A panic is an episode of intense fear of abrupt onset, usually peaking within a minute. The fear, often bordering on terror, is generally accompanied by unpleasant bodily sensations, difficulty in reasoning, and a feeling of imminent catastrophe (Rachman, S & De Silva, P, 2010, p.2).
|I DECIDED TO WRITE THIS piece on anxiety-related topics both from a personal and professional perspective. People associate me with my work on anxiety, panic and suicide prevention. I have developed a considerable amount of expertise on these areas over the years, both in a professional capacity and on a personal level. Anxiety related disorders are very common in modern day society. In fact, millions of people experience anxiety related symptoms at some stage in their lifetime. It is possibly the most common mental disorder and there are several categories of which I will talk about further on in this chapter. Anxiety and panic are fearsome experiences for the majority of people, however, learning to cope or how to manage your anxiety is very possible. The good news is that it takes time, awareness, compassion with the self, along with the necessary self-care tools learned in therapy or otherwise. I am living proof of this. I decided to be very open and vulnerable by giving an actual account of my experiences in the hope of helping other people that might be going through something similar at this point in time or in their past. I have had feelings of hopelessness, despair, low self-esteem and low self-worth. I reached out for support which in turn changed and saved my life. My main objective in my life presently is to help others that are struggling daily and to reassure them that thoughts and feelings change.|
My Personal Story
My panic attacks occurred unexpectedly and often, as frequently as one or two per week. So on top of the actual anxiety, I had developed a fear around the reoccurrence of a panic attack. I feared ‘blacking out’ as I had fainted on a few occasions after major ones. Each and every panic attack was extremely frightening and I remember having absolutely no control, before, during or after. I felt helpless, extreme terror and very fearful. The ultimate fear I had developed was that of death. Although my panic attacks went on for a considerable amount of time, they became less frequent. It controlled me completely and I had reached the point where I had contemplated ending my own life. I just wanted the pain, fear and anxiety to end. I longed for the end of the turmoil and uninvited interruption of my life. I could feel that agoraphobia was beginning to set in. I was in the depths of despair. It all began with a traumatic event that occurred in my life as a teenage girl. I came to the realisation that I was suppressing a huge amount of anxiety as a result of this. I recall having feelings of isolation.
In my twenties, I developed alopecia. I had patches of baldness throughout my scalp. It became my daily routine to disguise the patches so much so that I got used to it. My hair eventually grew back after a number of years. I had attended many physician appointments and taking into account my history, not one of them suggested it may have been stress related. I lived a normal enough life, I furthered my education, and I experienced various employment experiences in companies. I was married at the age of twenty-six. I had a little girl one year later.
My First Major Panic Attack
I recall my first major panic attack vividly. I was feeding my baby girl on a Sunday evening and suddenly I began to perspire profusely. My breathing changed and I felt extremely hot, nauseous and dizzy followed by an acute chest pain and heart palpitations. I remember thinking that I was going to die. The panic attack lasted for at least fifteen minutes, which seemed lengthier. A short time after, I felt exhausted and I was trembling uncontrollably. I experienced another panic episode a while after and I was taken to hospital as I was unsure about what had been happening and naturally I was very worried. There was a series of tests carried out and cardiac issues were ruled out. Although I was relieved to hear this at the time, the fear and anxiety remained. I had convinced myself that there was something more sinister going on with my body. The next panic attack occurred in my workplace. It had been months since my last and I was working at my desk when all of a sudden I felt dizzy and couldn’t catch my breath. My heart began to race and again I had a tightening sensation in my chest. I subsequently went to the hospital. The hospital had my file and they were aware that I had attended previously with similar symptoms. They conducted various different tests. Then the consultant suggested that I may have had panic attacks and told me to visit my general practitioner to organise an assessment.
I did attend my G.P. on numerous occasions and I found this to be a helpful support. Nevertheless, I seemed to be in a constant state of anxiety resulting in me being hypersensitive to people and my environments. I was becoming fed up of waiting for my next imminent panic attack, it was around this time I had thoughts of ending my life.
As I am writing this I can feel surges of emotion emerge from inside of me as I realise how far I have come on in life especially in the management of my anxiety. My doctor recommended that I try some acupuncture treatments as it seemed to work well for some people with anxiety related issues. I went to an acupuncturist/therapist and she was very helpful. Her support helped me to feel more at ease. Over time, I went to twelve sessions with her and I felt much more at ease and I began to get my confidence back again. It seemed like a slow process but it was very effective and I was very hopeful.
