Surviving a Panic Attack

1. Remember that although your feelings and symptoms are very frightening, they are not dangerous or harmful.
2. Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress; rapid heart rate and breathing, difficulty breathing, sweating, dizziness, tingling in your hands or feet, indigestion or chest discomfort.
3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become.
4. Do not add to your panic by thinking about what "might" happen. If you find yourself asking "What if?" tell yourself "So what!" ("what if I freeze when I'm in front of the audience?" Say to yourself, "So what! it isn't the end of the world, no one will get hurt and I will figure a way to get through it." Force yourself to think rationally instead of imagining that it will be the worst thing in the world - it isn't.
5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen.
6. Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds. Every 5 seconds say the number out loud to make it real, to reinforce the truth to your brain - that this is not going to be the end of you - that you do have control.
7. When you find yourself thinking about the fear, change your "what if" thinking. Focus on and carry out a simple and manageable task such as counting backwards from 100 by 3's or snapping a rubber band on your wrist. Sit down; try counting the squares of tile on the floor.
8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade.
9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.
10. Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

Signs & Symptoms

This is intended for educational information only. If you believe, after reading this, that you might have PAD, you should see your physician who can either diagnose and treat you, or refer you to a specialist.

Panic

"Panic" was hardly the word to describe how terrified she was feeling. It went beyond any feeling of fear that she had ever experienced. Although she had gone to the emergency room several times, nothing seemed to be found by the doctors to explain why she kept having the attacks. She frantically searched for her car keys so that she could get to the hospital immediately. She thought desperately, "What's wrong with me?"

What it feels like

The main symptom of a Panic Disorder is the panic attack itself. Panic Disorder is a medical disorder characterized by severe and sudden episodes. It is important to mention that sudden episodes of the symptoms listed above caused by another reasonable cause are not panic attacks. Two such reasonable causes would be

1. a certain medical ailment that might mimic a panic attack, or
2. a life threatening experience immediately preceding the attack. If these reasonable causes are found to not be the cause of the problem then there is the possibility of a Panic Disorder.

Panic attacks reach maximum intensity within a minute or two once they begin. They diminish slowly over the next 30 minutes or the next several hours. It is common for the first attack to cause a person to go to an emergency medical facility. Subsequent attacks occur several times a month and are often as severe as the initial attack. About three fourths of Panic Disorder sufferers are women. Panic Disorder begins most often when people are 20-30 years old. It begins less often in teenagers or persons in their forties. It is uncommon for the disorder to appear in the elderly for the first time. It is important to note that experts say it is more common in persons who experienced a separation experience as a child. Panic Disorder generally afflicts emotionally healthy people. Persons with Panic Disorder are no more likely than the average American to have suffered from emotional problems at the time the disorder begins.

Afraid of Something

Persons experiencing repetitive, severe panic attacks may simply have panic attacks and that is all. Other persons may begin to experience a progression of bothersome or distressing panic attack "side effects". This progression commonly occurs as follows:

1. A few weeks or months prior to the first panic attack there are sometimes minor symptoms such as rapid heart beat, sweaty palms, racing thoughts or waves of anxiety.

2. The first major panic attack occurs. The person often seeks emergency medical evaluation at this time. The initial examination is commonly normal. The physician may or may not diagnose a panic disorder; but will likely prescribe an anti anxiety medication and tell the patient to reduce their stress level.

3. Continued panic attacks cause the person to seek further medical evaluations which may be inconclusive. Many panic attack sufferers go for months or years before receiving the proper diagnosis and by that time may have seen over a dozen physicians, psychologists and counselors. This appearance of "doctor shopping" may cause others to regard the sufferer as a hypochondriac.

4. An individual with Panic Disorder may begin to avoid a certain activity because it occurs to them that it would be especially embarrassing or dangerous to have an attack while engaged in that activity. A typical sufferer of Panic Disorder might think, "It's bad enough to have an attack at all, but it would be dangerous to have one on Interstate 75 because I would be preoccupied with the attack and would not be a safe driver. I might wreck my car, injuring myself or someone else!" This avoidance behavior may appear to be a fear of driving when it is really a fear of having a panic attack while driving.

