Panic attacks are brief episodes of intense fear that can come on completely unexpectedly and, in some cases, develop into a panic disorder. Anxiety is a very normal part of everyday life, and not everyone who experiences it will go on to develop panic disorder.
Panic attacks are sudden rushes of intense fear or discomfort that reach a peak intensity in a very short time, usually just minutes. Panic attacks usually involve many physical sensations, like sweating, increased heart rate or pounding heart, shortness of breath or the feeling of choking, chest pain, trembling, chills or feeling too hot, nausea, and numbness or tingling. They can also include the fears of dying, losing control or going crazy.
Derealization is another common symptom of panic, and occurs when it feels like your surroundings are surreal. Depersonalization happens when a person can suddenly feel like they are outside of their body). Only four of the symptoms above are needed to qualify as a panic attack.
While many people experience occasional panic attacks in their lifetime, only a small percentage go on to develop a full-fledged panic disorder. According to the Canadian Mental Health Association, this number is around 4% of Canadians. Panic disorder happens when a person has one or more panic attacks and then begins to fear the possibility of having another. Some people can be so afraid that they cope by avoiding places and situations where they have experienced panicky feelings in the past, or places and situations where they fear they might have a panic attack in the future. Not surprisingly, panic disorder can be quite debilitating.
Many factors can lead to the onset of panic disorder, including biological, psychological, and social factors. Firstly, our biological makeup, passed on from our parents, can play a role in how we react to situations.
There is a clear link between hereditary (that is, genetic) factors and the development of panic disorder. Take a look around your family tree. If you find that people in your family tend to worry easily or panic, then some of your anxiety might be related to you genes.
Genes aren’t the only biological reason for anxiety disorders. It is well understood that feelings of anxiety can be influenced by our brain structures and how they communicate with each other. One of the main systems involved in anxiety is something called the limbic system. Sitting in the middle of the brain, the limbic system is the heart of emotion and memory. It is also the bridge between the thinking part of the brain (the cortex) and the brain stem, which takes care of basic life-support and is often called the ‘reptile brain’.
Some people have over-reactive limbic systems that make them more likely to experiencing panic. The amygdala are two, small, almond-shaped organs located within the limbic system. They are just like the smoke-detectors of the brain: They don’t really think, they just react automatically whenever they sense a possible threat. Trauma and other painful experiences can cause them to become hypersensitive and more likely to sound the alarm even when no danger is present. (Think about a “Panic” button that get pushed so often it become loose and easier to push each time.)
Certain lifestyle factors, like smoking cigarettes, especially in the teen years, can also lead to greater risks of panic. Nicotine use in adolescence is associated with higher levels of emotional reactivity and with the development of panic disorder in adulthood.
Our individual psychological makeup 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, angry-looking dog. This response would be called a true alarm because the body would be correctly identifying a very real threat.
The brain might then incorrectly generalize that fear, pairing those feelings of panic with situations that are similar to but not exactly the same. For example, some children who are scared by one dog start to fear all dogs.
The tricky thing with panic attacks is that after the first one, your body might also start to fear any kind of intense, physical arousal. In one extreme case, a person who always felt hot and sweaty when panicking made the error of fear hot summer weather, believing that being hot and sweaty were sure signs that a panic attack was coming.
The more that false alarms become associated with true alarms, the more likely it is that anxious people will believe all physical sensations are dangerous and should be avoided. Many people can become so hyper-aware of what they are feeling they may try to avoid almost any situation that makes them feel anything.
It is important to keep in mind that panic is actually helpful for survival — it’s good that our bodies fear true dangers and survive by avoiding them. Fear triggers an alarm in the brain that activates the body to defend or escape.
When this happens in the presence of a genuine threat, we survive. In the case of panic attacks, these very useful reactions can be triggered just by thoughts about possible dangers. Our survival systems can begin to overreact to everyday stresses in ways that end up making us feel scared and too overwhelmed to function in regular life.
Panic disorder is extremely treatable. Psychological therapies can be extremely effective and long-lasting treatments for panic disorder. Cognitive behavioural therapy (CBT) is one with a long history of success helping individuals overcome panic.
CBT is based on the understanding that our thoughts, feelings, and perceptions directly affect our behaviour. Through CBT, psychologists and psychotherapists help people change problematic patterns of thought and behaviour that lead to panic.
From research, we know that people with panic disorder are more prone to having self-defeating beliefs that lead to low self-esteem and a greater likelihood of anxiety. These negative patterns of thought are associated with increased risk of panic attacks.
Medication treatment, including benzodiazepines and selective serotonin reuptake inhibitors (SSRIs), can help, but medication alone can also result in relapse of symptoms when people stop taking the drug.
CBT provides tools to help individuals cope with these thoughts and their symptoms through a 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.
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.
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.