On reflection, at the time, I felt very lost and desperate, as I had no knowledge about panic attacks or what was actually going on with my mind and body. Today, I feel gratitude for having had the support of my family, general practitioner, alternative methods and learned coping skills. Today I am managing extraordinarily well. I have learned so many different strategies on how to manage feelings of anxiety. I have also learned that there are warning signs unique to me prior to a panic attack. I have since gone down the psychology route and obtained a degree in psychotherapy & counselling. I am currently working in this area. It gives me the greatest pleasure to witness vulnerability, growth, hope, well-being and good self-care during and throughout sessions. My message to people is to not lose hope. There is light at the end of the tunnel, you will be well. It takes time, support, compassion and energy to get to that space. Do not despair, reach out for support in a safe environment with a qualified and accredited therapist. You will reap the benefits of your personal development work by living with and managing anxiety.
So What are Panic Attacks?
Panic attacks are sudden periods of intense fear or heightened anxiety. They usually occur when the “fright, fight or flight” response is triggered, this will happen even if there are no signs of imminent danger. The “fright, fight or flight” response is a survival mechanism that the body uses. This involves the brain thinking the body is in danger, therefore, your body gets ready to fight or run away. Basically, if you experience a panic attack, your body will react like you are in danger even if this is not the case. ‘These attacks are experienced as acute episodes of intense anxiety and are extremely distressing.The person may experience a fear of losing control, a fear of going crazy; or a fear of dying’ (Carr, 2009, p.44).
According to the diagnostic criteria listed in the DSM-iv, panic attacks are experienced as a sudden sense of fear and dread along with four or more of the following psychological, emotional, and physical symptoms:
- Heart palpitations or accelerated heart rate
- Excessive sweating
- Trembling or shaking
- Shortness of breath or smothering sensations
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal pain
- Feeling dizzy, lightheaded, or faint
- Chills or hot flashes
- De-realisation and/or de-personalisation
- Fear of losing control or going crazy
- Fear of dying
- Feelings of numbness or tingling sensations (paraesthesia)
There are Two Categories of Panic Attacks
Expected Panic attacks – These panic attacks are anticipated when a person is triggered by an existing fear. An example of this would be a person who has a fear of flying also known as aerophobia – a panic attack may ensue before or during a flight.
Unexpected Panic Attacks – These panic attacks happen without any warning or indications.The person may be completely relaxed and in a good space before an attack may occur. This type of panic attack does not involve a person being triggered or exposed to a fearful event or situation. These attacks occur at night when a person is asleep, they are known as nocturnal panic attacks. When a person has one or more such attacks this can lead to them developing panic disorder. Panic disorder can prevent a person from living a normal life. The person will spend a lot of time stressing and worrying about future attacks. They, in turn, may become lonely and place themselves in isolation, feeling ashamed of their ailment and fearing that they may be judged negatively by other people.
What Causes Panic Attacks?
The mind is very powerful and we have the ability to overthink situations and self-doubt. We also have the ability to relive past traumas when we are triggered by an event or occurrence. A panic attack may ensue due to the stress response. The stress response that you experience are feelings of fear and anxiety that manifest through the body. Your brain has developed over time to keep you feeling safe by monitoring potential threats that could potentially cause you harm. As human beings, it is inherent in us to respond appropriately to danger or fear. The fight or flight response naturally kicks in to protect us from danger. However, our minds have the potential to overreact and mark up some relatively harmless scenarios as threats. When you experience such feelings of anxiety, a good exercise is to bring yourself back to the here and now present moment. I also find grounding exercises can be very beneficial as in reality there is no real danger present.
Also, research has found that there can be a genetic predisposition present that would contribute to a person developing panic attacks/disorder. Psychological factors and stressful or unexpected life events are also contributing factors to the onset of panic. Some people may suffer panic attacks due to having another mental disorder such as social anxiety, obsessive-compulsive disorder or post-traumatic stress disorder. People with social anxiety may experience anxiety attacks when exposed to social situations and people with PTSD may have panic attacks when they become triggered or reminded of their own traumatic event.
What is Panic Disorder?
