Anxiety and panic attacks
In common language we often hear about “anxiety attack”. Less often we use the more correct expression of “panic attack”. To avoid confusion, we should immediately say that panic disorder is a subtype of anxiety disorders. Anxiety can take different forms and has several levels of severity. This of course has a lot to do with the predisposing factors, life history and cognitive schemas of the person.
But how does the panic disorder present?
The central characteristic of panic is the presence of sudden and out of the blue attacks caused by apparently nothing, that in a relatively short period become recurring and trigger intense concern. The person develops the anticipatory fear of having other attacks and begins to change some aspects of his/her life to prevent this from happening. These modifications can lead to the need to be accompanied out of the house, or to be always with someone, fearing another panic episode. This fear is associated with the idea of not being able to move away in case of a new attack, or that this would be embarrassing. In particularly serious cases the avoidance is such extended that the person rarely leaves the house, giving up all the ordinary activities. In these cases we are faced with a panic disorder with agoraphobia.
What is a panic attack?
A panic attack is a sudden episode of intense fear that rapidly grows over the course of a few minutes. During the attack can occur palpitations and tachycardia, dizziness and feelings of fainting, tremors, chest pain, nausea, shivering or flushing, tingling. These are all symptoms of sympathetic nervous system activation, not dangerous in nature though.
What scares the person most are in fact the interpretations over these vegetative symptoms.
“I’m having a heart attack, now I’m going to die” “I’m about to faint, i’il lose control” “I’m going crazy!”
Of course, one cannot even say that they are pleasant experiences!
In some cases panic can lead to symptoms of depersonalization or derealization. Specifically, the feeling of being strangers to oneself, as muffled and unnatural, or to perceive the environment as unfamiliar and unreal.
This disorder has a high prevalence, in other words is very widespread. Women seem to suffer from it more than men, in a 2:1 comparison.
Panic usually begins as a result of stressful events or periods, both emotionally and physically. A state of anxiety can therefore evolve into a panic disorder. Under certain conditions.
The presence of emotional or physical stressors: illness or loss of a family member, sentimental problems, pressure at work, a physically debilitating condition. These can all act as decompensating factors for a panic disorder.
Beside these, a central role is linked to personality characteristics. Hardly a self-confident individual will develop panic in the absence of stressful events.
The nature of anxiety and its function
Imagine that you are crossing the road when a car suddenly comes out and is just a few meters from you. You are frightened and run to the opposite sidewalk. Even before you start running, the brain has sensed the danger and activated the autonomic nervous system, whichhass promptly started to release adrenaline in your blood stream. This activation determines the physiological changes that all have the useful purpose of allowing to react in a fast and efficient way. The goal is to save our lives.
What are the changes triggered by the autonomic nervous system? The same ones we find during a panic attack. The same that characterize response of fight or flight response.
- Breathing becomes more frequent, the nostrils and lungs expand, increasing the amount of oxygen available for the muscles.
- Heart rate and blood pressure increase so that the oxygen and nourishment required by the muscles are rapidly transported.
- Blood is diverted to the muscles, particularly to the lower limbs. Flows less blood towards the internal organs and also to the face. You can become “white with fear.”
- The muscles tend to get ready to contract quickly.
- Blood clotting capacity increase so that in the case of injury this will prevent blood loss.
- It begins to sweat, to counteract the overheating due to physical activity.
- Digestion stops. The mouth becomes dry and produces less saliva.
- The food stops in the stomach and can give rise to a feeling of nausea or “knot in the stomach”. Sugar is released into the blood to provide energy.
- The immune system slows down. The body concentrates all its efforts in the fight/fight reaction.
- As is the case of the body, the mind also focuses on a goal that becomes dominant: “I am in danger, how can I avoid it?”. Everything else disappears into the background.
Fight or flight
The fight or flight response was particularly useful in our primate ancestors’s living conditions. Back then, the aggression by a predator was much more likely than today. So it still survives, by natural selection. If it did not exist we wouldn’t be able to react to dangers, whatever the nature they may be. But when this mechanism gets activated too easily or at the wrong time can lead to develop a problem. In fact a panic attack is a fight or flight response activated at a wrong time, in the absence of a real danger outside: the plane will not fall, the supermarket won’t explode, you won’t choke at the post office.
One can be healed from panic?
If you work well together with a good therapist, the answer is generally positive. Forget the goal of “no longer having anxiety”.
As we have seen, anxiety is an adaptive defense mechanism, which has ancient biological origins.
It will not become extinct and it is good that it is so.
What determines a successful treatment of anxiety and panic is to overcome the fear of its physiological symptoms!
The fight/flight response in fact ends when the upper centers of the mind evaluate that there is no danger and therefore you can relax. Until the person however considers dangerous for his survival to have tachycardia, tremor, tingling, this will maintain anxiety and trigger panic crises.
The example of hyperventilation
In individuals who are easily frightened by “body noises” hyperventilation often acts as a trigger for panic attacks: the person, perhaps because in a state of distress, experiences a sense of shortness of breath, or constriction to the throat. Once becomed frightened, evaluates this symptom in a catastrophic way, convincing himself being about to die suffocated. To compensate for the subjective sensation of lack of air increases the frequency of breaths and goes into hyperventilation. Hyperventilation causes manifestations due to the imbalance between oxygen and carbon dioxide in the blood. Sense of light head, tingling, dizziness etc… Not at all dangerous, these symptoms scary even more the person that catastrophize them, thus entering into panic.
Cognitive Therapy for Panic
The therapy of panic attacks acts at several levels. At a more superficial level it focuses on the psychoeducation of symptoms and their biological function.
The person is educated on the adaptive function of anxiety and gradually brought to a tolerance level of its symptoms. You learn not to fear the manifestations of your body and to eliminate all the avoidance and maintenance factors of the disorder.
Moreover, the therapeutic work has the objective of restructuring the catastrophic beliefs like, for example, that “having panic attacks will cause me a stroke”. The behavioural exposures, during and outside sessions allow the person to verify the unfoundness of his/her fears.
Work will focuse on early maladaptive schemas too. People who suffer from panic attacks usually suffer for a vulnerability schema. They possess an image of themselves as vulnerable people and of the world as a treacherous and dangerous place.
This of course may be involved in the development of an anxiety disorder. Deepening the basic structures of the person allows to work on these vulnerabilities and help to develop an alternative perspective of one’s person and of the events, to change the way of relating to oneself and to the world. To, ultimately, live a more conscious and full life.