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Panic Attacks and Panic Disorder

Sherry-Lee Smith

Registered Psychologist
Perth, Western Australia

What is anxiety?

Anxiety can be considered a normal human experience, everybody feels anxiety from time to time. Moderate anxiety can be helpful in a number of ways such as improving your performance by increasing your motivation, energy levels and alertness. This can be helpful prior to playing a sporting match, attending a job interview or sitting examinations. If you find yourself in a dangerous situation, high levels of anxiety can be helpful to motivate you to act (i.e. if you arrive at the scene of a car accident) or escape (i.e. if someone is threatening you). As long as the anxiety you experience is in proportion to the event that triggers it, anxiety can be considered functional.

Anxiety becomes dysfunctional when it is out of proportion with the triggering event, when it reduces your performance (rather than enhances it), or is severe and persistent. Anxiety that causes excessive worry, avoidance or panic can become detrimental to daily functioning.

Symptoms of anxiety may include;

  • restlessness
  • rapid heart rate
  • nausea
  • dizziness
  • dry mouth
  • shortness of breath
  • muscle tension
  • feeling on edge
  • sweating
  • concentration difficulties
  • irritability

What are panic attacks or anxiety attacks?

When an abrupt surge of intense anxiety happens, a person is said to have had a panic attack (also sometimes referred to as an anxiety attack). The anxiety reaches a peak within several minutes and can last for up to half an hour. During this state of intense apprehension, 4 or more of the following physiological and psychological symptoms may occur;

  • Increase in heart rate
  • Sweating
  • Shaking or trembling
  • Feelings of choking
  • Breathlessness
  • Pain or discomfort in the chest
  • Nausea
  • Hot or cold sensations in the body
  • Feeling light headed or dizzy
  • Tingling or numbness
  • Feeling like things arenít real or detached from oneself
  • Fear of dying
  • Fear of losing control

A panic attack can start from a previously calm state or an anxious state. In any one year, around 11% of adults are thought to experience panic attacks. They can occur in the context of any mental health issue and are therefore quite common. They can be expected (triggered by an event, thought, situation etc.) or unexpected (where there is no obvious trigger).

What is Panic Disorder?

Panic disorder is one of the most common mental health issues. When a person has recurrent unexpected panic attacks they may have what is known as Panic Disorder. However most individuals with panic disorder experience both expected and unexpected panic attacks. Sufferers of this disorder often have worries that the symptoms of panic are caused by life-threatening conditions such as heart attacks or strokes, or worry they might have a seizure, faint, stop breathing, lose control, collapse or even die. Unfortunately, thoughts of this type often exacerbate the panic response and make it more difficult for the person to manage the ensuing anxiety.

Individuals with panic disorder persistently worry about having more panic attacks or what might happen as a consequence of having another panic attack. They may have worries about illnesses, being embarrassed or judged negatively by other people. Sometimes they have concerns about going crazy or losing control.

In response to these worries individuals with panic disorder will change their behaviour to avoid panic attacks or minimise the chances of having a panic attack. Some people will avoid exercise, restructure their lives so that they donít have to visit places that are anxiety provoking, or ensuring help is always available or nearby (i.e. a doctor or significant other). This can significantly impact a personís ability to live a functional and productive life. Furthermore, although these changes in behaviour temporarily reduce anxiety, over time they reinforce the fear of having more panic attacks.

The severity of panic disorder symptoms often changes over time. If left untreated panic disorder is most often a chronic condition which reduces a personís quality of life. It is important to seek professional help if you think you or someone you care about has panic disorder.

Factors that contribute to the development of panic attacks and panic disorder

There are many factors that contribute to the occurrence of panic attacks and the development of panic disorder. Some of these risk factors include;

  • Temperamental factors Ėsuch as negative affectivity (neuroticism), a personís proneness to experience negative emotions, anxiety sensitivity or separation anxiety in childhood
  • Environmental factors Ėsuch as;
    • a history of sexual and physical abuse or other traumatic events
    • smoking
    • identifiable life stressors (interpersonal stress and stress related to physical wellbeing such as negative experiences with illicit or prescription drugs, disease or death in the family, separation from parents, childhood illness, divorce, or the addition of a baby to the family)
    • family violence or alcohol abuse
  • Genetic and physiological factorsĖ such as a genetic vulnerability towards anxiety or other mental health issues and family history of panic attacks or panic disorder
  • Intrapsychic and relationship issues (ambivalent attachment patterns, underlying psychic conflicts/defences, fears of loss or abandonment, conflicted feelings about autonomy, unexpressed anger towards loved ones)

How medical treatment or counselling/psychotherapy can help

Both medical treatment and counselling/psychotherapy can be helpful in the treatment of panic attacks and panic disorder. It is recommended that both medical and psychological treatment is sought. It is important to have a medical check up to ensure that the symptoms you are experiencing are not related to a medical condition.

Once medical conditions have been ruled out, medication may be helpful in the treatment of panic attacks and panic disorder. These include anti-depressants such as serotonin re-uptake inhibitors SRIís (Prozac or Luvox), tricyclic antidepressants (i.e. Tofranil or Anafranil) or monoamine oxidase (MAO) inhibitors or benzodiazepines (such as Xanax). If you are considering medication for panic attacks or panic disorder you will need to see a GP and possibly a psychiatrist.

Psychological treatment for panic attacks and panic disorder may focus on the following;

  • Education about anxiety, panic attacks and panic disorder
  • Changing unhelpful behaviour patterns
  • Changing unhelpful thinking patterns
  • Exposure to physical sensations related to panic
  • Normalising thoughts related to the physical sensations of anxiety and panic
  • Problem-solving skills
  • Interpersonal communication skills
  • Relaxation strategies
  • Breathing strategies
  • Mindfulness skills
  • Thought stopping and distraction techniques
  • Addressing avoidance and Ďsafetyí behaviour
  • Exploring the psychological significance of panic and unconscious conflicts and addressing interpersonal issues related to panic (such as unconscious anger towards loved ones, fearful dependency, ambivalent attachment patterns, ambivalent feelings about autonomy, fear of loss or abandonment)
  • Encouraging emotional experience and expression
  • Developing exercise routines
  • Relapse prevention

Tips to help with panic attacks

  • During a panic attack slow your breathing down as much as possible Ė try breathing through a straw or into a paper bag. Take slow deep breaths
  • Remind yourself that the panic attack is temporary and it will pass
  • Educate yourself on anxiety and panic attacks
  • Avoid nicotine and caffeine as much as possible
  • Recognise that you are beginning to panic, remind yourself you are not in danger and that panic attacks arenít life threatening
  • Remember that you arenít alone, lots of other people also suffer from panic attacks
  • Relax your body as much as possible
  • Focus on something other than your body and the symptoms. Try naming one thing around you that starts with each letter of the alphabet
  • Meditation or yoga can be helpful in teaching you to relax
  • As much as possible try not to avoid situations where panic has happened
  • Make exercise a regular part of your daily schedule
  • Talk to your GP to ensure there arenít any medical conditions that might be causing your symptoms.

If you are experiencing any difficulties with panic attacks or other mental health issues and would like help please contact Sherry-Lee Smith on 042 135 1020 or or smith.sherrylee@gmail.com

Sherry-Lee Smith
Registered Psychologist

Mt Lawley Counselling Centre
13 Alvan St
Mt Lawley WA 6050

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