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Panic Attacks: What Are They and How Can You Prevent Them?

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What causes panic attacks? What happens in the body during a panic attack? What happens mentally during a panic attack? What triggers panic attacks? What kind of people are more likely to have panic attacks? If you have a panic attack, how can you stop or minimise its impact? How can you make yourself less likely to have a panic attack in the future?

What are panic attacks? 

An overwhelming physical sensation is present, along with sudden, brief surges of intense fear known as panic attacks. Although they usually last only a few minutes, they can be incredibly frightening and leave a person feeling like they are seriously ill and losing control. Despite their ferocious intensity, panic attacks are not dangerous, and with the right approach, people can learn to manage them effectively.

What happens to the body during a panic attack?

During a panic attack, the body goes into a form of pre-programmed “fear overdrive“, known as the “fight-or-flight response”. Under threat or immediate danger, such a dramatic response maximises our chances of survival. The fight or flight response has evolved over millennia to flood our bodies with ‘immediate survival’ hormones such as adrenaline and cortisol. This activation of the sympathetic nervous system triggers multiple physical reactions.

  • Increases in heart rate and blood pressure prepare our bodies for action. If there was a real threat, those changes would help, but when the fight or flight response is triggered yet there is no real threat, it can feel overwhelming, and cause panic.
  • Rapid breathing, known as hyperventilation, strangely leaves people feeling as though they can’t catch their breath. Dizziness or lightheadedness are frequently present.
  • Sweating and chills as our body diverts blood flow to prepare for extreme muscle movement are very alarming when there is no threat.
  • Muscle tension to prepare for action can, when it occurs in the chest or abdomen, feel like pain or difficulty breathing.
  • Nausea and dizziness can be induced by the surge of hormones. That can also impact our digestive system and balance, adding to the sense of feeling ill.

What happens mentally during a panic attack?

During a panic attack, the overwhelming physical sensations and intense fear can lead people to misinterpret what’s happening, leading to the natural emergence of a number of frightening thoughts. Here are some common experiences that people have during a panic attack:.

  • Losing control. The combination of adrenaline and extreme physical symptoms creates the perception of losing control of the body or mind, which can and does escalate the sense of panic. 
  • Intense fear and anxiety.  Many people report a sense of impending doom and a strong fear of dying.
  • Feeling detached from reality. Some people say that the world around them seems unreal, foggy, or “other-worldly”.
  • Feeling detached from yourself. Also, often reported is the sense that the person was disconnected from their body, as though they were watching themselves from a distance.
  • Having a heart attack or stroke. The rapid heart rate, chest tightness, and shortness of breath can mimic symptoms of a heart attack, leading to intense fear of dying. That further intensifies the sense of panic.
  • Becoming mentally ill. Being overwhelmed by emotions and having such extreme thoughts makes people think they are “losing their minds”. Again, the symptoms are self-amplifying. 
  • Smothering or choking. Rapid breathing (hyperventilation) can cause tightness in the chest and a sense of difficulty breathing, leading to the feeling of suffocating or choking. This fear can further heighten the anxiety.

Is it all in the mind?

Some people are dismissive of panic attacks, saying, “It is all in the mind.” Although it is, in many/most cases, started in the mind, once a panic attack is in full flow, the symptoms are very real and very measurable. 

It’s important to remember that these physical symptoms, in this context, although intense, are not life-threatening.

What triggers panic attacks?

Panic attacks can be triggered internally or externally, in various ways. 

  • Imagining a feared scenario. People can have such dread of a feared scenario that it triggers a fight or flight reaction as if the situation were a real and present danger.
  • Phobias and stressful situations. One of the most common phobias, impacting around 70% of the population, is public speaking, which can and does trigger panic attacks. Exams, financial stress, relationship problems, and legal woes have all been known to start panic attacks.
  • Physical sensations. People can misinterpret or overinterpret physical sensations so badly that they can trigger a panic attack. For example, imagine conducting your routine reproductive organ self-inspection, and finding a lump that is painful to touch. That would cause alarm, which could, and has in many people, started a full-blown panic attack. 
  • Physiological extremes and medical conditions. Some normal variations in bodily function, at extreme limits, can trigger panic attacks. For instance, having such low blood sugar that the person thinks the worst as they start to shut down. Thyroid and cardiac problems, such as heart arrhythmias, can mimic or even trigger panic attack symptoms.
  • Substance misuse. Alcohol, drugs, or caffeine are just some of the substances that, with misuse or withdrawal,can trigger panic attacks.

