Understanding and Managing Panic Attacks
Hello Everyone,
I hope you’re all managing during this challenging time in our history. I’m hopeful that we may see the end of the pandemic in the not too distant future as some experts have predicted. Let’s keep our fingers crossed.
Understanding and Managing Panic Attacks
Panic attacks are often the reason people consult me. People experience panic attacks as coming out of the blue, terrifying, and significantly interfering with their daily functioning. The understandable usual request is some form of “How can I get rid of these panic attacks?” In this post, I hope to provide an understanding of what usually causes panic attacks and how to use this understanding to better cope with and eventually reduce or eliminate the frequency of panic attacks.
What Causes Panic Attacks?
In short, panic attacks are usually caused by being afraid of anxiety. There is usually an initial trigger of some kind, perhaps a panic attack while giving a presentation and being terribly embarrassed or perhaps a panic attack with driving leading to a fear of causing an accident. An initial panic attack can be caused by any number of triggers, but once the first panic attack has been experienced, people often become quite afraid of having future panic attacks because they fear what they believe the panic attack means: heart attack, losing control, embarrassment, etc. Rather than seeing the panic attack as unpleasant or uncomfortable, it is experienced/interpreted as terrifying, dangerous and even life-threatening. In the vast majority of cases, panic attacks are not harmful at all (though it’s not a bad idea to consult your primary care provider to rule out any possible physical causes). They are just a series of physical sensations that can be uncomfortable, but aren’t going to hurt you. But when a panic attack is interpreted as threatening and dangerous the next logical step is to do all that you can to prevent a recurrence - which is the exact opposite of what you should do. The more you try to avoid panic attacks, the more persistent they become.
Most people try all sorts of techniques to stop their anxious sensations such as deep breathing, relaxation, meditation, etc., but if you look closely at these tools they all are forms of avoidance. Medication is also often used to avoid and/or stop the sensations but medication can also be a means of avoidance. There are certainly times when medication can be helpful and I’m not against using medication in some cases. Avoidance can be of physical sensations and also of situations where it is feared a panic attack might occur.
How to Manage Panic Attacks
The treatment for panic attacks is paradoxical. To eventually have fewer panic attacks you must allow yourself to have panic attacks. That probably sounds like it doesn’t make sense, but it is at the heart of how you learn to manage panic attacks. If you treat a panic attack as dangerous and at all costs seek to avoid the sensations associated with panic, then the message you’re sending your brain is that these sensations (and a panic attack) are dangerous. The more you believe the sensations are threatening, and the more you try to resist and avoid the sensations, the stronger they become and the more intense and lasting the panic attack is likely to be. The more you seek to avoid panic, the more it will follow you around. Understandably, people with panic disorder often start to avoid situations where they are afraid they might panic. In the two examples mentioned above, the person might start to avoid giving public presentations or avoid driving as a way of avoiding the feelings of panic. Yet if you follow that way of coping where does it lead…more and more avoidance? Perhaps avoiding public presentations might be easy to do, but even this can have consequences such as missing out on a promotion at work or being unable to speak at your daughter’s wedding. At first driving on freeways might be avoided, then certain “dangerous” bridges, then driving at night, and you can see where this is going. If left unchecked, the person may get to the point where driving anywhere becomes difficult, if not impossible. When the avoidance becomes pervasive and significantly interferes with daily functioning then we have agoraphobia.
Cognitive Behavior Therapy (CBT) is the treatment of choice for anxiety disorders. Exposure is the “Behavior” portion of CBT, but we also want to attend to the ”Cognitive” aspect of CBT. This means paying attention to what you’re thinking during a panic attack. If you think thoughts like: “This is terrible and it has to stop or I’m going to have a heart attack!” or “I can’t stand these sensations! They have to stop now!!” - can you guess what these thoughts will do to your anxiety? Of course, they will only increase your anxiety! This is a good example of how being afraid of anxiety inevitably leads to more anxiety.
The Paradoxical Solution - Accept Your Anxiety and Face Your Fears
So what are we to do to manage panic attacks? First of all, understand what I wrote above - the more you avoid anxiety and panic attacks the more they will follow you around and likely over time will continue to get worse. Recognizing that it is your mistaken interpretation of your anxious sensations as being dangerous that is at the heart of the problem followed by your unwillingness to experience those sensations. To get to the other side of panic you must stop avoiding anxiety. Acceptance and willingness are your tools to manage anxiety. Accepting anxiety and being willing to fully feel the sensations are how you overcome anxiety. Acceptance precedes change. Noticing and questioning your anxious thoughts and then facing those situations that trigger your anxiety are crucial steps. But perhaps the most important step is to adopt an accepting/willing posture toward your anxiety/panic attacks. If you drive over bridges but continue to resist your anxiety it will likely continue to be a problem. You must do what you’ve been avoiding doing and be willing to feel whatever you're going to feel. That is the only way you can process your feelings and “learn” that you can survive a panic attack.
As always, let me know if you have any questions or if there are any topics you’d like me to cover in future blog posts.
Stay safe,
Dr Bob