As Pam was driving on a highway bridge overpass, she was suddenly struck with the thought that the bridge could collapse and she would die. She had driven on this overpass a dozen times without ever thinking twice about it so she dismissed the thought as ridiculous. But that did not work. Almost immediately, her heart started pounding, she was sweating profusely, her breathing became labored, and felt like she was going to vomit. She became so concerned that after crossing the bridge, she pulled over on the side of the road to collect herself.
That is when things escalated. She felt weak, as if she was going to pass out. Her body started trembling and she felt like she was losing her mind. She tried to reason with herself but that made things worse. Finally, she closed her eyes and began saying, “Just breathe,” over and over until her breath returned to a more normal state. Looking at her watch, she realized that this episode lasted about 15 minutes.
Pam dismissed the incident as a one-time freak-out moment. But the next time she needed to go on the same bridge overpass, she became so anxious that she avoided it and took the long way. Eventually, Pam started avoiding all on-ramps, bridges, and even highways. Knowing that this could not be sustained for the rest of her life, Pam reached out for help from a therapist where she was diagnosed with a panic disorder.
What is a panic disorder? Panic disorders are characterized by their attacks. It is a sudden and often repeated attack of intense fear that can last from several minutes to 30 minutes. The fear drives the panic attack. It could be a fear of a disaster, losing control, or dying in situations for which there is little to no real danger. The physical symptoms are so strong that feels like a heart attack. The problem is that once a person has this attack, the fear of having another becomes the driving fear.
What are the symptoms of panic disorder? A person with a panic disorder may have:
- Sudden and repeated attacks of intense fear and overwhelming anxiety;
- A feeling of being out of control, or a fear of death or impending doom during the attack;
- Physical symptoms such as a pounding or racing heart, sweating, chills, trembling, breathing problems, weakness or dizziness, tingly or numb hands, chest pain, stomach pain, and nausea;
- An intense worry about when it will happen next;
- A fear or avoidance of places where the attacks have occurred in the past.
Who gets this? Panic disorders tend to begin in the teenage years. Women, more than men, are more likely to have this happen. There is also a genetic component meaning that if a parent suffers from a panic disorder, a child might have the same or similar problem. Whether this is biological, environmental, or both is unclear. Basically, the brain interprets a benign event as harmful and triggers a survival mode response of fight, flight, freeze, or faint.
What is the difference between an anxiety attack and a panic attack? During an anxiety attack, a person might feel fearful and apprehensive while experiencing a racing heart or shortness of breath. But it’s short lived, and when the trigger goes away, so does the attack. Usually there is a slow build from feeling anxious to having an anxiety attack. Panic attack however don’t come in reaction to a trigger initially . Rather, it’s unprovoked, unpredictable, and illogical. However, the more times a panic attack occurs, the more increased anxiety which then leads to more panic.
What causes it? The increase of life stress can make panic attacks appear. A change in employment, marriage, divorce, the birth of a child, death of a loved one, or recent sickness can be contributing factors. For some, there is an unresolved abuse from childhood or a series of traumatic experiences that have not been properly processed that causes the panic. For others, it is the improper handling of emotional reactions such as anger, sadness, fear, guilt, or loneliness that exasperates the attack.
What are the consequences? Just because a person has a panic attack does not mean they will develop a panic disorder. However, left untreated, panic disorders often leave a person feeling embarrassed and ashamed of their attacks. As a result, they often avoid any and all situations, even normal routines, that might bring about the attack and often have unhealthy coping mechanisms such as overeating, alcoholism, and financial problems. In more severe cases, they develop phobias. Here are some possibilities:
- Anticipatory anxiety – Instead of feeling relaxed in between panic attacks, the person feels anxious and tense and unable to reset to ‘normal’. This is anxiety from the fear of having future attacks. This “fear of fear” is present most of the time, and can be extremely disabling.
- Phobic avoidance – The person begins to avoid certain situations or environment that might have caused a previous attack. Or they may avoid places where escape would be difficult or help unavailable if it occurs again.
- Agoraphobia – Taken to the extreme, phobic avoidance becomes agoraphobia. Traditionally, this disorder involves a fear of public places and open spaces. However, it can also develop as a complication of panic disorders. Although it can manifest at any point, agoraphobia usually appears within a year of recurrent panic attacks. The person might avoid crowded places, traveling, social gatherings, restaurants, or going out with someone who triggers anxiety.
What can be done? Education about panic, anxiety, and survival mode responses is the first step to overcoming the attacks. Accepting anxiety as a normal and healthy emotion goes a long way to resetting a fear response. Smoking, alcohol, and caffeine can make panic attacks more frequent, so avoid these substances. Getting adequate amounts of sleep is essential to minimizing attacks and regular exercise is also helpful. Deep breathing exercises such as the ones taught in yoga are extremely beneficial to begin as soon as the first sign of anxiety hits. Finally, practice meditation and relaxation exercises when things are calm so the attack begins, this is well rehearsed.
What if that doesn’t work? Then it is time to seek out a licensed therapist familiar with a variety of techniques as each person is different and unique. Emotion focused therapy focuses on emotions and their responses while teaching emotional intelligence. Cognitive behavioral therapy focuses on thinking patterns that trigger the panic attacks while putting fears in a more realistic light. Exposure therapy involve gradual exposure to the fearful situations usually with the therapist present so the anxiety can be addressed as it occurs in real time.
How can I help someone having an attack? Watching a friend or family member suffer from a panic attack can be frightening. It is important that the danger they feel is very real so minimizing it is not helpful. Even worse is telling someone in the middle of an attack to “Just calm down”. Instead, do this:
- Calm yourself, quiet your voice, slow your speech, and remove any judgmental tones.
- Remind them to breathe and take some deep breaths with them.
- Find a quiet and private place quickly.
- Grab some ice water and have them take a few sips.
- Don’t ask them to say what they are thinking or feeling, rather say, “I’m here, you are safe,” over and over.
- When they appear to come back, have them names things around them such as, “There is an orange chair, a black table, the paint color is white, you are wearing a red dress.” This is grounding them to their current space.
- Finally, listen. Don’t argue, dispute, disprove, or show disappointment. Be empathetic.
Pam gradually got better after treatment. This process takes time and should not be rushed. Sometimes, the triggers return and need to be readdressed at a later date because life stress has increased. But Pam was not discouraged because she knew what was happening and had a plan going forward.