What causes panic attacks?

Superficially, given that we can list the common triggers, it seems that we understand what causes panic attacks. Alas, that is not so. Knowledge of triggers is not the same as understanding causes. We do have some insight into some of the factors that are involved: 

  • Genetics. Having a family history of anxiety or panic disorder increases a person’s risk of panic attacks. 
  • Age. Although panic attacks can occur at any age, they are more common in adolescents and young adults. The significant changes taking place during that stage of life might be to blame.
  • Significant life changes.  Major life events have long been predictors of all sorts of illnesses. The more significant life changes take place over a short period of time, the more likely someone is to become ill. With panic attacks, too, big events such as job loss, divorce, or the death of a loved one make panic attacks more likely.
  • Gender. Females are twice as likely as males to experience panic attacks on a regular basis. 
  • Mental health conditions. People with a history of anxiety disorders, obsessive compulsive disorder, depression, or phobias are more prone to panic attacks. 
  • Certain behavioural characteristics. If a person has perfectionistic tendencies, or neuroticism, they are more prone to anxiety and panic attacks.
  • Adverse life experiences. People who have been subjected to trauma or stressful life events can increase vulnerability. PTSI and childhood trauma, are common examples of experiences that increase the chances of panic attacks.
  • Chronic stress. Prolonged exposure to stressful situations takes a toll on mental health generally, and can also make a person more prone to panic attacks. 

Why are some people less susceptible to panic attacks?

Many people with one or more of the above factors in place never experience a panic attack. 

Frankly, we don’t understand why, when the same factors are in play, that some people do, and others don’t, have panic attacks. 

How to help prevent panic attacks

Even though we don’t understand the causes, we are aware of some methods that have worked:

  • Manage stress. When people who have had panic attacks practice relaxation techniques, such as deep breathing, meditation, or yoga, they have panic attacks less frequently.
  • Maintain a healthy lifestyle. It seems likely that there are physical causes of panic attacks. Even though we don’t fully understand them, we do know that people who choose to live a healthy lifestyle have fewer panic attacks. 
  • Limit or even avoid drugs, caffeine and alcohol. The fewer state-altering substances a person takes, the less likely they are to have panic attacks. 
  • Trigger habituation. If you can’t avoid the triggers that you know will set off your panic attacks, one approach is to desensitise yourself to the trigger by deliberately exposing yourself to it over and over again until the trigger loses its power over you.

How to deal with panic attacks

If, despite the above steps, a panic attack does emerge, here are some “in the moment” ways to deal with it.

  • Focus on your breathing. As difficult as it is to do this, when panic has set in, engage in slow, deep breathing. Inhale to the count of four and exhale to the count of eight. Focus alternately on the air flowing through your nose, and on your stomach, rising and falling with each breath. 
  • This, too, shall pass. Now that you understand what is happening during a panic attack, you can think that it is a passing event and that you are safe. 
  • Focus outside yourself. Engage your senses: name five things you can see, four things you can physically touch, three things you can hear, two things you can smell, and one thing you can taste.
  • Challenge your negative thoughts. Spot the negative thoughts that emerge, and replace them with factual statements. For instance, “I acknowledge that these physical sensations are unpleasant, and they will stop once I can relax.”. 
  • Relax your muscles. Choose a muscle group to deliberately tense, then relax. That will remind you that you have control, and it will give your body biofeedback of the same. Then repeat with another muscle group, and so on throughout your body until the episode passes.
  • Find a place of tranquillity. Move to a calm, quiet setting where you can unwind if the panic attack hasn’t completely paralysed you.
  • Visualisation techniques. If you can’t move yourself to a place of tranquillity, imagine yourself in a peaceful place and visualise calming images.
  • Distract yourself. Make a decision now, that if you have a panic attack, you will engage in a simple activity like counting backwards or repeating a mantra, such as “This too will pass.”

Final thoughts

If you know someone who suffers from panic attacks, you can help by sending them the link to this article.

If you have experienced panic attacks, what will you do to minimise them in the future? 

If you experience a panic attack, which of the above approaches will you take to deal with it?

Professor Nigel MacLennan runs the performance coaching practice PsyPerform.

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