Panic Attacks

One of the most frightening things you may find yourself experiencing is a panic attack and it is very difficult to fully explain how it feels unless you have experienced one. The very first panic attack often seems to come completely unexpectedly and can even occur whilst you are doing something that you do every day like driving to work, shopping, walking the dog, watching TV, cooking etc. Suddenly you are struck by a barrage of frightening and uncomfortable symptoms and you are convinced that something terrible is going to happen to you there and then.

If You Are having A Panic attack NOW

• Remember that although your feelings and symptoms are very frightening they are not dangerous or harmful.
• Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.
• Do not fight the feelings or try to wish them away. The more you are willing to face them, the less intense they will become.
• Do not add to your panic by thinking about what “might” happen. If you find yourself asking “what if?” tell yourself “so what!”.
• Stay in the present. Notice what is really happening to you as opposed to what you think might happen.
• Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds.
• When you find yourself thinking about the fear, change your “what if” thinking. Focus on and carry out a simple and manageable task such as counting backward from 100 by 3’s or snapping a rubber band on your wrist.
• Notice that when you stop adding frightening thoughts to your fear, it begins to fade.
• When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.
• Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

General Information

Panic attacks can start for many reasons such as stress, overworking, bereavement, family, an accident, childbirth, following surgery and so on but at the time panic strikes for the first time, you think you are doing fine and there seems to be no apparent reason at all. If you have subsequent panic attacks, they too may seem to be unpredictable and random. There is now emerging evidence that anxiety and panic may have a genetic link.

People that have never had a panic attack assume that that it is just a feeling of nervousness or anxiety, but in reality the attacks are far more frightening and overwhelming. If nervousness is a 3 on a scale of 1-10, then a full blown panic attack is 11.

What often happens next is that you begin to associate the panic attack with the activity or place you were at the time so you start to avoid that situation. This is where the problems begin as each time you are forced into the situation that caused the attack, you automatically assume that it will happen again and start to re-live the feelings and this can lead to agoraphobia and limiting of activities and leading a normal life.

Panic disorder can be frightening, disabling and frustrating, both to recover from and to live with someone suffering with it.

Often the sufferer will not go out as they say they ‘know’ they are going to faint or ‘have a heart attack’. See the “Symptoms” section for explanations of these feelings and the reasons for them. Please read the “Self Help” section for some really useful information on how to cope.

As panic can strike very quickly, and often the trigger is not apparent, there is usually little warning that it is about to happen. It is not surprising therefore, that many sufferers avoid situations that they think or ‘know’ might cause the panic attacks to happen. This leads to fears of situations or places that last caused anxiety and so the sufferer avoids them at all costs! This is agoraphobia. The problem here is that it can take months, even years, to re-educate the individual that it is their thoughts and assumptions that are to blame for these attacks and not the place at all but it still takes a long time to return to such places.

Getting appropriate and quick medical help is not easy and the slide from anxiety to panic and then to agoraphobia can progress quickly without intervention and support.

Talking from experience, I avoid public transport because of several incidents in taxis where I was terrified and therefore starting associating any public transport with fear and panic. The problem then ‘spread’ to include trains, buses and eventually I was unable to get in the car with someone else driving. This is still a problem today. I do drive myself but the problems do not stop there!

I was once told that if you ‘sit out’ a panic attack to see how bad it can actually get, it will reach a point where it can’t get any worse and you ‘automatically’ start to calm down.

If you suffer from severe anxiety or panic attacks, but don’t know it, you can end up going to numerous doctors and Accident & Emergency departments with a variety of symptoms and self diagnoses, only to be told that there is nothing medically wrong with you and you are not given any help, information or solutions. This leads you to the conclusion that you may have some terrible mysterious condition that could kill you one day and that the doctors aren’t managing to find it. With each test and subsequent treatment that is performed and is deemed normal, your conclusion is strengthened and your fears (and panic attacks) get worse. This can lead to house-bound agoraphobia and very commonly to Health Anxiety.

