A panic attack can be defined as a short period of intense anxiety or tension. Usually, the attack comes on suddenly, intensifies quickly and then subsides after a few minutes. People who have a panic attack often do not understand what is happening to them. Some think they are having a heart attack, others think that they are passing out or losing control. People often feel a strong need to flee the situation which evoked the panic attack. Some of the physical sensations that can occur are heart palpitations, sweating, dizziness, feeling ‘weird’, hot flushes, shortness of breath, nausea, tremors, breathing faster or not being able to think clearly.
What exactly is a panic attack?
Anxiety and panic are physical responses to a situation that are experienced as nerve-wracking or dangerous, such as taking a driving test or giving a presentation. Your heart beats faster, you feel hot and you may feel your legs shaking. By doing this, your body is preparing to respond and take action. This physical reaction is harmless. Your blood pressure rises, your heart beats faster, and you begin to sweat, etc. This does not mean that you are going to have a heart attack or go crazy. Fainting or passing out is also practically impossible, because it requires your blood pressure to drop rather than rise.
Then why is it possible to experience a panic attack when there is no apparent danger? You can regard a panic attack as a type of ‘alarm’ response that usually only goes off in the presence of danger. In your case, however, that alarm may be too sensitive, and it can go off when there is no ‘real’ danger. The first attack may be so scary that you consciously or unconsciously start to focus your attention on what is going on in your body to see whether another panic attack will occur. You will start to react to any signal that could indicate a panic attack with a lot of anxiety. For example, if your heart skips a beat once, you may feel scared, while someone without anxiety wouldn’t even notice. A person who experiences panic attacks is more sensitive to their bodily sensations, and, in turn, their fearful interpretations and thoughts create a new anxious reaction, causing even more physical sensations. This results in a vicious cycle.
Vicious panic circle
A panic attack consists of three components:
- You will feel something during a panic attack (heart palpitations, dizziness, tremors)
- You will have alarming thoughts about the physical sensations (“oh, help, this is wrong, I’m going to pass out”, “I have to go home soon” or “I am going to lose control”)
- You will react in some way (quickly go home or sit down)
This circle can cause you to become so scared of having a panic attack that you run away from situations or end up completely avoiding them. Avoidance can provide some short-term relief because you will not experience another panic attack, but, in the long term, it will worsen your symptoms and the panic disorder will persist. You won’t experience that it is possible to endure your anxiety, and, by avoiding your anxiety, you will end up participating increasingly less in (social) activities.
With the help of Cognitive Behavioural Therapy (CBT), you will break this vicious cycle by intervening during every stage of the panic circle. Each component is therefore discussed during treatment. You learn to manage your fear. It is not possible to prevent an attack, but once you are less afraid of them, they become less common.
We start by teaching you how to get used to the physical feelings by consciously evoking them, which will prove to you that they cannot do you any harm. After a few sessions, we will investigate your thoughts – what you are thinking during a panic attack, for example, and what you are afraid of exactly. We are going to challenge these thoughts together and try to interpret them differently. Finally, the behavioural (reaction) component is discussed, during which we will tackle the avoidance. You will practice with situations that you find difficult or that you actively avoid, so that you learn to manage your fear instead of avoiding the situations.
The most important thing you will learn during the treatment is that what you are most scared of will not happen.
Source: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.