5. Tendencies to avoid circumstances in everyday life may increase and extend to more activities. This extensive avoidance behavior is referred to as agoraphobia. Places, activities or circumstances frequently avoided by persons with Panic Disorder include the following: Shopping malls Department stores Restaurants Church Meetings Classes Driving Being alone Airplanes Elevators

6. After months or years of continuous panic attacks and the restricted lifestyle caused by the typical avoidance behavior, the sufferer of Panic Disorder may become demoralized and psychologically or physically depressed. Some sufferers turn to alcohol in an attempt to self medicate or to diminish the symptoms of the disorder. This greatly complicates the individual's life and ability to seek appropriate treatment.

 

About Panic attacks

The most essential thing to learn about panic is the experience of panic itself. Once it happens, a person's life changes dramatically. A panic attack brings on the fastest and most complex changes known in the human body. It is experienced as overwhelming, uncontrollable dread, as if one is terribly ill, about to die or lose one's mind. It drastically changes the the functioning of major glands, heart, lungs, stomach, intestines, pancreas, kidneys, bladder, eyes, and the largest muscle groups. Even violent poisons or traumatic injuries have less effect. A cascade of stimulants and hormones - adrenaline, epinephrine, glycogen, among others - flood all the cells of the body via the bloodstream. The impulse is to run, get out, or hide. The immediate cause is believing one is trapped and helpless, by some overwhelming threat.

 

While panic can happen as a consequence of crime or disaster, it doesn't matter whether the threat is real. Often, panic happens after several weeks or months of stress. It happens more often with persons who are very worried, perfectionist, socially avoidant, or who have had abuse in childhood. Heredity may play some part. What keeps panic going, and getting more intense and frequent, is worrying excessively about it and avoiding situations that appear to bring panic.

 

Panic masquerades as a variety of medical disorders. Panic mimics some medical conditions almost completely, causing years of misdiagnosis. These are hypoglycemia, complex partial seizures, drug effects, heart arrhythmia and hyperventilation syndrome. Panic partly mimics others: angina, asthma, irritable bowel, colitis, vertigo, heart attack, post concussion syndrome, hypertension, postural hypotension, and hiatal hernia.

Almost everyone who panics believes they have a serious physical illness, and go from doctor to doctor for several years as symptoms shift. Yet panic is easily diagnosed by professionals experienced in panic. About 7.2% of all adults, or 1 in 15, have a panic disorder which is a primary part of their disorder, (NIH, 1993). In any given year, about 1/3 of American adults have at least one panic attack; most of these adults never develop repeated attacks. This startling data means that a phobia/panic disorder is the most common emotional disorder, more common than alcohol abuse or depression (phobias are an irrational fear of something, spiders, heights etc.).

 

Phobia/panic disorder also has the lowest rates for seeking help and finding it, about 22%. Phobia is the most common and the most hidden condition at the same time. After a few months of panic, about 10% of people become housebound and unable to leave home alone. After a few years, about 30% of panic sufferers have a loss of job, pay or job responsibilities. Some 17% are at risk for alcoholism and about 40% risk a chronic depression as life opportunities are cut off. A majority have marital problems and much reduced travel and social life.

 

For most, panic closes life off like a prison. If you are agoraphobic (fear of crowds, fear of leaving your home alone), there's a 40% chance you had near relatives who were phobic. You may have suffered early abuse. In addition, there may have been a lot of instability in your home, such as repeated moves or foster care. You may have had your first panic as part of a school phobia.

Your phobia most likely started with a panic attack about age 23, as if "out of the blue". After a while you saw that only certain situations brought it on, those in which you were trapped in some way. Just before the first attack, you were likely to have been under unusual stress, responsibility, or loss of security. Then you soon started to avoid those panic situations and to worry and dread going back to them. Very soon you began multiple consultations with several physicians to check out your alarming symptoms, which shifted from year to year. By the end of the first year you were already avoiding crowds, stores, transportation, and closed in spaces. There was a 10% chance you became housebound. After 8 to 10 years of mostly misdirected treatment, you found that periods of panic would be followed by 1 or 2 years of some relief, only to return stronger than before.

