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[ November/December 2003 ]

Panic Attacks and Treatments

by Skip Hrin

Panic disorder (the presence of recurrent, unexpected attacks)
strikes between three and six million Americans, and is twice as
common in women as in men.

Anxiety is a prevalent and, in my opinion, all too accepted problem in our lives. There are various ways anxiety presents itself, such as through diminished health, poor sleep habits, and decreased satisfaction with life. In this article, I will be discussing a specific development of anxiety – panic attacks.

Panic attacks are discrete periods of overwhelming apprehension, anxiety and fear. They appear abruptly and often for no apparent reason. After the onset of the panic attack, a person will experience both physical and mental discomfort. Symptoms peak in about ten minutes and attacks can subside as abruptly as they began. Panic attacks can last anywhere from seconds to several hours (most panic attacks, however, pass in a few minutes). The frequency of these attacks may vary from several times a day to only once or twice a year.

The physical and psychological symptoms can include the following:

  • Chills or hot flashes
  • Chest pain or discomfort
  • Increase in heart rate or palpitations
  • Sensations of not being able to breathe or shortness of breath
  • Feelings of “going crazy” or loss of control
  • Feelings of lightheadedness, dizziness, or unsteadiness
  • Nausea or abdominal discomfort
  • The fear of dying (i.e., “my heart is going to explode!”)
  • Sensations of tingling and numbness or trembling and shaking
  • Feelings of being outside oneself (depersonalization)
  • Feelings of being cut off from reality (derealization)
Panic disorder (the presence of recurrent, unexpected attacks) strikes between three and six million Americans, and is twice as common in women as in men. It can appear at any age, but most often begins in young adulthood. Panic disorder is often accompanied by other conditions such as depression, and may also spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while riding an elevator, one may develop a fear of elevators and start avoiding them.

Some people's lives become greatly restricted as they avoid normal, everyday activities such as grocery shopping or driving and, in some cases, even leaving the house. They may also only be able to confront a feared situation if accompanied by a loved one or other trusted person. Commonly, sufferers avoid situations which they fear would make them feel helpless if a panic attack were to occur. When people's lives become this restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is referred to as agoraphobia.

Most specialists agree that a combination of cognitive and behavioral therapies is the best treatment for panic disorder. The first part of this type of therapy is largely informational; many people are greatly helped by simply understanding what panic disorder is, and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they're “going crazy” or that the panic might induce a heart attack. Cognitive restructuring (changing one's way of thinking) helps people replace those thoughts with more realistic, positive ways of viewing the attacks.

While cognitive-behavioral approaches teach patients how to view panic situations differently, they also demonstrate ways to reduce anxiety. For instance, cognitive therapy can help the patient identify possible triggers for the attacks. Doing so can create an awareness and, therefore, distance between the once automatic connection linking triggers and attacks. Once the person understands that the panic attack is separate and independent of the trigger, that trigger begins to lose some of its power to induce an attack.

The following are examples of cognitive-behavioral therapy that can be applied to panic attacks:

  • Learn to change your breathing. Habitual over-breathing can lead to hyperventilation (responsible for shortness of breath, racing and pounding heart, dizziness and feeling detached from oneself) present in panic attacks. Concentration on relaxed breathing is practiced and implemented into one’s life with the expectation that it will replace the problematic breathing style.
  • Learn to change anxiety creating thoughts. As important as faulty breathing is towards inducing panic attacks, it is not the sole factor. Learning to change fearful thoughts producing anxiety (i.e., “this is not a heart attack”) is integrated into daily practice.
  • Reduce Stress. Learning to deal with stressors as they present themselves can prove helpful in avoiding the overwhelmed feeling that often accompanies (and initiates) panic.
  • Interoceptive exposure. Intentional experiencing of sensations associated with panic attacks is practiced, which can “normalize” the feelings and help better prepare for unexpected future sensations. For example, spinning in a chair can induce dizziness associated with panic attacks.
  • Relaxation. Easy relaxation techniques (such as visualization) can also reduce symptoms.

Medication might also be appropriate in some cases. In cases where the need is indicated, anti-anxiety drugs may be prescribed, as well as antidepressants. Sometimes even heart medications (such as beta blockers) can be used to control irregular heartbeats.

Finally, a support group with others who suffer from panic disorder can be very helpful to some people. It can't take the place of therapy, but it can be a useful complement.

Studies have shown that proper psychotherapy treatment (cognitive-behavioral therapy, for instance), medications, or possibly a combination of the two helps 70 to 90 percent of people with panic disorder. Significant improvement is usually seen within six to eight weeks.

The best way you can help yourself is by avoiding things that make you anxious. It is also sensible to reduce your ordinary day-to-day stresses so that you are more generally relaxed. You may find you can then cope better with any anxiety attacks. If you suffer from panic disorder, these therapies can help you. But you can't do them on your own; all of these treatments must be outlined and prescribed by a psychologist or psychiatrist.

Dr. Skip Hrin is a Clinical Psychologist with over 12 years experience helping children, adolescents, and adults with a wide range of difficulties experienced in today’s world. Offices in Anchorage and Wasilla: (907) 350-9603.