In today’s world, it’s not uncommon to find yourself feeling overwhelmed. Intense worries and fears about work, home life, and other stressors can take a toll on your body and mind. However, if you ever find that these fears get so intense at certain times, manifesting in the form of panic so much so that they start to interfere with your daily functioning, you may be living with panic disorder.
What is a Panic Disorder?
According to the Canadian Mental Health Association, approximately 4% of Canadians will deal with the symptoms of panic disorder at least once in their lifetime. Panic disorder is characterized by the occurrence of frequent, unanticipated feelings of extreme fear and anxiety, called panic attacks, which often come along with physical symptoms. While panic disorder can feel insurmountable and debilitating, there are several treatment options available to help people learn to cope with their fears and anxieties and recover from the disorder.
What is a Panic Attack?
In order to accurately describe panic disorder, we must first understand what a panic attack is. In its simplest form, a panic attack can be described as a sudden swell in feelings of powerful fear or discomfort. Panic attacks are often accompanied by physical sensations which can include sweating, an increased heart rate or pounding heart, feelings of shortness of breath or choking, chest pain, trembling, chills or feeling too hot, nausea, numbness or tingling.
People undergoing a panic attack might also experience feelings of derealization (feeling like their surroundings are no longer real) or depersonalization (feeling like they are separated from their body). The fear of dying is also sometimes present during panic attacks. Only four of the symptoms above are needed to qualify as a panic attack. Typically, symptoms will rise to their peak intensity within a few minutes of occurring and then come back down to normal levels.
What are the Symptoms of a Panic Disorder?
People with panic disorder can experience powerful fears and worries over the possibility of having other panic attacks in the future and the possible consequences they may lead to. People report feeling afraid that they may lose control, experience a heart attack, or feel like they are “going crazy”.
Panic disorder can also move people to engage in avoidant behaviours, in order to feel sheltered and protected from situations in which they might have another attack. Avoidance of these situations can greatly decrease an individual’s quality of life, causing them to miss social events or discontinue engaging in exercise. Importantly, avoidance can also prevent a person from discovering that the situation or event they fear is not as dangerous as it seems in those panicky moments.
What Causes Panic Attacks?
Panic attacks can come on completely unexpectedly. In other cases, someone may experience a panic attack in a certain setting and then continue experiencing them whenever they find themselves in that same situation. However, not everyone who experiences feelings of anxiety and panic will go on to develop panic disorder.
There are a few factors that can lead to the development of panic disorder, which include biological, psychological, and social influences that, when coupled with a specific circumstance, can intertwine and lead to these overwhelming instances of panic. Firstly, our biological makeup, passed on from our parents, can play a role in how we react to situations.
Studies have shown that a more anxious temperament, or our individual nature and how we react to situations, can be passed down to us through our genetics. Take a look around. If you find that members of your family also have a tendency to panic in response to stressful situations, then some of your anxiety might be a factor of your genetics.
Biological Influences that Cause Panic Disorders
However, temperament is not the only biological explanation for this kind of anxiety disorder. It is well understood that feelings of anxiety can be influenced by our brain structures and how they communicate. One of the main systems involved in anxiety is our limbic system. Sitting in the middle of the brain, the limbic system’s primary responsibility is to aid in communication between the upper part of our brain, the cortex, and the brain stem below.
The brain stem uses the limbic system to relay information about how our body is reacting to the environment around us. Any changes within the body that may result in our lives being in danger, such as heavier breathing or a pounding heartbeat, are noted and sent through the limbic system to the cortex so that we can act accordingly to increase the odds of our survival.
Reactions to Panic Attacks
In someone with a typical level of reactivity to stress, the limbic system would not be as susceptible to feelings of panic. However, people who have over-reactive limbic systems have been shown to be more prone to experience panic. The amygdala, two, small, almond-shaped organs located within the limbic system, are there to function like the smoke-detectors of the brain.
Their sole job is to scan the environment and decide, immediately and based on past experience, whether any new circumstances are ‘safe’ or ‘dangerous’. Trauma and other life events can cause the amygdala to become hypersensitive and more likely to sound the alarms even when danger is not present. Trauma can also hinder higher-level structures of the brain, like the cerebral cortex, interfering in their ability to calm the limbic system and return the body to a state of rest.
It is also important to note that certain lifestyle factors, such as smoking cigarettes, especially throughout the formative teenage years, can lead to this tendency of our brain to panic. Nicotine use in adolescence has been associated with higher levels of emotional reactivity and the development of panic disorder in adulthood. Its addictiveness and the way in which it increases bodily symptoms and respiratory system issues can increase our biological vulnerability to developing panic disorder.