Because you still didn't know your condition, you began to feel a bit alien and became good at hiding you condition. You slowly began to give up on friendships, social life, travel, work ambition and other life plans. If male, you began a period of heavier drinking, as a way of self-medication. A kind of chronic, low grade depression set in along with lowered expectations in life. You started to get resigned to your prison. After 20 or more years of having agoraphobia, you found you could get by in safe areas or with a safe friend, but your life became narrow and limited. You became very dependent on your partner to travel. In fact, your relationship got strained as your partner felt increasingly helpless and distant. There was less sexual desire. There was a good chance you had some loss of your work role and impaired work performance. Amazingly, you have not learned what to call your condition. It has become a way of life, the way your life has turned out. While panic is always part of agoraphobia. social phobia, or any phobia, it also turns up some of the time in other anxiety disorders.

About 30% of people with obsessive-compulsive tendencies experience panic, particularly around the need to stop the rituals of washing, checking, or cleaning. A good estimate is that about 40% of those of who have post-traumatic stress disorder (PTSD) panic at least occasionally, and sometimes regularly. Those with PTSD have undergone a major trauma such as rape, assault, a natural disaster, combat, major surgery, or early childhood abuse. Sometimes panic disorder exists by itself, but is much more common with the above conditions.

Treatment

Treatment for panic attacks and panic disorder is very effective. The outlook is good if you seek help, and most people are able to resume everyday activities. Be willing to admit that this is something that you need help with. It is not something that will get better with time. In fact, left untreated, it is likely to get worse over the years. Call your family Dr. S/he can give you referrals to therapy groups, specialists, and can get your treatment started.

Treatment may involve:

1. Medications. Your doctor may prescribe an antidepressant medication, such as one of the SSRI group (such as Zoloft, Paxil, Effexor, Lexapro). Antidepressant medications are usually effective in preventing future attacks. In some cases, doctors prescribe a medication to relieve anxiety, such as Klonopin or Xanax. The effectiveness of these drugs often varies. Be very aware that anti anxiety drugs such as Xanax and Klonopin are very habit forming and should not be taken long term. Unlike antidepressants, anti-anxiety medications are likely to cause drowsiness and lethargy. They are designed to reduce the immediate stressor and do not prevent symptoms long term as do the anti depressants. The duration of treatment depends on the severity of your disorder and your response to treatment.

 

2. Cognitive behavior therapy. During sessions with your psychiatrist or psychologist, you learn to better understand your panic attacks and how to deal with them. In the cognitive part of your treatment you will learn to recognize those things that trigger your panic attacks or make them worse. The behavioral part of the therapy involves learning ways of coping with anxiety, such as using breathing and relaxation techniques, journaling, learning to express anger appropriately, learning to recognize your feelings and to express them without fear and to recognize your red flags, those life situations which trigger anxiety for you. You will learn how to curb your anxiety before it escalates into a panic attack and you will learn better ways to cope with daily anxiety. If you're avoiding common situations because of fear of panic attacks, behavior therapy can help you overcome this avoidance, which may be limiting the quality of your life. Most people need only eight to 10 sessions. Long-term psychotherapy usually isn't necessary to get panic attacks under control. However because it is common for panic disorder to to develop in people who have had a significant childhood loss (death of a parent, divorce or a traumatic event), longer term therapy may be indicated to work through those emotional triggers for your panic episodes.

Therapy/support groups specifically for those with panic disorders are often the best way to learn how to deal with a panic disorder, especially for those who do not have an underlying mental illness. Groups help the individual realize that they are not alone. And the unthreatening environment is often helpful to reduce the anxiety than can accompany beginning treatment.

Some people do well with either antidepressant medications or therapy. But the combination of the two have been shown to create the best long term healing.