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What happens when we panic

It’s normal to feel anxious sometimes, but if you are having a panic attack, you will experience severe levels of anxiety. You may think this means you are having a heart attack, are about to collapse or even die, or think that you’re going mad or completely losing control. During a panic attack, you may feel shortness of breath, tingling sensations, stomach discomfort, a sense of impending doom, trembling, light-headedness, choking sensations, chest tightness pressure or even pain and sweating, and you may notice that your heart is pounding. It’s not a surprise that panic attacks can therefore be quite terrifying! They are not only terrifying, but they can often be quite debilitating, forcing sufferers to change how they live their lives – often to detrimental effect.

If you are the kind of person who is prone to panic attacks, then you may be hypersensitive towards any sensation that might suggest you are about to have one of these dreaded attacks. So it’s no surprise that it’s your own physical sensations that are, believe it or not, the primary triggers for your panic attacks. If there was just one fact I wanted you to remember from this article, it’s that how you think about these physical sensations is actually what determines your reaction to them. It really is all in the mind.

Central to maintaining panic disorder is the catastrophic misinterpretation we make of the physical sensations we experience when we begin to panic. Pretty much all of my patients have reported they fear this signals imminent collapse (e.g. as a result of fainting or even a heart attack); alternatively they may instead fear losing control. However, thinking like this serves only to bias your thinking by making you maximise any cues signalling potential danger, and minimising anything that could perhaps suggest that you are in fact actually quite safe. This catastrophic misinterpretation of your symptoms makes you focus even more on them, a strategy which backfires as this intensifies your symptoms, and stronger symptoms often make people think that danger is indeed imminent. No wonder we can really feel quite vulnerable when we are in the grip of a panic attack!

By this stage you will probably find it quite difficult to generate alternative, but more realistic interpretations of your symptoms. This is a shame because if you could, you could stop your panic attacks literally in their tracks. Patients tend to view panic attacks as overwhelming and uncontrollable. Consequently this makes the individual more anxious of future attacks – they literally develop a fear of their fear. To try and cope with this, people increasingly rely on avoidance and safety seeking behaviours, which they think helps them to cope with the problem. Safety behaviours can include things like only going out if you are with somebody, or always making sure you have some medicine or herbal remedies with you. You might think this is helping you, but in reality relying on things like this serves only to maintain the problem.

Many patients who have panic disorder also suffer from agoraphobia. People who have agoraphobia fear places or situations from which they fear escape might be difficult if they have a panic attack (e.g. “I may have an anxiety attack on the tube and faint in front of everyone”). They may avoid being out alone, being home alone, going to supermarkets, travelling on buses, trains or airplanes, avoid bridges, heights, tunnels, open fields, driving, elevators etc. Agoraphobics fear that they will have a panic attack in these situations and, as a result, are more likely to avoid or to escape situations that are too challenging for them.

Avoidance and escape become their major coping mechanisms for handling anxiety and panic. Even though their avoidance/escape may have led to few or no anxiety attacks in months, individuals with panic disorder and agoraphobia continue to worry about the next attack. Their world becomes smaller and smaller as a result of their avoidance. Is it any wonder that, because of this constriction in their lives, many individuals with panic disorder and agoraphobia become depressed and chronically anxious. As a result, many may even medicate themselves with sedatives, alcohol or drugs. While these efforts may seem helpful in the short term, in the long run they actually strengthen these individuals’ beliefs that they cannot cope, they are in danger and they need protection.

The good news is that CBT (Cognitive Behavioural Therapy) can be really effective in treating anxiety and panic issues. This type of therapy works by helping to help “retrain” the brain that the feared situations are not dangerous, that panic attacks are harmless symptoms of fear, and that no safety, escape or avoidance behaviours are needed.

If you are struggling with this issue, it is important that you seek help before the problem worsens even more. CBT has been evidenced extensively to treat social anxiety and NICE guidelines recommend this therapeutic approach as the NHS treatment of choice. For optimum results, CBT treatment is best administered by a fully trained, experienced, BABCP accredited CBT therapist.

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