What is a Panic Attack

Sometimes people come to us suffering from debilitating panic attacks, experiencing sudden sensations of racing heart, shortness of breath, dizziness and frightening compulsive thoughts. These attacks may seem to come from nowhere and can result in people living small, impoverished, isolated lives ruled by the fear of having an attack in public. We have worked with people who have left jobs, college, relationships and lived in social isolation due to their experiences of panic attacks.

The information in this post is based on the excellent book ‘When Panic Attacks’ by Dr. Anne Tubridy and also our experience as therapists. We would definitely recommend reading ‘When Panic Attacks’ to anyone who is interested in learning more, it is written in laymen’s terms and sets out clearly and succinctly what is a panic attack, the biology behind it and how you can support yourself with simple exercises to reduce and eliminate your panic.

“A panic attack is an extreme fear response which occurs when a person is convinced they are in extreme danger, although no real danger exists.” Tubridy, 2007 pg 7.

Panic is a mind- body disorder, the mind becomes matter; the mind encourages production of chemicals in the body, which produce the symptoms. The chemical produced is a surge of adrenaline into the bloodstream and symptoms are commonly muscular tension, racing heart, shortness of breath, racing frightening thoughts, sweating and dizziness. Such surges of adrenaline are produced as part of the fight-flight response; the fight-flight response is a protective mechanism which kicks in when our survival is threatened.

Such threats to our survival can be traumatic events such as abuse or an assault, or a threat to our identity such as losing a job, relationship breakdown or social humiliation can also provoke the fight-flight response as our view of our self moves from one of safety, to one of being vulnerable and insecure. It is possible to identify the cause of the attacks and link them to this event and working with the original trauma is an important part of the work in this case. However, sometimes we may not be able to pinpoint the original cause of the attacks and confusion and frustration reign.

What we do know, however, is that at some point, it is not the original trauma that we are reacting to any more but the trigger becomes the body symptoms of panic themselves, such as racing heart, shortness of breath, that lead to the panic attack. In other words, we become afraid of having another attack, afraid of the fear itself. Eventually it is the internal body symptoms of the fight –flight response themselves that are being read by us as the life threatening situation, so as soon as the body symptoms start we react as if our survival is threatened and panic ensues. The task has now become surviving/avoiding these symptoms. So we become hyper vigilant to a slight increase in heart rate, body temperature or shortness of breath and our life becomes built around surviving/avoiding these symptoms.

Generally a panic attack lasts for 5-20min, but the state of anxiety can last for days before and after. The frequency can be several times a day or every few weeks, sometimes people only have 1 or 2 attacks or they can last for years. It may feel like a panic attack comes out of the blue but all attacks have triggers and they all have a beginning, middle and end.

The good news is that once we understand that the threat that we panic about is an internal one, i.e. the body symptoms of panic itself and not an external threat, then it is within our control to influence these internal symptoms. Once you understand the mechanics you can intervene, reduce the adrenaline level and break the cycle.

The Biology Behind a Panic Attack

Information is power, learning about the biology behind panic will give you information you need to understand how to dampen down the fight-flight response. The fight-flight response is essentially a surge of adrenaline molecules released into the blood stream, this is a protective and necessary response to danger. Anxiety is a slow, constant drip of adrenaline. Panic is intense rush of adrenaline. In panic attacks the fight-flight response is triggered and stimulates this adrenaline cascade. As a result of the surge of adrenaline the sympathetic nervous system (emergency wing) gears up to deal with an incoming threat. It is an alarm system. The sympathetic nervous system energises you, hones your senses, increases alertness and gets you to safety, it is an automatic reflex response to overwhelming fears. This is why you have symptoms such as racing heart, faster breathing/ hyperventilation, pins and needles, muscle tension, these are all necessary adjustments for a person about to flee danger. Your rational brain is high jacked by the primitive brain which takes over the decision making – all of this is good if you’re in an actual dangerous situation. The brain also alerts the parasympathetic nervous system (restoration wing) to return equilibrium once crisis is over.

