The symptoms and triggers of a Panic Attack
When Panic strikes
All these thoughts, and more, flood the mind, as we are consumed by the fear of fear
There is an analogy in Mindfulness which talks about the Two Arrows of pain. The first arrow is the initial physical pain, which causes understandable hurt. The second arrow is the mental suffering that results from the original blow. Something similar is at play with Panic Attacks. The initial arrow is the panic attack itself, but then the second, and probably more damaging arrow, is the fear of having another attack.
Where did this anxiety attack come from? Why did it happen? Is there something wrong with me? Can I trust myself out in public? How can I face the embarrassment and humiliation if it happened again? All these thoughts, and more, flood the mind, as we are consumed by the fear of fear.
When Panic takes over
If left untreated, our lives can quickly become boxed in and constrained, as we try to avoid the triggers of our attacks. Because, most of these triggers can be everyday occurrences. Being on public transport, or in a room where escape is difficult. Walking down a busy street. Social Situations. Alcohol. Sitting on your couch with thoughts ablaze. Driving on motorways. There are so many different triggers for different people. It can often be most upsetting when the source of our panic is unknown to us, or random.
The onset of a panic attack cannot be easily predicted. This uncertainty, therefore, can play into the tension and fear of not knowing. Is an attack imminent? How can I tell if it is or isn’t? What will happen if it is? We often avoid places or situations, ‘just in case’ panic might strike. The second arrow starts to dictate what we can and can’t do…where we can and can’t go. Sometimes even leaving the house can be a risk. We begin to avoid places or situations associated with panic attacks, or we bring someone with us for ‘protection’.
Symptoms of a panic attack – ESCAPE!
…away from the eyes, the questions, the sympathy, the overwhelming feeling of impending doom…just get me out of here
During a panic attack our mind kicks into overdrive, thinking something awful is happening or about to happen. The feeling is usually intense fear. I’m going to faint, vomit, have a heart attack, suffocate, go crazy, make a fool of myself, etc. The feelings can appear to come out of nowhere, and have us ramped up in seconds. The intensity can be very frightening, and the overwhelming desire is to escape. Whatever that looks like at that moment in time…just get me away from here. To safety, to comfort, to calm. Away from the eyes, the questions, the sympathy, the overwhelming feeling of impending doom…just get me out of here!
What is happening during this period, is our body’s threat system (fight or flight) is being engaged. All animals have evolved to react to acute physical emergency with a jolt into action. To either stand their ground and fight, or run for their lives. This has kept us alert to danger for thousands of years, and is the reason we are here today. When panic strikes, this brilliant system kicks in to protect us. However, protect us from what? What is the acute physical emergency? It is at this point our mind steps in to interpret what is going on, but unfortunately, it gets it all wrong. Here is how the threat system works, to keep us safe, and these are all symptoms of anxiety.
|Breathing becomes quicker and shallower / hyperventilation
To fight or run, we need our muscles powered by oxygen, hence the quicker breathing.
|“I can’t breathe, I’m going to suffocate”
|Dizzy / Lightheaded
If we don’t use all this extra oxygen through action (fight or run), we can quickly start to feel lightheaded
|“I’m going to faint”
|Changes to vision
Our vision becomes sharper to focus on the threat
|“I feel like I’m not here, I feel weird”
|Heart beats faster / Palpitations
More blood is needed by the muscles
|“I’m having a heart attack”
|Nausea and ‘butterflies’ in the stomach
Blood is diverted away from the digestive system
|“I’m going to get sick”
Bladder muscles relax to get rid of excess fluids Blood is diverted away from the digestive system
|“I’m going to wet myself (humiliate myself)”
|Muscle tension / shaking
In preparation to fight or run, muscles all over the body tense. This may turn to shaking if you stay still and don’t expend energy.
|“I’m losing control, I have to escape”
Blood is diverted from extremities (hands, feet) to our muscles.
|“I feel cold / numb”
The body begins to sweat to cool down, in order to act. Palms, brow, underarms.
|“I’m going to pass out or get sick. People can see I’m sweating”
Quicker thoughts help us evaluate the threat and make quicker decisions. Staying calm in this instance may be difficult as our mind is looking for danger.
|“I’m going mad, I’m out of control, I’m not normal, I can’t trust myself.”
Misreading our symptoms of anxiety can have a twofold effect. It can cause us to think there is something wrong with us when we are perfectly safe. It can also ramp up our anxiety, which then causes more, or prolonged symptoms. This cycle can then continue, extending the panic, which often comes in waves.
So, what now?
Oftentimes, panic attacks are caught up in other anxieties. General anxiety (GAD), which is basically constant worry, can feed into panic. Social anxiety can make it excruciating to be in social situations, where embarrassment or judgement may occur. This can lead to feelings of panic when out with friends, just out in public, or in work.
There is no magic cure for anxiety. Nothing we can do will suddenly turn it off, or make us less anxious. Our brains are hardwired to have anxious thoughts, and we have evolved to be anxious for our own protection. Without anxiety, we would not be around today. So, the idea is to manage anxiety, and learn to live with it, not try to eliminate it.
For those who have experienced panic, learning to live with it does not sound like a great option. The starting point is to get to know and understand how our bodies work during times of anxiety. With this, often comes an easing of the misreading of our body’s reactions to anxiety. As frightening as they seem, is it very important to understand that we are in absolutely no physical danger during a panic attack. Sometimes just thinking “this is my body’s way of protecting me” can help in the moment.
Cognitive Behavioural Therapy (CBT) has been proven to be very effective for overcoming panic. This can be done with the help of a therapist, or on your own, with many available online resources. I will be dedicating more blogs to the CBT model for panic in the coming weeks.
Acceptance and Commitment Therapy (ACT), and Mindfulness are also two very good ways to learn to accept our anxiety as part of us. If we can, we need to learn to live with our anxiety, and not be constantly working against it. Our anxiety will only get worse if we try to resist of fight it. It will not go away if we try to avoid it with alcohol, or bury ourselves in work or achievements. It will always be there, waiting for us, when we slow down again. We bring it with us wherever we go. It will always be a part of us, so maybe it is time to try something different.