Panic Attacks - Understanding And Managing Panic Attacks

An unexpected episode of rapid heart beating, nervousness, hot/cold flashes and dizzy legs can be so frightening that you are convinced you are dying or losing your head. Panic attacks reach their peak intensity within a few minutes of onset and it can take thirty minutes to multiple hours for symptoms to diminish.

Later finding out that your heart pounding and superficial breathing is not an indication of heart disease is merely half the battle, the biggest challenge is to convince yourself that the heart pounding is an ordinary phenomenon of excess adrenaline being pumped into the body.

What are the symptoms of Panic attacks:

• Difficulty in breathing
• Rapid and racing heartbeat
• Feelings of nervousness
• Trembling/ feeling extremely nervous
• Heart palpitation,
• Terror that is almost paralyzing
• Dizziness, light-headedness, or feeling of nausea
• Choking sensation
• Chest pain/ distress
• Hot flashes or sudden chills
• Tingling in fingers or toes
• Fear, fright, or anxiety
• Fear that you may die

What are panic attacks?

Wherever we do not feel safe and secure in an environment we will experience some anxiety or panic.

A panic attack sets off the body’s “flight or fight” response. This is an automatic response that’s is triggered when the body faces danger in some form. This mechanism helped us survive during the cave man years, it’s what we relied on when we used to hunt in the jungle and came face to face with a dangerous beast. Our body prompts us either to do fight, or to run (flight).

The body releases hormones such as adrenaline, epinephrine, glycogen, cortical, nor epinephrine, and others flood the body’s cells through into the bloodstream, which results in the symptoms of a panic attack: our heart beats faster to pump more blood to important organs (the muscles, lungs, and brain); our rate of breathing speeds up to increase our intake of oxygen; and our alertness intensifies.

The main five symptoms of panic attacks include a rapid heart rate, hyperventilation, chest pain, nausea and headaches. It’s easy to see how an unfortunate person suffering a panic attack for the first time, can end up think (s)he’s having a heart attack!

Causes of Panic Attacks:

• Gamma-aminobutyric acid (GABA) receptor dysfunction is thought to play an important role in panic disorder pathophysiology.
• Caffeine: Increased intake of coffee can provoke feelings of anxiety
• Stuffy environment: A hot close room can set off feelings of discomfort
• Stress : For example losing a job or a significant relationship is coming to an end
• Depression: Depression has been revealed to be an anxiety producing situation in and of itself and about 67% of people with depression suffer from comorbid anxiety disorders.
• Family history of anxiety disorders
• Deficiencies in particular vitamins and minerals

Physical conditions that can mimic panic attacks:

• Hyperthyroidism.
• Hypoglycaemic episodes
• Paroxysmal cardiac dysrhythmia.
• Mitral valve prolapse.
• Myocardial infarction.
• Recurrent small pulmonary emboli.
• Epileptiform disorders, particularly temporal lobe epilepsy.
• Withdrawal from alcohol/sedatives/opiates.
• Paroxysmal vestibular disorders, e.g. Ménière’s disease
• Complex partial seizures
• Hypoglycemia
• Drug effects
• Angina
• Asthma
• Irritable bowel
• Colitis
• Hypertension
• Hiatal hernia
• Vertigo
• Post concussion syndrome
• Postural hypotension
• Heart arrhythmia
• Hyperventilation syndrome

Treatment for Panic attacks:

There are couple of treatment techniques which are available for treatment of panic attacks and the most preferred therapy being Linden method of treating panic attacks. Lets check out the various treatment therapies here.

Therapy:

Cognitive-behavioral therapy:

CBT (Cognitive behavior therapy) involves a therapist working with the patient to understand how thoughts and feelings influence behavior(1).The goal is to change negative thought patterns that lead to the patient’s anxiety and replace them with positive and more realistic thoughts.

Cognitive therapy helps patients to limit cognitive distortions by teaching patients to record their worries, listing evidence that justifies or contradicts the extent of their concerns. Through CBT patients learn that “worrying about worry” worsens anxiety and they are taught to take a proactive approach to solve their problems instead of practicing avoidance or procrastination.

