Does having a rapid heart rate, sweating, breathlessness, dizziness, feeling like you’re loosing control seem all too familiar? If so, you may be experiencing a panic attack. A panic attack is defined by a sudden rush of fear or discomfort that peaks within ten minutes, and is accompanied by at least four symptoms. In addition to the symptoms listed above, choking, chest pain, nausea, chills or hot flashes, numbness and tingling sensations can also be experienced. Panic attacks can be experienced in combination with other mental health conditions such as depression, anxiety, mood disorders and other medical conditions. Some may experience fewer than four of the symptoms listed above, often termed “limited-symptom attacks”. Panic attacks may clearly be linked to an identifiable trigger, or may seem to occur “out of the blue”.
Not everyone that experiences panic attacks meets the criteria for Panic Disorder. Those that do meet the criteria have repeated and unexpected panic attacks. In addition, there is persistent concern about when the next panic attack will occur, and a change in behavior is observed. This change could include avoidance of activities that simulate the same feelings such as intense exercise, sex, or hot showers. Avoidance of some of the places and/or situations where one fears the possibility of experiencing a panic attack may also occur. Therefore, it is not uncommon for someone to experience agoraphobic symptoms (e.g. avoid certain modes of transportation, being outside of the home alone, being in large open spaces). When situations cannot be avoided an individual may use “safety behaviors” as a way of decreasing their anxiety symptoms, for example having someone with them when confronting feared situations or staying near exits or doorways or using safe objects such as water and/or medications. Safety behaviors can be defined as anything a person does to eliminate or minimize the anxiety symptoms. Safety behaviors provide negative reinforcement, as they alleviate symptoms in the short term, but long term maintain the anxiety symptoms. People can attribute their safety to these behaviors and can distract from learning that these situations are rather safe. The energy put towards preventing a feared outcome maintains focus on the feared object/situation/sensation/place and may heighten the anxiety experienced. As a result, individuals begin to experience an impact on their ability to function at home, work or school, and interpersonally.
It is postulated that genetic, biological (e.g., somatic sensitivity), early childhood experiences that elicit a loss of control can predispose some people to panic symptoms. These symptoms are then maintained when natural somatic symptoms like increased heart rate, breathlessness and are interpreted as a panic attack and appraised as being dangerous, therefore sending a message that they are to be avoided. By avoiding situations where these symptoms are expected to occur, and the employment of “safety behaviors”, these panic symptoms are maintained.
Cognitive behavioral therapy (CBT) can help an individual identify what triggers their panic symptoms and the maladaptive rules, assumptions and beliefs that maintain these symptoms. For example, some individuals may conclude that as a result of these somatic symptoms, “I am going to lose control” or, “I am going to have a heart attack” or “People will know I am having a panic attack.” There can be rules or assumptions that underlie these thoughts, for example, “If I show panic symptoms, then others will think I am weak” or “If I am not on guard, then something bad will happen.” Those who experience panic symptoms often undervalue their ability to cope and/or overestimate the probability that something bad will occur like going crazy, having a heart attack, or even death. As a result, this situation is often seen as threatening and causes anxiety. As a way to manage anxiety, a person may be vigilant to signs that a situation is dangerous, hyper focus on their bodily responses, avoid situations that create these symptoms, or engage in an activity that gives a sense of safety when they are in these situations.
A CBT therapist will often utilize exposure and response prevention strategies to interrupt behavioral patterns that strengthen or maintain these symptoms. Exposure therapy aims to help some overcome the fear structures (thoughts, feelings, beliefs) that maintain anxiety symptoms. This is done in a collaborative manner as a way of increasing a person’s level of self-efficacy, decreasing avoidance behaviors through acknowledging that the feared consequences are unlikely to occur, and acknowledgement that the panic symptoms do not last forever.
At Cognitive Behavior Institute, we also work closely with to train one’s body how to breathe as a way of managing these symptoms. When someone experiences a panic attack, breaths tend to get shorter and more rapid, and predominantly from their chest. This type of breathing creates an imbalance of the oxygen and carbon dioxide levels. Finding ways to retrain the body how to breathe differently is a crucial part of treatment for panic disorders.