Panic Disorder and Panic Attacks

Panic Disorder is a form of anxiety disorder in which the sufferer experiences ongoing worry about repeated panic attacks and maladaptive changes to their daily life. Panic attacks and anxiety attacks are overwhelming spikes of anxiety, physical discomfort, and exaggerated thoughts about health and safety. Anxiety and panic attacks can occur at predictable locations or events, or can sometimes appear seemingly out of nowhere. When left unaddressed, Panic Disorder can develop over time as a result of recurring over-attention and unhelpful responses to panic or anxiety attacks. At its core, Panic Disorder is chiefly concerned with the fear of having a panic or anxiety attack.

Panic disorder differs from Obsessive Compulsive Disorder (OCD) in that Panic Disorder often has a singular, or at least more focused, feared story. Conversely, OCD often has elaborate and bizarre associations and connections between the triggering event and the feared outcome. They are similar, however, in that their core fear begins with a “What if” or “If ____, then ____” thought. In the case of Panic Disorder, overwhelming fear and a panic or anxiety attack can germinate from the thought “What if I get a panic (or anxiety) attack?”

Panic Disorder Symptoms

Panic and anxiety attacks are overwhelming and often emotionally and physically painful. While they usually reach their peak discomfort after 10 minutes, they can last for up to several hours until they fade away. Although panic attack and anxiety attack are often used interchangeably, they are not exactly the same. They share many of the same characteristics, however panic is more intense.

Symptoms of panic and anxiety attacks can include:

• Chest pain
• Dizziness
• Elevated heart rate
• Muscle tension
• Numbness
• Shortness in breath
• Lightheadedness
• Feeling suddenly hot or cold
• Throat tightness
• Stomach discomfort
• Nausea

In addition to the above symptoms, panic attacks often include more intense physical and cognitive disruption such as:

• Fear of dying
• A feeling of depersonalization or derealization
• Fear of losing control or going “crazy”

Panic Attack Triggers

Anxiety attacks are often the result of specific triggers, such as work, school, relationships, or finances. The experience of an anxiety attack can vary widely. For some, the anxiety attack is an intense and inarguably distressing event, while for others it’s felt as an irritating and mildly uncomfortable “hum.”  Panic attacks, being the more intense version of anxiety attacks, are not necessarily triggered by a specific event or situation. Instead, they can come out of nowhere and have a rapid onset.

Some people will experience panic attack while sleeping. Nocturnal panic attacks, or panic attacks occurring while the sufferer is asleep, are another way people can experience their panic or anxiety attacks. These jolt the sufferer up at night, often 30 minutes to an hour after falling asleep, and can feel like waking up right in the middle of a panic attack. While not everyone with panic or anxiety symptoms will experience a nocturnal panic attack, they are not rare.

After suffering from many panic or anxiety attacks, Panic Disorder symptoms can develop. Panic Disorder can be thought of as a fear of the onset of a panic attack. For those experiencing Panic Disorder, the mere thought about a panic attack, thoughts about panic inducing items or situations, and being in the location of a previous panic attack can all bring about another panic attack.

Avoidance and Compulsions in Panic Disorder Treatment

People suffering with Panic Disorder symptoms often engage in avoidant and other compulsive behavior as a way to control the onset or duration of the feeling. Avoidance begin slowly and sometimes innocently but can spiral into self-imposed isolation. For example, asking someone else to drive when feeling anxious can develop into an outright avoidance of driving and even an avoidance of riding in cars altogether. Sometimes, in order to subdue or eliminate the anxiety onset or intensity, sufferers will resort to “magical” means such as using a “lucky” rabbit’s foot or knocking on wood before a trip. Additionally, some panic and anxiety sufferers may resort to drugs or alcohol as a desperate means of coping with anxiety. However, none of these behaviors have any real impact on the outcome of the activity. Instead, they are used only to provide a false sense of safety and control over the anxiety. Unfortunately, there is no anxiety cure, and some attempts to cure anxiety will only make it worse.

Agoraphobia may or may not occur with Panic Disorder. The term “Agoraphobia” literally means “fear of the marketplace.” More broadly, people with Agoraphobia experience intense fear of going out in public or any other place not deemed “safe.” This intense fear leads to rigid isolation, which in turn can have a detrimental impact on every aspect of someone’s life. People suffering with Agoraphobia can drop out of school, end relationships, and quit or be fired from their job.

Panic Disorder Treatment

Panic Disorder, including anxiety and panic attacks, can be treated using Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness approaches, such as Acceptance and Commitment Therapy (ACT). Altogether, these tools help clients learn that anxiety is manageable, and that feelings do not dictate their action. CBT starts by helping clients develop more effective strategies of handling the avoidant and compulsive urges by re-thinking their misunderstandings about panic and its impact on their lives. Once the basic fears and assumptions about Panic Disorder can be challenged and re-thought, the belief that they are always “bad” and potentially dangerous begins to lose its power.

Treatment for Panic Disorder will include facing the physical sensations of panic attacks. After the initial fears are challenged, and panic disorder symptoms are not seen as the enemy as they did in the beginning, then the client is put through a series of exercises to help them experience and habituate to the individual panic feelings. This process, called Interoceptive Exposures, helps the client learn how to deal with panic attacks, and that the feelings need not be feared. Instead, they are just feelings that will not kill or harm them. Instead, the panic disorder symptoms are merely uncomfortable, but tolerable.

Mindfulness tools help client develop a new relationship with the physical sensations by seeing that they can, metaphorically, stand in the fire and not get burned. Armed with this new mindset and confidence, clients engage in exposure therapy to the individual feelings experienced during panic attacks as well as the locations and activities that were previously labeled “off limits.”

Over time and repeated exposures to triggering situations, two things happen. First, clients often experience a reduction in the intensity of the anxiety, also known as habituation. Second, clients develop an understanding that they can continue living their life however they want despite the periodic presence of anxiety and panic related symptoms. In other words, clients are able to get back to living their life.

To learn more about Panic Disorder Symptoms and Panic Disorder Treatment, or to schedule an initial assessment, please contact me. 

FearCast Podcast episodes about Panic Disorder:

Episode 28- Panic!