Don’t give up! Read the other sections on this site to learn and understand what is happening and how to access the help you need.

What is Panic Disorder?

A panic disorder is diagnosed when a person has four or more panic attacks in one month, or one panic attack followed by a month of fear of having another attack. Panic disorder is the next step up from panic attacks and it is generally recognised that it takes longer to recover once you are diagnosed as having panic disorder rather than with isolated panic attacks.

What are the long-term effects of the condition? If a panic disorder is not effectively treated, a person may not be able to function at work or at home. This can have a negative effect on relationships, education and other important parts of a person’s life.

Understanding the problem

The body has a natural ‘fight or flight’ response to danger. When a person perceives some threat or danger, the autonomic nervous system is stimulated. This helps a person escape from danger. During a panic attack, the body’s automatic nervous system is triggered for no apparent reason – a false alarm, but it feels so real.

Once you’ve got the diagnosis that you are suffering from panic attacks or panic disorder – what next?

It is essential that you understand the diagnosis and its implications. The good news is that it is not terminal and there is a way to recovery, but it may be a long uphill struggle and it could take years to recover. Ok, so this is the worst case scenario but a realistic one and it would be naive to suggest that you are likely to recover in a few weeks. Yes, people do recover within a few weeks but then there are sufferers that take years to overcome all effects of panic. I have been suffering since 1993, so I know that it is hard work.

The biggest problem for most people is that they are embarrassed by the illness (like I am) and they see it as some kind of mental of psychiatric disorder or weakness that is not something you want to be telling people about. If you can learn to accept that the disorder stems from malfunctioning of the central nervous system receptors then you are well on your way to recovery.

The rewards are well worth the effort but you MUST be prepared to work at the problem and accept help.

When caught in its early stages, further (more complicated) conditions can be avoided, including depression, alcohol abuse and agoraphobia, so it is essential that you and your doctor recognise the condition early on and start treatment immediately.

Hindsight is a wonderful thing and I suffered from panic attacks for nearly a year before the doctor officially diagnosed it and then I could begin treatment. I first went to the doctor and explained all my symptoms and I was told “to eat more brown bread”! This may sound funny but each time I went back I was just fobbed off and went away thinking that something must be wrong because it wasn’t normal to feel the way I did.

Once I was aware of what I had to deal with, I began treatment but it was too late to control the panic attacks and I did go on to suffer from panic disorder and agoraphobia.

Steps for sufferers to take

STEP ONE

Have a complete medical examination to see if there is any physical condition that could be causing your symptoms. Explain the symptoms to your doctor and ask him if he would do full blood tests – this will rule out anything such as diabetes, thyroid problems etc. Get your eyes tested as well to make sure your sight is not causing those worrying dizzy spells and headaches. If necessary, ask to be referred to an ear specialist to make sure the dizziness is not caused by an ear infection or something similar.

You could ask for an ECG (electrocardiogram) to make sure the pounding heart is quite normal.

Do not go to your doctor and demand all these tests, however, be advised by what he suggests and accept that he will give you all the test he deems necessary.

You will not be able to start your recovery if you are still convinced that there is something physically wrong, so this step is very important. There may be many more visits to the doctors each time a new physical symptom appears but a general health check will allay a lot of the fear.

If the doctor does find a physical condition that is causing the symptoms then you may find that once it is treated and cleared up, the panic attacks will stop.

Above all, if you are given a clean bill of health, you MUST believe that panic attacks are not going to kill you and the symptoms are just temporary and will, in time and with some effort, recede and go away.

STEP TWO

Not everyone develops panic attacks because they are stressed, tired, over-worked, anxious, worried, or even after suffering traumatic life events. Panic attacks have been known to run in families and can strike every walk of life.

Take a look at your personality to see if you have any high-anxiety personality traits that could be contributing to your anxiety. You may need to seek the help of a therapist to work on these feelings.