According to the World Health Organisation (WHO) classifications, Panic disorder is broken down into two different categories as follows:
Panic disorder – moderate: at least four panic attacks in a four week period. Panic disorder – severe: at least four panic attacks per week over a four-week period. According to the WHO – Depression and anxiety are increasing Common mental disorders are increasing worldwide. Between 1990 and 2013, the number of people suffering from depression and/or anxiety increased by nearly 50%, from 416 million to 615 million. Close to 10% of the world’s population is affected, and mental disorders account for 30% of the global non-fatal disease burden. Humanitarian emergencies and ongoing conflict add further to the need for scale-up of treatment options. WHO estimates that, during emergencies, as many as 1 in 5 people are affected by depression and anxiety.
The main feature of a panic disorder is the existence of reoccurring unexpected panic attacks. Such panic attacks can occur at any time without provocation leaving the person with a feeling of constant anxiety. The constant agonising worry ofanother attack occurring can alter a person’s behaviour dramatically. A person may become withdrawn and develop a tendency to avoid people or certain situations.
With panic disorder, there are recurrent unexpected panic attacks. These attacks are experienced as acute episodes of intense anxiety and are extremely distressing. The person may experience a fear of losing control; a fear of going crazy; or a fear of dying (Carr, 2009, p.44).
If panic disorder is left untreated or ignored it is very possible that secondary Agoraphobia will develop. The person would remain in the safety of the home and in fear of venturing out into the world in case another panic attack may occur. It is evident that panic disorder can be very debilitating and lead to depression or other disorders. Therefore it is most likely that these people will have an impaired social, work life and personal life. This can lead to suicide ideation, attempts and some cases death. According to Beck et al When a severely anxious person becomes intensely aware of his own unpleasant physical and emotional reactions, he may begin to dread and fear the symptoms themselves even more than the situation that triggers them. The more upset he gets, the more exaggerated his symptoms become, and he is involved in a self-perpetuating spiral of increasingly intense emotional and physical suffering (Beck et al, 2005, p.317).
Causes of Panic Disorders
There are many causes for panic disorder, as I stated earlier, a predisposition may exist from birth, and therefore, it could be genetic. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, (DSM-iv) is the handbook used by mental health providers in making accurate diagnoses According to the DSM iv p.211,
“It is believed that multiple genes confer vulnerability to panic disorder. However, the exact genes, gene products, or functions related to the genetic regions implicated remain unknown. Current neural systems models for panic disorder emphasise the amygdala and related structures, much as in other anxiety disorders. There is an increased risk for panic disorder offspring of parents with anxiety, depressive, and bipolar disorders”.
Traumatic life experiences, especially during childhood, are linked to the development of anxiety in later life. According to the DSM iv p.211,
“Reports of childhood experiences of sexual and physical abuse are more common in panic disorder than in certain other anxiety disorders. Most individuals report identifiable stressors in the months before their first panic attack”.
Subsequently, the person is constantly worrying about the panic itself, which include the reoccurring of panic attacks without any prior warning.
Coping Skills and Useful Treatments for Panic Disorders
I feel that with the help of a good therapist and gained knowledge on panic disorder a person can overcome their fear and live out their lives normally with good management of their disorder. A good therapist will bring the client to a place of understanding and acceptance of the self and their anxiety. I believe the Cognitive Behavioural Therapy (CBT) combined with Person-centredapproach could work very well in most cases. ‘The key to switching out of an anxiety state is to accept it fully. Remaining in the present and accepting your anxiety cause it to disappear’ (Beck et al, 2005, p.324). I also like the Aware Model.
The Aware Model
The A-W-A-R-E model is a very good strategy for coping with an anxiety disorder. The model is adapted from the work of Dr. Arron Beck. It is a fantastic tool that can be used to better cope with anxiety disorders. By putting the AWARE model into practice, a person can begin to change their relationship with anxiety and break the cycle of avoidance that allows for anxiety to take hold and grow. A – Accept the anxiety ‘Decide to be with the experience. Don’t fight it. Replace your rejection, anger, and hatred of it with acceptance’ (Beck et al, 2005, p.323). W – Watch your anxiety. ‘Remember, you’re not your anxiety. The more you can separate yourself from the experience, the more you can just watch it’ (Beck et al, 2005, p323). A person can measure the peaks and fall of the panic attack. It will help them to recognise that the emotion is time limited. A – Act with the anxiety. Don’t let the panic or anxiety overwhelm you and prevent you from living your life. ‘Act as if you aren’t anxious. Function with it’ (Beck et al, 2005, p.323). R – Repeat the steps. This takes lots of practice but over time a person will accept their anxiety. E – Expect the best. A person should try to notice the small changes for the better. ‘By expecting anxiety, you’re putting yourself in a good position to accept it when it comes again’ (Beck et al, 2005, p.324).