There are 3 areas affected by the adrenaline cascade; thoughts, sensations and behaviour which are all interlinked and influence each other so fearful thoughts provoke fearful sensations which provoke fearful behaviours in a vicious circle scenario.

So we can see how the symptoms are created and how they can in turn be seen as a threat and create a state of hyper vigilance in the panicker. So when we panic when we feel a slight sensation and live in anxiety of the next attack which means we increase our overall adrenaline level which increases the chance of the sensations and therefore the chances of the next attack and so on................

So What Can I Do?

“The core aim in the campaign to eliminate panic centres on the calming down of the flight-fight response and reducing the number of adrenaline molecules in your bloodstream” Tubridy, 2007, pg 132

Raising Awareness

The first thing you can do is raise your awareness in the 3 areas of thought, sensation and behaviour, the more information you can gather the greater your arsenal against panic attacks is. Become a witness to your thoughts, sensations and behaviours, keep a journal noting down negative, frightening thoughts and what sensations and behaviours are associated with these thoughts. Notice when you feel anxious or panicky make a note of this and start to pay attention to any patterns that emerge. If you have a panic attack keep a record of what happened- where, when, how long did it last, what thoughts did you have, what sensations did you feel, what behaviours did you engage in. You will need to be present to yourself and pay attention to your internal world to gather your information.

As we have said previously panic affects 3 areas; thoughts, physical sensations and behaviours. If we change our responses in any one of these areas the others also change too as they all influence each other.

Reducing The Physical Sensations of Panic

The most common physical sensations associated with panic attacks are hyperventilation and muscle tension. So if you can reduce these 2 symptoms of the fight-flight response, you will thus halt the adrenaline cascade and stop the chain of chemical events leading to a panic attack.

Hyperventilation happens in 60-70% of panic attacks and is when the breathing is fast and shallow and the oxygen –carbon dioxide balance in our bodies is altered and thus produces some of the common effects associated with panic. When someone who panics picks up they are hyperventilating this is seen as a threat and increases the adrenaline cascade and so the vicious circle starts.

Abdominal breathing is the correct way to breathe; it uses the diaphragm and not the intercostal muscles of the ribs employed by more shallow breathing. Abdominal breathing uses the stomach and so the stomach moves in and out as we breathe, children do this naturally. Often we need to retrain ourselves to use the diaphragm to breathe. Abdominal breathing reduces adrenaline.

Abdominal Breathing Exercise: Do this exercise at least twice a day for at least 5 minutes each time. It is best to do it lying down initially so you can really feel the movement in your stomach. You can breathe through your mouth or nose, it’s up to you.

Place one hand on your chest and one on your abdomen. Breathe in for 4 counts and out for 4 counts, keeping your breath even. Breathe so that you feel your hand on your belly move and the one on your chest stays still. Focus on your abdomen. Over the subsequent days and weeks you can extend the breaths to 5, 6, 7, and 8 counts and try doing it walking and sitting also. You can add a calming affirmation on the out breath if you like such as ‘I am calm’ or ‘All is well’. You might like to notice how you feel before, during and after doing this exercise, it might be useful for you to keep a journal and note the effects and your progress.

To apply the abdominal breathing during a panic attack stay still and focus on your breathing, slow down your breathing, start counting your breaths, put your hand on your abdomen and move it in and out with your breathing. Trust that the abdominal breathing is reducing the adrenaline level in your body. You are sending a message to your brain that all is well, so no more adrenaline is needed and the panic subsides. You can again add a calming affirmation on the out breath such as ‘my adrenaline is reducing’ or ‘I am safe’

We have seen how increased muscle tension is part of the fight-flight response gearing us up for action in the face of threat. This increased muscle tension gives us the symptoms of racing heart, sweating, pins and needles, headaches, shaking. In a panic attack these symptoms are proof of further danger and the adrenaline cascade increases as panic ensues. Being able to relax our muscles gives our body a different message, one of safety prevailing, it stimulates the restorative parasympathetic nervous system and in turn reduces all other symptoms of panic also.

