Understanding Anxiety: What is a Panic Attack?

And Tips on How to Address Them

Not all anxiety is the same. What causes anxiety and specific symptoms can vary dramatically across individuals and situations. For example anxiety may feel like excessive worry about something terrible happening, it may mean struggling with social situations or feeling uncomfortable around others, or an extreme fear of something specific that outweighs the actual danger posed. Today we explore panic attacks: what they are and tips to address them.

Panic attacks come on quickly and create intense distress and physical discomfort. They can escalate during times of stress and anxiety, or come out of the blue during a calm state without any warning. If you have ever had one or know someone else who has you know they are extremely uncomfortable and downright scary. Many people feel like they are having a heart attack or dying and seek emergency medical care. It can be confusing to learn that the physical symptoms which feel like a heart attack or life threatening emergency are actually the result of anxiety. What exactly happens during a panic attack?

According to the DSM-V (Diagnostic and Statistical Manual, version 5), a panic attack consists of experiencing 4 or more of the following symptoms:

1. Feeling your heart beat faster, pounding heart, or palpitations

2. Sweating

3. Shaking or trembling

4. Feeling a shortness of breath or a sense of being smothered

5. Feeling like you are choking

6. Discomfort or pain in your chest

7. Nausea or abdominal distress

8. Feeling like you might faint, dizziness, or unsteady

9. Chills or feeling sensations of heat

10. Body numbness or tingling

11. Feeling a sense of detachment from your body

12. Feeling like you could be going crazy or losing control

13. Fear of dying

None of these symptoms are pleasant, and while they are uncomfortable and can leave a person feeling exhausted, the important point to remember is that they don’t last. Panic attacks escalate quickly and they also resolve quickly—in a manner of minutes. Our bodies simply can’t maintain a heightened level of physical arousal for a sustained period of time. This can actually be reassuring. That doesn’t mean it doesn’t feel like an eternity due to the intensity of physical distress and sometimes unpredictable nature of these episodes. However, like gravity, our stress response follows the same principle—what goes up, must come down. So even though panic attacks make us feel like we have no control, they are quite predictable in terms of running their course. Focusing on skills to manage a panic attack can be empowering.

If not addressed, panic attacks can evolve into Panic Disorder, which simply means there is prolonged persistent worry about experiencing future panic attacks and this translates into actively avoiding activities or situations that you believe may bring on a panic attack. In essence, the fear of having a panic attack creates anxiety and avoidance patterns around daily activities and gets in the way of desired functioning.

Other Facts about Panic Attacks:

• In the United States, approximately 11% of adults report experiencing them

• They affect women more than men

• The average age individuals experience their first panic attack is during young adulthood, around 22-23 years old

TIPS to Address Panic Attacks (PAs):

• Use the BAY technique. Remember the post about managing emotional distress? If not you can revisit it here. If a panic attack hits, the only option is to ride it out. If possible, it can be helpful to get to a quiet place and utilize coping skills such as:

  • Breathe. During a PA, people experiencing difficulty breathing. They tend to inhale and not exhale which creates hyperventilation. Focusing on exhaling and making it slightly longer than the amount of time you inhale can create relief. I suggest counting (which also helps your brain focus on a simple task and can feel grounding). For instance, inhale for a count of 2-3 and exhale for a count of 4-5. Try to increase the count as you calm down and expand your breath.

  • Accept. Acknowledging you are having a PA and accepting it is actually helpful. When we try to push something away, tell ourselves it is “horrible” and avoid it, it can be counterproductive and worsen the experience. Simply noting, this is a panic attack, reminding yourself it will pass quickly and reassuring yourself you will be okay is a way to comfort yourself.

  • Use YOU language. Coaching yourself through a difficult situation is key and using “you” instead of “I” allows the rational part of our brains to engage. Say the following “You are having a PA…You will be okay…You can get through this…”. This has a much different impact than saying “I don’t like this…I can’t handle this…etc. Our language and internal dialogue can play a powerful role in reducing or increasing our emotional distress.

• Focus on an object. During a PA, it can be helpful to focus attention on an object to keep yourself present. PAs can create a feeling of disconnection with our bodies and using our senses to touch, smell, examine, something concrete and make us feel more grounded.

• Seek professional support. Ruling out a medical problem is important. Discussing symptoms of concern with a medical provider is a first step. If it is determined that the episodes are anxiety driven, there are empirically supported ways to address the issue. Panic attacks are very treatable through evidence based treatments such as cognitive behavioral therapy (CBT). A professional can focus on specific techniques to use to manage panic attacks and reduce avoidance patterns by focusing on thoughts (cognition), emotions, and specific behavioral patterns. In addition, this is a useful way to identify and address triggers that may prompt panic attacks.

• Talk to others. Talking about PAs with others can be hard. We often hide the things that make us feel the most uncomfortable. However talking about panic attacks and letting others know about your experience with them can help us feel better. It allows others to understand what is happening if a PA occurs and potentially help in a moment of distress.

Panic attacks can feel scary and overwhelming, however as you build up confidence and tools to manage them they can become more manageable and resolve over time. As with any anxiety disorder, approaching what makes us uneasy rather than avoiding it is the key to reducing symptoms and improving well-being.

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