I was once told that many sufferers of anxiety/panic tend to have low self-esteem and self-worth. Working with a therapist to increase the opinion they have of themselves can help reduce the panic and anxiety.

STEP THREE

Take a close look at your lifestyle and make changes that will help in the long-term. This could be something as simple as watching your diet and trying to cut out different food groups to see if the symptoms are eased.

I stopped drinking tea, coffee and any soft drinks containing caffeine in September 2000 and it has had a dramatic effect on my panic attacks. I also tried cutting out all dairy products and found that this had no effect on the panic attacks so it was reasonable to consider that they weren’t contributing in any way.

Seriously consider how much alcohol you are drinking. Write down how many units you drink in a typical week and then write down why you had a drink at a particular time. Do you find that you are drinking to alleviate the symptoms of the panic attacks? Do you always “reach for the bottle” when you have had a bad day at work?

Take up exercise on a regular basis – walk up the stairs instead of taking the lift.

What about your job? Are you bored, unhappy or so stressed at work that you are constantly running on Adrenalin? Would it be so bad if you got a different job that you enjoyed doing?

STEP FOUR

Learn to live with the panic attacks but NEVER give in. It could be a long struggle, but some people make remarkably quick recoveries and never suffer attacks again. Others may suffer for years and never really make a full recovery. Accept that you are a panic attack sufferer and do everything you can to overcome it – do not allow it to rule you life.

TAKE CONTROL OF YOUR LIFE TODAY!

Spontaneous Panic – What is it? How to deal with it?

Most people with anxiety states are simply more alert and aroused than the general population. The chemical processes which underlie anxiety are complex but essentially lead to the body being put into an optimum state of preparedness. One way of looking at anxiety is that the body goes into this state of preparedness without a rational external reason. For many anxiety sufferers there is a simple cure which activates an attack. This may be the sight of a spider, the thought of going shopping or talking to a large group of people. Attacks of anxiety like this can be managed by the exposure based approaches which have been shown to be so effective. Therefore gradually facing one’s fears and avoided situations in graduated doses of difficulty, perhaps with some attempt to change how you think about such situations, will lead the body eventually becoming used to those situations and no longer producing the state of arousal.

However, some sufferers seem to experience surges in arousal for no apparent reason. I have come across a very large number of patients who have become physiologically very aroused and hence develop an anxiety state although there is no particular source of anxiety in their lives. Perhaps these people are more prone to produce Adrenalin than some people and for some reason their system becomes more prone to spontaneous panic attacks. The other group of people who are more prone to spontaneous panic attacks are those who repeatedly encounter anxiety linked to a particular phobia or obsession. In these cases the repeated episodes of anxiety have a generalised effect and after a while the body seems to just produce surges of Adrenalin for no apparent reason.

What then does one do about this?

To begin with, one must look at simple factors which pre-dispose sufferers to panic attacks. Being hungry or tired can often be a factor and simply eating regularly and getting plenty of sleep is one remedy likewise, some people report that they are more prone to these apparently spontaneous panic attacks after indulging in alcohol the day before. This association has been known for some time but, it is becoming clearer that large numbers of anxiety sufferers can develop panic attacks in response to alcohol. More recently I have seen a number of patients who have developed such spontaneous panic attacks in the aftermath of taking illicit drugs such as Marijuana or Ecstasy. In the latter cases I have seen a worrying number of young people who have developed the severest states of panic disorder after even an isolated intake of this drug.

Sometimes, spontaneous panic attacks are not really spontaneous. There is a great deal of research which shows that sometimes the arousal which occurs when one gets angry can be misinterpreted as anxiety and sometimes a panic attack may actually be a feeling of anger which presents itself a little later after the original event which caused the problem. Sometimes, there are other factors which may produce anxiety which are not so obvious. For example, one patient of mine recently developed spontaneous panic after seemingly making a good recovery from her agoraphobia. I asked her to keep a diary and eventually we isolated the cause of these “spontaneous” panics.

