Fundamentals of Panic Attacks

What is a Panic Attack?

A panic attack is a sudden rush of fear accompanied by certain physical sensations, thoughts, and urges.

Common physical symptoms include accelerated heart rate or a pounding heart, sensations of shortness of breath or smothering, feelings of choking, chest pain or discomfort, sweating, trembling or shaking, nausea or abdominal distress, chills or hot flashes, feeling dizzy, unsteady, lightheaded or faint, derealization (feelings of unreality), depersonalization (feeling detached from oneself), numbness or tingling, dry mouth, blurred vision or seeing spots.

The most common fearful thoughts that come up during a panic attack are of going insane, losing control, having a nervous breakdown, suffering a heart attack or fainting. Panic attacks involve strong urges to escape from the feared situation. Furthermore, attention shifts to scanning for any potential threat in the environment or within oneself.

What Causes Panic Attacks?

To understand what causes panic attacks it is important to first understand the fight-flight response. When our brains perceive that we are in danger the sympathetic nervous system, which controls the body’s energy levels and preparation for action, is automatically activated. This is called the fight-flight response. The primary purpose of this survival mechanism is to protect us from imminent danger. For example, if someone were to cross the street and suddenly see a car speeding towards them an automatic fight-flight response would take over causing them to take immediate action by running out of the way of the oncoming car. While the fight-flight response is protective and helpful when it is triggered in response to a real threat, it can also be triggered when our brains misperceive something benign as dangerous. The fight-flight response that occurs during a panic attack is a false alarm alerting us to danger when we are actually safe.

According to researchers, panic attacks are caused by a complex interplay between biological and psychological factors.

It is likely that people inherit a genetic vulnerability to panic, which explains why panic disorder tends to run in families. According to research estimates, about 15-20% of first degree relatives of someone with panic disorder develop panic disorder themselves, compared to about 5-8% of the general U.S. population.

The major psychological contributor to panic attacks is holding beliefs that certain physical symptoms are physically, mentally or socially harmful or dangerous. While the causes of these beliefs are not fully understood, personal experiences with health and illness are one important contributor. For example, watching a close family member suffer a heart attack may increase the likelihood that someone interprets their own benign physical symptoms as harmful.

Stress is another major contributor to panic attacks for those with a biological and psychological vulnerability towards panic. During periods of stress, people tend to experience an increase in overall levels of physical tension and a reduction in confidence in their ability to cope with life. In fact, most people tend to experience their first panic attack in their 20s, during an especially stressful life period such as starting a new career or relationship.

What Happens in the Body During a Panic Attack?

Cardiovascular symptoms: Many people describe a fast and/or heavy heartbeat during a panic attack. This is because during fight-flight activation, blood flow to the muscles speeds up to deliver more oxygen and remove waste, readying the muscles for fighting or fleeing from danger. Blood is also steered away from non-essential areas like fingers, toes, and skin to provide more blood to large muscles. As a result, people may look pale and feel cold, especially near the extremities. Sometimes people report feeling hot instead, which can occur if the heart speeds up before blood is redirected. Additionally, the blood supply to the head may slightly decrease; while this is not dangerous, it can lead to blurred vision, dizziness, confusion, or a sense of unreality. Although many people experience a fear of fainting, this is actually less likely to occur during a panic attack, as blood pressure increases rather than decreases.

Respiratory symptoms: Breathing can speed up or become deeper because the body requires more oxygen for fighting or fleeing. Sometimes, people report sensations of breathlessness, choking or smothering, and pain or tightness in the chest.

Sweat-gland symptoms: People often report sweating more during a panic attack. Sweating cools the body, facilitating fighting or fleeing without collapsing from the heat.

How To Prevent Future Panic Attacks

People who experience multiple panic attacks are trapped in a vicious cycle. Briefly, this cycle begins when physical sensations are feared because of beliefs that they are dangerous. In turn, these beliefs place more attention on physical symptoms which triggers more fear, which perpetuates the panic cycle. A type of psychotherapy called Cognitive Behavioral Therapy (CBT) helps people break the panic cycle by teaching skills for working with thoughts and behaviors. A few helpful tips from CBT include:

Learn to breathe at a slow pace using the diaphragm. You can practice breathing using an app such as Calm, or looking up diaphragmatic breathing on YouTube.

Learn to reframe common unhelpful thoughts that are associated with panic. The two most common thoughts are jumping to the conclusion that negative events are much more likely to occur than they actually are and “catastrophizing” or believing that things are much worse than they really are. A helpful strategy for working with these thoughts is switching from thinking about how bad it would be if a negative event were to occur to coming up with ways to cope with the situation.

Finally, and most importantly, face the feared situations and physical symptoms instead of avoiding or escaping. That is the best way to learn that panic attacks, while uncomfortable, are not dangerous and that it is possible to survive and cope with feared symptoms and situations. Clinical psychologists refer to this as “exposure therapy”. It is helpful to come up with a list of situations and physical sensations that are associated with panic and to gradually and systematically face each feared item, working from the least to the most challenging. Ultimately, exposure to feared situations leads to more confidence and less anxiety about having a future panic attack.

Cognitive Behavioral Therapy (CBT) Can Help

If panic attacks are significantly interfering with your quality of life it can be very helpful to work with a clinical psychologist who specializes in CBT for panic disorder. You may be heartened to know that CBT for panic disorder is very effective and about 70-90% of people report that they are free of panic at the completion of treatment.

Therapy at Compass CBT can help you navigate panic disorder so you can reclaim your life from fear.