Psychological Influences for Panic Disorders
Our individual psychological makeups can also influence whether or not we develop panic disorder. For example, we might experience a sense of extreme fear in response to a truly dangerous situation, like encountering a large, snarling or angry-looking dog. This response would be called a true alarm because our body would be correctly identifying a genuine threat.
The brain might then associate the internal sensations we felt and the circumstances of the dog or environment with the sensation of fear, such that some, susceptible people, like those who may not have had much prior experience with dogs, might then begin to fear all dogs, places that are similar to the one where the snarling dog was encountered, or any situation where their body reacted in the same way as in that original one.
The tricky thing with panic attacks is that after the first attack, your body may start to associate internal cues with the immense fear and overwhelming feelings of a panic attack. So, in situations like engaging in vigorous exercise and having your heartbeat increase may lead you to feel like you are experiencing the same intense danger that leads to panic. Internal and external cues can trigger unexpected panic attacks that can become an unwelcome interference in our daily functioning.
Social Influences that Cause Panic Attacks
The more that false alarms are associated with our learned, true alarms, the more likely it is for sufferers of panic disorder to come to believe that any physical symptoms are dangerous and should be avoided. Many people can become hyper-aware of how they are feeling in terms of their physical symptoms and may try to avoid situations that can trigger them entirely.
It is important to keep in mind that panic is usually an evolutionarily beneficial response to danger. Meaning that when we perceive a threat in our environment, it’s good for our body to register it and become fearful of the situation. This fear triggers an alarm in our brains, telling us to defend ourselves or get going. More specifically, our autonomic nervous system, responsible for controlling our breathing and heart rate outside of our conscious awareness, sends messages to our bodies to get ready for fighting or fleeing.
When this response occurs in proportion with a perceived threat, it is completely beneficial. However, in the case of a panic attack, people can experience these strong feelings of fear and anxiety over a threat or just the thought of a threat that may not actually be detrimental to their survival. Our evolutionary stress response can start to react to everyday stress in a way that can end up making us feel scared and too overwhelmed to function.
How to Treat a Panic Disorder
Luckily, panic disorder is extremely treatable. Psychological therapies have been shown to act as effective and long-lasting treatments for panic disorder and are often used in conjunction with medications to help people who experience frequent panic attacks. More specifically, cognitive behavioural therapy (CBT) can help individuals overcome feelings of panic and get them back to a higher level of functioning.
CBT is based on the understanding that our thoughts, feelings, and perceptions can greatly affect our behaviour. Through CBT, psychologists and psychotherapists can help people work to change the patterns of thought that may lead them to panic in certain situations, ultimately changing their behaviours for the betterment of their mental, physical, and emotional health.
Research has shown that people with panic disorder are often more prone to holding self-defeating beliefs which can lead to decreases in self-esteem and increases in anxiety. These negative patterns of thought have been shown to be associated with increased instances of panic attacks.
Medication therapies such as benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) can also benefit individuals in the short term. Although, it has been shown that medication alone can lead to higher relapse rates for panic disorder when individuals stop taking the drug.
Positive Self-Talk to Treat Panic Disorders
CBT provides the tools to help individuals cope with these thoughts and their symptoms through a simple, two-step practice. The first step taken to help someone with panic disorder involves teaching them how to recognize and challenge the negative thoughts that lead to their increased anxiety and apprehension. Psychologists can help people identify the habitual thought patterns that they routinely fall into. Becoming aware of how our thoughts influence our behaviour can help us change how we think for the better.
How to Develop Skills to Cope with a Panic Attack
The second step CBT emphasizes involves providing and implementing coping skills that will help those with panic disorder reduce their stress and anxiety levels and help them physically get through a panic attack.
People are often not able to control when they have a panic attack, but with the help of CBT, they can control how they get through it. CBT can help individuals become more comfortable with the stimuli that usually bring about panic through controlled exposure, leaving them feeling stronger and more capable of coping with the feelings of fear and acute anxiety.
Relaxation Techniques for Panic Attacks
CBT can also provide people who have panic disorder with skills to help them relax their body and calm the physical symptoms that usually arise during episodes of panic. Learning how to engage in calm breathing and meditative exercises can greatly reduce heart rate and built-up tension in the body, lowering the discomfort caused by panic attacks without flat-out avoidance. Decades of clinical research has shown that CBT is an effective treatment option for treating panic disorder.