Betty W. Phillips, Ph.D., Psychology
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PANIC ATTACKS: CAN YOU COPE?



PANIC ATTACKS: CAN YOU COPE?

The answer to the question above is YES! Panic attacks are extremely frightening when they occur. However with new information, practice and other coping strategies designed for your individual situation, panic attacks will be a thing of the past. The power of the panic attacks first is the fear engendered by this unusual and startling occurrence and after that the fear of recurrence. As some great person has said, our greatest fear is fear itself.

How can knowledge help? When a panic attack occurs the sensation you feel is that you are dying of a heart attack or some dire emergency. Medical intervention or simply the passage of time will soon let you know that your life has never been in danger. Dismissive hospital personnel may even tell you that you "just had a panic attack." Easy for them to say, because they did not feel the full intensity of this frightening occurrence. Others may feel the panic attack is a sign they are "going crazy." The unexpected surge in physiological arousal does feel "crazy" in that the physical sensations are extremely unusual and distressing, but the panic attack is actually a temporary response not connected to a real "nervous breakdown." It does help to understand that a panic attack actually consists of a normal body response triggered in an inappropriate situation and is not a medical or life-threatening emergency of any kind. To understand a panic attack, it is useful to understand the sympathetic nervous system response of "fight or flight" which is a primitive behavior pattern arising from our distant past. When a caveman saw a tiger at the cave door, the body went into immediate overdrive to fight a superhuman struggle or run away as fast as humanly possible. The fight or flight response is very understandable and appropriate for that situation. A panic attack occurs when this sympathetic nervous system response is triggered without understandable immediate danger to explain the response. Whether in an individual or social setting, the panic attack response is alarming and obviously unnecessary and inappropriate to the situation. An individual can use knowledge about this response to calm down and defuse the power of the panic attack. Calming self statements (such as, there is no life-threatening danger and no emergency) will help alleviate part of the power of the anxiety response. If the attacks recur, which may or may not happen, you can learn to calm yourself by interrupting the anxiety response with some planned self talk such as, "Chill out. I can just calm down. This will go away soon and I don't need extra help."

If, however, you have experienced a panic attack, you will know that calming self statements may not work all by themselves. The next thing you will need to learn and practice is how to use the relaxation response of the parasympathetic nervous system to calm your body as well as your mind. We actually have two nervous systems which oppose each other, and the parasympathetic nervous system can be utilized to counteract the power of the sympathetic panic response. You can learn and practice deep slow abdominal breathing which will be able to interfere with the hyperventilation and cardiac acceleration of the panic attack. To further explain the calming and restorative power of slow abdominal breathing, it is important to realize that the fight or flight response causes your body to hyperventilate as it prepares for action. The extra oxygen mobilized actually leads to diminished oxygen release to the tissues, including the brain, which often causes feelings of dizziness, unreality and blurred vision. Usually people then try to compensate by breathing harder, perhaps causing discomfort and chest pains. The paradox is that a panic attack will cause you to feel as if you are not breathing enough air, when you are in fact taking in more oxygen than is needed.

What next? It is important to realize that in most cases observers cannot see the full intensity of the storm raging within you. They may see you sweat a little, breathe faster or become flushed, but generally there is no way for an observer to know that you are having a panic attack. Therefore, to help alleviate any possible social embarrassment about other people observing a panic attack, your response could include a "cover story" to explain whatever symptoms may be observable to others. You can say that you feel faint from an infection, lack of food, lack of sleep, you could be having a hot flash, whatever description will spare you from possible social embarrassment. The cover story will help remove one of the greatest powers of the panic attack, the fear of recurrence in a social situation. Others feel they don't need a cover story and find it is more helpful to tell friends about the panic symptoms as long as the friends stay calm and don't escalate the anxiety. Anxiety about a panic attack may itself be a trigger for an attack.

