A Little About Anxiety Disorders: Panic Attacks
By Steve Wodka, Psy.D. x313



Description of a panic attack:


Tom is working, sitting in his cubicle, suddenly he begins to perspire, and feels his heart start to race. His hands tingle, and he feels an overwhelming urge to run. Tom feels light-headed and jumpy, completely unable to concentrate. Fear begins to build within him, and he's worried that everyone in the office is watching him. He's had episodes like this lately, but not this severe. Tom recently went to his physician, and knows his heart is in good shape. He's positive he's going crazy, and then feels his heart just race faster, like it's going to jump out of his chest. Why can't these feelings stop?


Biology of a panic attack:


Everyone has a built in "fight or flight" system that biologically prepares us to deal with stressful or crisis situations. The "fight or flight" system prepares us for action or attack in a dangerous situation. This process was adopted to deal with moments when hyper-alertness and readiness for action are necessary. Cro-Magnon's without a responsive "fight or flight" system would not have thrived during the occasional saber-tooth tiger visits to their caves. Nowadays, we still need to prepare for those moments of crisis which require immediate reaction (e.g., a near car accident or a similar incident). During these events, we tend to feel our hearts race, adrenaline and epinephrine pumping in our system, blood rushes to our limbs, we take quicker, more shallow breaths, and feel instantly alert and ready for action. Panic attacks, however, are a triggering of the "fight or flight" response that occurs randomly, and is not directly related to a crisis event. Thus, the physiological experience of this action response can be frightening and misinterpreted when it occurs out of context.


Emotions that contribute to panic:


Panic attacks often run in families, suggesting a degree of genetic inheritability of being "wired" towards the "fight or flight" response. In addition, individuals who are prone to panic attacks often display a number of emotional features that can exacerbate future incidents. Typically, these individuals are ruled by anxious apprehension regarding events. They want to avoid conflict and stress, are more externally oriented regarding what others' think of them, and tend to suppress their emotions. Often, panic prone individuals' thinking process includes tendencies towards worry, obsessing, and "what if" thinking. These thinking styles can exacerbate day to day tensions and potentiate panic attacks.


Treatment for panic attacks: 


Treatment for panic attacks can be varied, including a medication evaluation by a physician; or behavioral, cognitive, and emotional psychotherapy.

Psychotherapy can be conducted via individual or group formats by psychologists, social workers or licensed counselors. Psychotherapy, although highly effective, can be particularly daunting for individuals with panic attacks, as they often utilize avoidance as their main defense mechanism. Admitting a problem exists, confronting it directly, and/or seeking therapy can be overwhelming and even exacerbate an existing anxiety situation. The good news is, however, that once over this first hurdle, management of anxiety becomes more feasible.


Medication:


Because of the biological underpinnings of panic attacks, a medical evaluation is recommended. Other physical disorders (thyroid disorders, mitral valve prolapse, etc.) can often contribute to panic attacks. A Family Physician or Psychiatrist are the best resources for medical evaluation. In addition, medication management through the possible use of anti-anxiety and/or antidepressants can often be helpful.


Behavioral treatment and Relaxation techniques:


Behavioral interventions are very effective in managing panic attacks. Individuals can learn progressive muscle relaxation and develop effective breathing techniques to restabilize and calm their "alarm" system. Deep breathing helps reoxygenate the system, and most clients report that deep, full breaths are most effective in getting through panic attacks. Progressive muscle relaxation also provides clients with a greater sense of control by learning to identify ways to relax your body, and then concentrate on more positive sensations. Systematic desensitization is a behavioral technique where individuals counter their tendencies to avoid anxiety provoking events by exposing themselves (coupled with relaxation techniques) to noxious stimuli in steps, gradually feeling more comfortable and relaxed. Clients overcome a series of situations in which the feared event (e.g. fear of snakes) occurs more and more intensely (a hierarchy of fears, starting with images of snakes, then a picture of a snake, then holding a plastic snake etc.). Eventually, they develop greater comfort as their reactions become desensitized.


Cognitive therapy:


Cognitive therapy is based on correcting ineffective or disruptive cognitions and thoughts. Retraining one's thinking eventually decreases potential panic attacks, and can help individuals "think through" panic experiences while they're occurring by focusing on realistic thoughts instead of catastrophic outcomes. Cognitive therapy helps identify and change negative thinking patterns. Panic prone individuals often slip into a negative view of the world, themselves, or the future. Individual thoughts are restructured to recognize these tendencies, and rehearse more positive or realistic appraisals of situations or their symptoms. Helping clients diminish "what-if' thinking is effective in controlling panic attacks while they are occurring, and decreases fears regarding future outcomes.


Another cognitive technique is utilizing visual imagery. By creating a mental image of a peaceful or safe place, these thoughts can also be used to create inner calm, helping clients decrease fear and worry.


Treatment of Emotions:


Therapists are effective in helping clients with panic attacks by teaching them to recognize, understand, and master their fears. As was mentioned before, persons susceptible to panic attacks suffer from anxious apprehension. Typically, these individuals are ruled by fearful anticipation of certain events. Typically, they avoid conflicts, are externally oriented regarding what other's think of them, and tend to suppress their emotions. Often, panic prone individuals display dynamics that include excessive worry, obsessing, and "what if" thinking. By learning to avoid conflicts, clients inhibit their ability to learn mastery over stress. After identification of fears, developing support and strategies to face fears help panic prone individuals develop personal growth. In addition, clients often struggle with anger or aggressive emotions. Anxious individuals often suppress their feelings and display assertiveness deficits. Learning to be less overwhelmed by one's anger and developing assertive communication helps decrease these suppressing dynamics. Involvement in therapy itself helps people discuss and acknowledge fears, and although initially anxiety provoking, therapy can work quickly to help develop greater management of anxiety. Please check the Personal Growth Associates' clinicians profilesto determine which therapist best meet your needs. In addition, Dr. Wodka is developing a therapy group specifically targeting individuals with panic attacks and anxiety disorders.


Life style changes:


Life style changes include most of the above tips: being aware of one's panic proclivities, monitoring one's thoughts or cognition's, learning relaxation techniques and breathing mechanisms, etc. Developing every day habits that reduce stress is very important. It's recommended that individuals practice healthy nutrition, get enough sleep, and exercise regularly. Communication of feelings to supportive others and developing assertiveness is also suggested. Common sense suggests we foster healthy life style habits, these behaviors are often ignored and/or neglected. Diminished stress decreases the frequency of panic attacks, and creates emotional resiliency.