“As a philosophy relaxation is encouraging an attitude of choosing, at times, to neither fight nor flee, but to flow” Tubridy, 2007, pg 152

You will find many relaxation exercises on the internet; body scan relaxations are good for muscle relaxation we would encourage you to practice muscle relaxation exercises at least once a day.

The following muscle relaxation exercise can be done when you are on the move and feel the muscle tension building, to stop adrenaline rising and developing into a panic attack:

Stop what you are doing, be still, close your eyes. Imagine a wave of white light falling onto you from above. Notice your mind stop racing and your face relaxing as the light pours over you. See the light flowing over your shoulders, arms and torso, dissolving any tension, softening your muscles so they become slack and loose. Slow down your breathing. Allow the light to spread down through your abdomen softening any tension you are holding there. Allow it to flow down your legs and into your feet relaxing all the muscles in its path until your whole body is calm, peaceful and relaxed.

Changing Thought Patterns

Along with sensations and behaviours, thoughts are the other area affected by the fight- flight response and fearful thoughts also stimulate the adrenaline cascade. Catastrophic thinking creates adrenaline, so, change the thinking and you stop the adrenaline production.

Again awareness is key. First you need to witness the sort of thoughts you are having, a lot of the time our thinking is on automatic pilot. It is estimated that the average person has 60,000 thoughts a day and that over 95% of these are repetitive.

Start to work on witnessing and identifying your thoughts, again information is power, keep records of your thoughts, see patterns emerging, note interactions between thoughts, sensations, behaviours. Thoughts, in turn, are also influenced by your adrenaline level and so it becomes a vicious circle with worrying thoughts increasing your adrenaline and then the increase in adrenaline creating more worrying thoughts etc.

“Thoughts and emotions are all part of a hormonal reaction which is happening in your bloodstream.” Tubridy, 2007, pg 164

Part of the thought awareness you need to cultivate is your ‘bottom line beliefs.’ A bottom line belief is something you hold as a fact. But a belief is not a fact, it is an opinion. Take the bottom line belief that ‘All dogs are dangerous’ this is clearly not a fact, it is your opinion, and it does not hold up to scrutiny as a fact. Or ‘I am stupid’ this is not a fact, it is an opinion, probably someone else’s opinion of you that they made clear to you. To identify bottom line beliefs you have to get very specific so it is not ‘it is scary’ but what is scary, when is it scary, why is it scary, how scary is it………

Thought exercises need practice and repetition to lay a new pathway. Write out your bottom line beliefs, challenge them and look for the evidence for and against them. Challenging beliefs for evidence breaks the cycle, reduces adrenaline before it spreads to panicky sensations and behaviours.

“If you learn to regard thoughts as guesses or theories, rather than solid facts, and decide that before you make a judgement you will examine the evidence for thinking that way, they will lose their power.” Tubridy, 2007, pg 173

When you feel the panic coming on it is very important that you stop and stay still, this is the only way to catch the thoughts as they come flooding in. Tell yourself they are only beliefs, not facts. Use your abdominal breathing and use positive coping statements on the out breath such as ‘I am safe’ ‘breathe slowly’ ‘I am not in danger’

Meditation

Meditation is the practise of cultivating immediate awareness of the present moment. It involves stillness, abdominal breathing and the witnessing and letting go of thoughts. For these reasons it is an excellent practise for people prone to panic. You could look for a meditation group in your area or find more information on the internet. Please follow link for more information on the meditation group we run.

The three techniques that will reduce adrenaline levels can be summed up as:

Slow breathing

Still body

Safe thoughts

In the book ‘When Panic Attacks’ Dr. Áine Tubridy goes on to describe further exercises of sensation exposure for practising dampening down the adrenaline cascade. If you are interested in these techniques we would heartily recommend purchasing the book. We hope this article has been helpful and informative in explaining panic attacks and providing some insight into how you can influence the onset of an attack rather than live at the mercy of panic.

Bibliography: Tubridy A. (2007) When Panic Attacks. Dublin. Gill and Macmillan Ltd.