Although quite common, panic attack symptoms are frightening and distressful. They often include accelerated heart rate, sweating, trembling, choking or smothering sensations, chest pain, nausea or GI problems, dizziness, lightheadedness, feelings of unreality or detachment from one’s body, numbness or tingling sensations, chills, and hot flashes. These symptoms reflect activation of the body’s fight-or-flight system, which has been implicated in panic. Physical symptoms frequently co-occur with intense worries and fears such as fear of dying, losing control, or going crazy.
One of the primary reasons that panic is so scary is because it often masquerades as something other than itself. In fact, up to 20% of ER visits are panic-related (Julien, 2001). In many cases, individuals who have panic attacks don’t understand what’s happening to their bodies and understandably misinterpret panic attack symptoms as symptoms of a heart attack or other serious medical condition.
Individuals with panic often live in fear about when the next attack might occur. Because these attacks can be unpredictable and may occur “out of the blue,” they often leave the panic sufferer feeling frightened and out-of-control. As a consequence, many individuals with panic try to anticipate and avoid any situations in which panic might arise.
Although this reaction to panic is understandable, it, unfortunately, perpetuates the panic cycle. Panic is maintained and strengthened through safety behaviors and avoidance. As such, breaking free from panic involves two primary steps: 1) learning to accurately attribute uncomfortable thoughts and feelings as normal and even adaptive symptoms of anxiety, and 2) resisting the urge to avoid situations or even physical sensations that may evoke panic. These are the two principles of Cognitive Behavioral Therapy (CBT) for Panic attacks/Disorder.
Although the primary goal of panic sufferers is generally to put an end to their distress as quickly as possible, CBT involves helping them to understand that the more we, as human beings, try to actively resist feeling or thinking a certain way, the more we do!!! Treatment instead involves learning how to peacefully co-exist with these uncomfortable thoughts and feelings, while at the same time recognizing what we do have control over, our actions and our choices.
As avoidance becomes the primary means of coping with panic, many sufferers find themselves unable to engage in many activities that they enjoy and value. Treatment involves taking back the control from the panic thru gradual exposure to these anxiety- provoking situations. I generally tell patients that our initial goal is not to eliminate panic symptoms but to become the “best panicker” possible. We do this by putting ourselves in these situations with a willingness to experience whatever comes up. As we learn to simply recognize the uncomfortable symptoms as normal experiences (just what our minds and do) as a result of anxiety, and therefore not something we have to “get rid of”, paradoxically the anxiety generally starts to subside.