Panic Disorder

To say that a panic attack may cause overwhelming fear is no exaggeration! 

In fact, individuals suffering their first panic attack often assume that something is catastrophically wrong with them physically...they may even believe that they are dying!  Panic episodes can be so intense that they frequently lead sufferers to seek assistance at their local hospital.  That’s why panic attacks and the anxiety condition for which they are the primary symptom, panic disorder, are often first diagnosed, not by mental health professionals but, by emergency room medical personnel. 

What is Panic?

A panic attack is an abrupt surge of physical and emotional fear that reaches a peak within minutes.  

Panic disorder occurs when you experience recurring, unexpected panic attacks.

Common symptoms associated with a panic attack include:

• Racing heart rate and/or heart palpitations
• Chest pain or tightness
• Shortness of breath 
• Feeling like you’re choking
• Dizziness or vertigo
• Lightheadedness
• Nausea
• Sweating or chills
• Shaking or trembling
• Numbness or tingling in the hands or feet
• Overwhelming feelings of dread (i.e., a sense that something terrible is going to happen)

With symptoms like these, it's no wonder sufferers initially believe they may be in grave physical crisis and in need of immediate medical help!

Is Panic Really Something to Worry About?

In fact, while the experience of a panic attack may be highly disruptive, both physiologically and emotionally, a panic attack is actually a benign physical occurrence.  It is experienced when our brain's sympathetic nervous system signals our body to release a strong surge of adrenaline in response to the perception of threat. A quick release of adrenaline is useful in activating the muscles of our hands, arms, and legs; a valuable mechanism in helping humans fend off real physical dangers.  Indeed, If we were being chased by a bear, our panic symptoms would naturally make sense to us and even our adrenaline-induced rapid heart rate might be welcomed as we race to distance ourself from the threat of that wild salivating carnivore.  

But, when panic symptoms occur in the absence of obvious threat or even at seemingly random times, it is typically experienced as both mystifying and acutely frightening. Why do we experience panic sitting on our own sofa?...while taking a shower?...or while shopping at the mall?   

Causes of Panic

The causes of an initial panic attack are varied and cannot necessarily be predicted. Indeed, there is evidence that some individuals may simply be genetically more likely to suffer from panic episodes.  

For others, however, a habitual tendency to worry or significant life changes, such as leaving for college, getting married, or becoming a new parent may trigger an initial panic attack because of the stress these transitions may induce.  So too, a panic attack may be triggered by stress related to a specific event in the course of our daily lives such as an important test at school,  a job interview, or even a trip to the dentist.  In these cases, the stressful life event may be thought of as "the wild bear" from our previous example...in reality, a stressful event may only be a psychological challenge but, it may be perceived by our anxious brain to be an actual "threat", rapidly gaining on us and endangering our sense of safety and well being.  

Panic about the Panic!

The above explains why stressful life events might trigger initial episodes of panic.  But, why then do panic attacks often re-occur seemingly out of the blue, even after the stress of a new situation or a particularly challenging event has already passed?  What's the "threat" that our sympathetic nervous system is responding to in the absence of any obvious challenge to our survival or well being?

Because panic symptoms are themselves so dreadfully uncomfortable (and maybe even embarrassing), the fear of a future panic attack or even the terror of recalling a previous panic attack can result in another attack!  We call this "panic about the panic".  For many sufferers of panic disorder, panic is triggered when they find themselves in situations similar to those in which they have experienced panic symptoms in the past. For that matter, panic symptoms may even be triggered by the worry that an attack might occur and disrupt a brand new situation where panic has never occurred before.  Either way, the very act of mentally anticipating panic may bring about the next panic attack and the one after that, and the one after that, and on and on it goes!  And, with each recurring panic attack, more and more situations become linked with the anticipation of panic, thus causing individuals to enter into what often feels like an uncontrollable cycle of worry, panic, and eventual avoidance of more and more otherwise benign situations. 

Treatment of Panic Disorder

While some individuals diagnosed with panic disorder may opt for medication alone to help them manage the symptoms of their panic attacks, numerous studies have found that Cognitive-Behavioral Therapy (CBT) remains the most effective counseling method overall for helping individuals manage and ultimately overcome panic disorder.

In CBT, individuals learn to understand the nature of their panic symptoms, thus making these physical and emotional experiences feel much less threatening in the first place and, consequently, much more manageable.  Reducing the anxiety provoking nature of panic symptoms goes a long way toward diminishing the fear and avoidance that typically dominates a panic sufferer's life before they enter treatment.

Cognitive-behavioral therapy also emphasizes the development of specific coping skills that individuals can use in the face of stressful situations to help them effectively reduce fear and anxiety.  Cognitive coping skills involve changes in thinking that help individuals deal more effectively with anxiety in general and and help reduce the fear and embarrassment that often accompany panic attacks. Behavioral coping skills include, among other methods, breathing techniques and muscle relaxation strategies that calm the brain's sympathetic nervous response, effectively shutting down panic attacks by preventing their escalation.  

If problems with anxiety and panic are limiting you and your enjoyment of life, you may want to participate in a course of cognitive-behavioral therapy.  CBT therapists help clients understand and manage their panic symptoms, ultimately enabling individuals to overcome their fear of additional panic attacks and experience confidence in place of anxiety and avoidance.

                                                                                                --M. William Futtersak, Ph.D.