Exposure therapy:

This is a form of therapy where the patient is exposed to the objects of their fear in a safe, controlled environment. Through repeated exposures to the feared object or situation, the patient develops control over the situation and no longer feels threatened by any negative outcome.

Relaxation techniques:

Relaxation techniques such as deep breathing, visualization are known to be helpful in the treatment of panic attack.

Recommended Therapeutic technique for Panic attack:

The method is designed to gradually shift your focus from thinking about internal factors, (i.e. pains, palpitations, dizziness) to your surroundings to help you regain composure.

So when you feel some symptoms of panic start to build up, first think about the specific areas where you are feeling something. Then slowly and surely you focus on each of your five senses, sight, hearing, touch, taste, smell one at a time.

Next , look around you, pick out 3 or 4 objects closest to you pick out a few of the colours, e.g. a black pen, a wooden table, the color of the wall, your surroundings. Next focus on the different textures i.e. the shape of the pen, the texture of the table etc.

Next think about and try to pick out just the sounds that are surrounding the noise on the road, people talking etc.

Next feel what surface you are sitting on, what are you holding in your hand, how do they feel to touch.

This type of exercise shifts your focus from inner sense of fear and panic and brings you in contact with your surroundings and makes you more present in the moment.

Medications:

1. SSRIs, or Selective Serotonin Reuptake Inhibitors. This class of drug includes Celexa, Zoloft, Prozac and Paxil. There are very effective in the treatment of Panic attacks.
2. SNRIs or Serotonin Norepinephrine Reuptake Inhibitors. Among this class of drug we find Cymbalta and Effexor. These are used when SSRIs don’t work.
3. Central Nervous System Depressants: They are mostly benzodiazepines and they have a sedative nature. These drugs provide short term relief from symptoms. Xanax and Klonopin are among the drugs used for this class, but great care must be taken due to their highly addictive nature.
4. Tricyclic Antidepressant (TCAs): TCAs in small doses canbe used for long term treatment of anxiety disorders. TCAs can have unpleasant, even dangerous, side effects, and if these are prescribed by your doctor, you should keep in close follow up with him/her and report any side effects you may encounter.

Self-help :

• Remember that it will pass: Once you have evaluated a panic attack and any serious medical disease has been ruled out, you can be certain that the feelings of panic cannot harm you in any way. At the peak of a panic attack, you may even feel like you’re having a heart attack, or losing your mind, or are dying, however these symptoms will pass. These are very intense feelings, but feelings aren’t facts. Know that you will never die, have a heart attack, or go mad after a panic attack.
• Remember there is only a limited supply of adrenaline: Even though the panic attack may come in full intensity, it thrives on adrenaline and the body has a limited supply of adrenaline, now that the panic attack is self-limiting and since your body only has a limited supply, it has to run out. So remember, no matter how bad it feels, it will stop.
• Don’t blame yourself for your panic attack: Many sufferers do this, but it only results in a loss of self esteem. Remember that you have a medical condition and like all other medical conditions it can be brought under control through proper care. Having panic attacks does not make you inferior or mentally ill, and it is not something to be embarrassed about.
• Connect with others: get as much quality help as you can. Talk to an understanding friend, counselor, priest, rabbi, or your doctor. You can also join any of a number of anxiety forums on the internet where you can discuss your thoughts and concerns. Do not isolate yourself or keep your feelings hidden.
• Try to eliminate caffeine from your diet. Coffee, soda, and energy drinks are to be avoided or limited if you have anxiety or panic attacks.
• Drink only in moderation and don’t do drugs.
• Eat natural foods: There are over 5000 chemical additives in commercial food processing. Try and eat whole unprocessed foods as much as possible. Purchase vegetables and fruit that haven’t been treated with pesticides.
• Foods to eat to reduce anxiety and maintain calm state:

• Specific nutrients such as magnesium, B complex vitamins, and calcium can decrease anxiety.
• Get professional help: Talk to a psychiatrist or psychologist.Also you can refer to the various self help techniques and treatments here.

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