Cognitive Behavioural Therapy
CBT works well when combined with other models for people diagnosed as having panic disorder. This type of therapy helps the client to recognise their issues and they are broken down into main areas such as – Situations, Thought, Emotions, Physical feelings and Actions. These five areas are interconnected and recognising how a thought can affect them on an emotional and physical level and in turn affect their behaviour or how they may respond.
The cognitive element helps the person to identify their cognitive patterns that may trigger their anxiety. CBT helps the person to question the validity of negative thoughts. According to Christian Otte:
“CBT is by far the most consistently empirically supported psychotherapeutic option in the treatment of anxiety disorders. Thus, CBT can be recommended as a gold standard in the psychotherapeutic treatment of patients with anxiety disorders” (Otte,2011,p. 421).
CBT can benefit people that suffer from panic attacks to replace negative thoughts with more factual and balanced alternatives. So when the person has a panic attack, they will recognise it as being as an attack and not fear that it is a life-threatening episode. The behaviour element consists of exposure and desensitisation. The therapist will help the client to build up their exposure to anxiety triggers and situations. This works well, especially if the trigger for panics is phobia based. This approach helps the client to learn from repeated experiences not to fear the challenging situation.
In conclusion, panic disorder is a debilitating mental illness that can take hold of a person and cause even greater issues if an intervention does not take place. Panic disorder is the existence of reoccurring unexpected panic attacks. It is a frightening experience for the person as the attacks may happen at any time regardless of how the person may be feeling. After diagnosis, treatment of this disorder is possible and in some cases medication is necessary. I feel that an integrative approach combining Cognitive Behavioural Therapy with Person Centred and the AWARE model is very effective in helping a person to deal with their disorder. I strongly believe that with the correct supports, people with anxiety or panic related issues are capable of living out their lives to their full potential. Talk therapy can benefit a person greatly as they learn coping skills and develop the ability to recognise a panic attack for what it actually is and how to work with it or prevent it. I also believe that changing your negative thoughts into more positive or conducive thoughts will change your behaviour and in turn give you power and ability on how you handle the anxiety or panic attacks. I feel that support is so vital when someone presents with panic attacks. Finally, I hope this chapter will encourage people to seek out support should they feel the need to do so. If any of this chapter resonates with you or has triggered something in you please seek out support.
*Please refer to yourmentalhealth.ie for information of supports and services available in Ireland.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 5th ed. Washington, DC: American Psychiatric Association.
Barlow, D H., Anxiety and its disorders 2nd ed. 2004 NY: The Gildford Press
Beck, A, Emery, G, Greenburg, RL, (2005) Anxiety disorders and phobias. Basic books
Beck, A. T, & Steer, R. A. (1993). Beck Anxiety Inventory Manual. San Antonio: Harcourt Brace and Company.
Carr, A. (2009). Abnormal Psychology. New York: Psychology Press.
McLeod, S. A. (2015). Cognitive Behavioral Therapy. [online] available: http://www.simplypsychology.org/cognitive-therapy.html [accessed 10 February 2018]
Otte, C. (2011) Cognitive behavioural therapy in anxiety disorders: current state of the evidence. Dialogues in clinical neuroscience. [online] Volume 13(4); p 413–421. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/ [Accessed 14 December]
Rachman, S. De Siliva, P. Panic disorder 3rd ed 2010 NY: Oxford University Press
Wells, A. (2002) Cognitive therapy of anxiety disorders NY: John Wiley & Sons Inc.
World Health Organisation. (2016) depression-anxiety-treatment. [online], available: http://www.who.int/mediacentre/news/releases/2016/depression-anxiety-treatment/e [accessed 07 Feb 2017].
*This blog is taken from a featured chapter published in Mental Health For Millennials Vol 11 (2018). Galway: Book Hub Publishing.