She had recently taken a new job and the bus journey to work which she was enjoying for the first time in many years passed a funeral parlour on a daily basis. She therefore glanced at the funeral parlour on the way to work and this activated a very long-standing fear of death, and cancer in particular (she had had four close family members die while she was a teenager). Thus, it became clear that this lady’s “spontaneous” panic was not really so spontaneous and she is in treatment for her long standing fear.

However, some panics appear to be genuinely spontaneous. The first thing to do is to keep a diary and record these panics, trying to also not what may have come before them so as to isolate a cause. Secondly, keep a note of what you eat and drink. In some cases, panic may be triggered by the intake of alcohol (as mentioned prior) or lots of strong black coffee. If a diary keeping exercise does not reveal a cause, think about ways of gradually reducing your base “level of arousal”. Although things like relaxation training and Yoga may be helpful, it is worth considering adding regular systematic exercise to your routines. There is a great deal of evidence which shows that regular exercise, a minimum-of 20 minutes, 3 times a week, can reduce states of high arousal. It is also worth looking at your pattern of breathing and seeing whether you are hyperventilating. It may be that you are breathing rather rapidly from the top of your chest and, some tell-tale signs are presence of pins and needles, yawning and sighing, feeling tired or having muscle cramps. The remedy for this malady is slow, but not deep, diaphragmatic breathing. The ‘No Panic’ help-line will assist you, if required, in learning some simple breathing exercises.

Finally remember that panic can do you no real harm. Obviously, therefore one needs to look at how one thinks about such panics and whether there is a pattern of catastrophic thinking. Therefore, if for example you think during a panic attack that you might die of a heart attack or stroke, this needs to be treated as an irrational though and you should practice writing down your irrational thoughts and countering them with rational responses. Thus, as you go along, you should record the irrational though and think about every other reasonable way of considering the situation In the cases of someone who’s thoughts are of their heart stopping, one might respond by saying anxiety puts the body into an optimum state of preparedness, one’s heart muscle is in a very healthy condition during increased arousal. Or one may say I have had these panic attacks on numerous occasions and I have had the same though and I am still alive!! Such simple self-help methods can often be successful however, if spontaneous panic and catastrophic thinking is a problem which will not respond to self-help strategies you should consider asking for a referral to a suitable cognitive behaviour therapist and, again, it may be worthwhile asking the help-line for advice. In some cases, medication can be useful but, although not a last resort, I would certainly not consider medication until the person showed themselves to be resistant to self-help and professional cognitive behavioural intervention. I would be very interested to hear from any of you who have developed your own strategies for dealing with spontaneous panic.

What to Do if a Family Member Has an Anxiety Disorder

• Don’t make assumptions about what the affected person needs – ask them.
• Be predictable – don’t surprise them.
• Let the person with the disorder set the pace for recovery.
• Find something positive in every experience. If the affected person is only able to go partway to a particular goal, such as a movie theater or party, consider that an achievement rather than a failure.
• Don’t enable avoidance: negotiate with the person with panic disorder to take one step forward when he or she wants to avoid something.
• Don’t sacrifice your own life and build resentments.
• Don’t panic when the person with the disorder panics.
• Remember that it’s all right to be anxious yourself – it’s natural for you to be concerned and even worried about the person with the disorder.
• Be patient and accepting, but don’t settle for the affected person being permanently disabled.
• Say: “You can do it no matter how you feel. I am proud of you. Tell me what you need now. Breathe slow and low. Stay in the present. It’s not the place what’s bothering you, it’s the thought. I know that what you are feeling is painful, but it’s not dangerous. You are courageous.”

Don’t say: “Relax. Calm down. Don’t be anxious. Let’s see if you can do this (i.e., setting up a test for the affected person). You can fight this. What should we do next? Don’t be ridiculous. You have to stay. Don’t be a coward. Pull yourself together”.