controlling Anticipation
A big component of panic attacks is that you tend to blow things out of proportion. If you feel a little dizzy then your anxiety kicks in and tells you that you’re going to faint for sure. And if you do faint, you’ll never ever be able to withstand the associated embarrassment.
Except that neither of these statements is true. But your thinking of them impacts your emotions and your behaviour, and that heightened emotional behaviour is what causes you some potential embarrassment.
So part of your psychological work is going to be aimed at learning how to recognise how overblown these thoughts are, and how they’re making your emotions spike to heightened levels. For example, you’ll examine the worst of the above – that you will faint in public.
You’ll examine what would happen if that actually occurred. Would you actually die from embarrassment? No, you wouldn’t. Gradually you’ll step down your frightened imaginings of panic attack-related events to a more reasonable level and integrate into yourself the knowledge that the consequences of your symptoms will lend you at most a touch of embarrassment.
And then you’ll get to work on how you feel about the symptoms themselves, stepping down your racing heart from a heart attack to what you’re actually feeling, nervousness, and down from there, and so on.
Exposure to Symptoms
Do you feel dizzy when panic disorder sets in? In this case you and your psychologist are going to help you get familiar with the symptoms and the actual consequences of feeling them. So in the case of dizziness your psychologist might have you spin in circles. If you’re the type that develops a racing heart maybe you’ll jog on the spot for a minute or two.
The goal here is to make you comfortable with your particular symptoms. Your familiarity will change how you think about the symptoms (which as we learned above, will further reduce the effect negative thoughts have on your emotions and behaviour).
A Return to Independence
People suffering from panic disorder often lean on family or friends to get them through having to go places that may have triggered anxiety attacks in the past. This can become such a crutch that you can no longer bear the thought of going to one of these places without your safety-blanket person.
Part of your psychological work is to aid you in returning to being the person who can go anywhere and do anything they want without the need for a friend or family member to lean on.
As always, if you have any questions at all please don’t hesitate to get in touch.