Panic & Acute Anxiety

Nature

There is a distinct difference between a panic attack and a diagnosis of panic disorder.

A panic attack is a brief period of extreme distress, anxiety, or fear that begins suddenly and is accompanied by physical, emotional, and behavioral symptoms. The physical symptoms of a panic attack are caused by the body going into a “Fight-Flight-Freeze” response mode; the body’s automatic, built-in system designed to protect us from danger. During an anxiety or panic inducing situation, your body tries to take in more oxygen and your breathing quickens. Your body also releases hormones, such as adrenaline, causing your heart to beat faster and your muscles to tense up. This system is critical to our survival from true threat or danger and can be put into action during both perceived and actual moments of threat. Panic attacks may occur in any anxiety disorder and typically consistent with the core fears and characteristics of the specific disorder. For example, you may experience panic attacks in conjunction with Social Anxiety Disorder in moments where there is the perception of judgment or embarrassment.

The diagnosis of Panic Disorder refers to panic attacks that are frequent, unexpected, and that have no clear or consistent trigger. Additional features of Panic Disorder are that individuals with this disorder engage in efforts to avoid situations where panic attacks have previously occurred. In Panic Disorder, these panic attacks significantly impact the individual’s day to day functioning.  In situations where the the primary fear is related to agoraphobia, a separate diagnosis of Agoraphobia is given.

Experience

Panic Disorder refers to recurrent panic attacks that typically reach a peak within 15-30 minutes and require the presence of four or more of the following physical and cognitive symptoms.
  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating, chills, hot flashes
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Numbness or tingling sensations
  • Feeling detached from oneself and from reality
  • Fear of losing control or “going crazy,” and/ or dying.

It is not uncommon for those experiencing their first panic attack to go to the hospital emergency room as they feel their life is in danger. When a medical condition is ruled out, it can often heighten the person’s anxiety in their search to explain the horrific sensations and emotions they experienced during the panic attack.

Cognition and behavior each play a central role in the experience and maintenance of panic disorder. The cognitive concerns related to panic usually center around the presence of a life-threatening illness (e.g., cardiac disease, seizure disorder); the social impact (e.g. being judged negatively by others); and on cognitive functioning (e.g. ”going crazy” or “losing control”). Chronic worry is characterized by focusing on and searching for any bodily sensations that may forewarn of another panic attack, and by increased levels of physical tension in general. For example, an individual with panic disorder may notice a change in their breathing and interpret this as cue that they could choke, as opposed to a normal physical symptom of anxiety or exertion. Another example is believing that their increased heart rate is a sign they are about to have a heart attack.

The most common behavioral response is to avoid places or activities that have or could trigger panic. Additionally, and in line with the fight or flight response, escaping from the places or situations where panic strikes. This in turn creates a hypervigilance to a multitude of variables in the environment that might be responsible for triggering the panic attack. This can lead to further avoidance of situations and scenarios that include these variables that one believes might have led to the panic.

Without intensive CBT and exposure therapy, other safety behaviors beyond escape and avoidance can be used to decrease, distract, and reassure. For example, carrying items such as medication, water or a cell phone, having a family member or friend accompany you, and sitting near exits or bathrooms. Other common safety behaviors include avoiding any physical activities, certain foods (e.g. spicy dishes) or beverages (e.g. caffeine, alcohol), and always keeping busy to avoid thinking about anxiety or feeling anxious. While these behaviors may seem rational diversion strategies, the benefits are short lived as they counteract the goal of decreasing the intensity and frequency of panic symptoms in the long run.

At the Anxiety Institute, we believe that “symptoms of panic are not indicators of threat, but signals of opportunity to face anxiety, transcend fear, and nurture courage.”

Impact

Panic Disorder, untreated, can negatively impact many aspects of an individual’s life.

The increasing social isolation and behavioral avoidance common with untreated Panic Disorder can negatively impact one’s physical health, make it difficult to develop and maintain healthy relationships, and can lead to other mental health conditions, such as depression and substance abuse. High school and college students who have not received treatment are also more likely to have sleep problems, insomnia, poor nutrition, school refusal, and greater conflict with parents and friends.

In sum, as the anxiety, panic, and avoidance become a bigger and bigger problem, the sufferer’s world becomes smaller and smaller. If the individual is willing to devote as much time and effort to inducing panic attacks with exposure therapy as avoiding them with no therapy, long term recovery is very likely.

Prevalence of Panic Disorder

The prevalence of Panic Disorder in the 18-29 year old demographic is about 4.4%, with 45% of annual cases classified as severe. The average age of onset is 24 years old, though gradually increases through puberty. Females have about a 35% higher likelihood to be impacted by Panic Disorder than males.

Treatment

Cognitive Behavioral Therapy (CBT) is an approach used to help people experiencing anxiety, OCD, and Trauma, and has shown to be especially beneficial for the treatment of Panic Disorder. CBT combines two therapeutic approaches – Cognitive Therapy and Behavioral Therapy.

Cognitive therapy teaches how certain thinking patterns influence behavior and maintain the symptoms of panic. Behavioral therapy aims to loosen the associations between physical and emotional discomfort and habitual reactions to these experiences. Behavioral Therapy also teaches how to calm the mind and body; aiding clearer thinking and improved decision making.

Response Prevention involves staying in a situation that is inducing panic for a short period of time with a gradual increase in the duration of time spend enduring the symptoms of panic. This technique is critical as sufferers who respond to rising anxiety through immediate escape only teach the mind and body that the situation is in fact dangerous and should be avoided at all costs.

The frequency and duration of treatment is critical to enduring recovery.  The Anxiety Institute’s 20 hour a week treatment approach maximizes the efficacy of exposure therapy and the expediency of recovery by helping clients “unlearn” unhealthy habits and habituate new health behaviors.  We’ve found that the frequency and relentlessness of treatment must match to the frequency and relentlessness of the anxiety.

Resources

American Psychological Association, APA;
http://www.apa.org/monitor/2014/09/cover-pressure.aspx

Anxiety and Depression Association of America, ADAA;
https://adaa.org/about-adaa/press-room/facts-statistics

How 25 College Students Cope With Anxiety and Panic Attacks
Teen Vogue
Read Article

MentalHealth.org;    
http://www.mentalhealth.org/what-to-look-for/anxiety-disorders/panic-disorder

National Institute of Mental Health (NIMH): An organization with the National Institute of health dedicated to mental health research;
https://www.nimh.nih.gov/health/statistics/panic-disorder.shtml

Panic Disorder and College
Verywell Mind
Read Article

Why Are More American Teenagers Than Ever Suffering from Severe Anxiety?
The New York Times Magazine
Read Article