After you learn how to cope with an ongoing panic attack, the next step will be learning to stop future panic attacks before they get started. You will want to pay attention to the first signals that a panic attack may be starting and then realize that many other signs of emotional arousal can be misinterpreted as the beginning signs of panic attacks. Any activities which cause some of the body responses of a panic attack (such as rapid breathing or an accelerated heart beat) can be misinterpreted as the start of a panic attack. Even positive experiences such as excitement or exhilaration after running a race will cause an increase in breathing and heart beat which should not be misinterpreted as symptomatic of a panic attack. This phenomenon can be countered in two different ways, by changing your thought patterns and also by intervening in the physical response. When you encounter situations causing these types of physical responses, it is important to label them with words other than "anxiety." When you label these feelings with words such as uncertainty, anticipation or excitement, you will start to break the anxiety-to-panic cycle. Any type of relaxation response will also head off the transition from physical symptoms to panic. Often therapists will teach their clients to put themselves in situations of physiological arousal in order to experience how the relaxation response can interfere with anxiety-based exacerbation of physical symptoms.

An individual experiencing a panic attack will feel a frightening loss of control over body and mind. Control is an important factor to consider in overcoming panic attacks. Understanding and mastering the concepts and tools discussed in this article will go a long way to regaining a feeling of control over your body responses. There are, however, situations which are impossible for an individual to control. Learn to differentiate between these types of situations, and learn to dampen down your thoughts and physical response to situations which are truly out of your control. Anxiety about panic attacks may cause a generalized increase in worry and obsessions even about issues clearly out of your control.

What other tools are available? Music has great power to call forth the parasympathetic nervous system response of relaxation, especially musical compositions which have been developed for this purpose. The hemi-sync technology is available on many of these CDs to alter your brain waves from anxiety to relaxation. With practice, your body will respond quickly to this stimulus. Some of my clients find it helpful to carry around their favorite tape or CD to help them relax when their mind or body starts into fear of a panic attack. Some people find a cool washcloth or cold air from a fan or car air conditioner helpful in diverting a possible panic attack.

What about medication? In many cases panic attacks can be conquered without any medication. Relaxing or calming supplements may be used to further the relaxation response. Some clients feel that psychiatric medication is very helpful to them in dealing with panic attacks, while others dislike the physical symptoms caused by the medication. Many of these medications are described as having a calming or numbing effect on the individual. Some feel that this helps dampen down their overall anxiety or depression levels, while others feel that this numbing effect interferes too much with their life pleasures. Many of these medications have side effects, take a number of weeks to become fully effective and can cause dependence as well as relapse, withdrawal and rebound effects. The medication decision is a cost-benefit decision to be made with your physician and therapist.

However you choose to treat your panic attacks, it is very important to cope with the symptoms actively rather than by avoidance. Although it would seem to be a common sense approach to avoid situations which may cause a panic attack, the avoidance itself becomes a significant problem. The avoidance verifies your anxiety about panic attacks and then spreads so that your life becomes too constrained as you find yourself needing to avoid an increasing number of situations. When you leave or avoid possibly anxiety-provoking situations, the relief you feel further reinforces your fear and avoidance. An avoidance response to panic attacks can often end up as agoraphobia. It also may be tempting to use alcohol or marijuana for relaxation to calm anxiety responses. Although these substances appear to calm anxiety in the moment, they also reinforce avoidance and possibly contribute to overuse or abuse of these substances.

What causes a panic attack anyway? While helping many individuals with this symptom, I've come to find out that the causes are myriad and varied according to an individual's sensibilities. A panic attack is a symptom which can originate in many different kinds of underlying and unsolved problems. When individuals come into therapy to deal with panic attacks they are usually surprised that the attacks disappear fairly quickly and the topic of conversation switches from panic attacks to coping with unresolved issues and problems. With the help of a good therapist both the panic attacks and underlying issues can be resolved successfully. Additionally, the chance to learn and practice the relaxation response is in itself a valuable tool which can be used to deal with other life issues which will emerge in an individual's future.

A resource helpful in overcoming panic disorders is the book, "An End to Panic. Elke Zuercher-White, New Harbinger, Second Edition, 1998. The book contains additional information in all the areas mentioned in this article including both cognitive and behavioral approaches. The book describes detailed methods for learning diaphragmatic breathing and interoceptive deconditioning.