Prevail Over Your Panic Attacks Katrina H Miller, PhD Marriage and Family Therapist A panic attack is a set of mostly physical symptoms that are triggered by fear, worry, or dread. The intensity of the physical symptom adds fuel to an overwhelming sense of anxiety. You might have thoughts like this: “I’m having a heart attack. . .I’m choking to death. . . I’m going crazy. . . I can’t breathe.” In this article, you will learn how your body and mind create a panic attack. You will even learn how to use your body to create the symptoms of panic, proving to yourself that those symptoms are not dangerous. Finally, you will also learn a strategy that can help you stop a panic attack before it flares out of control. The Emotional Triggers of Panic Your panic attack will probably follow an encounter with an experience with intense and visceral emotions. Are you reactive to social fears such as rejection, disapproval or losing someone’s love? Do you have fears of objects, such as dogs, spiders, or people? Might you be fearful of environmental circumstances, such as heights, closed spaces, or riding in an airplane? Fear of experiences is a trigger that is acquired after an initial attack. You can become fearful of having another panic attack, or what you think might happen if you have another attack: Choking, dying, or heart attack. If you are expecting an emotional reaction, the intensity and unpleasantness of the physical symptoms can catch you off guard, and can easily cause sufficient alarm to initiate calling an ambulance or seeking emergency care. Certainly, you should seek emergency care any time you fear that your life is in peril. Many panic attack sufferers have had the experience of seeking emergency care for a heart attack, only to find out their experience was panic. The Physical Symptoms of Panic All fears have a common component: The perception of threat. When we feel threatened, the hypothalamus, a tiny organ or organelle in of our brain, sends a signal to the autonomic nervous system (ANS) to prepare our body to survive the attack. The autonomic nervous system controls our internal organs: Our heart, lungs, bladder, sweat glands, and digestive system. It is the activation of the body’s
internal organs that creates the physical symptoms that define a panic attack. Table 1 lists the physical symptoms that define the condition of “panic attack�. During a panic attack, the heart speeds up to pump more oxygen into the system, causing sensations of pounding or racing of the heart. Palpitations, or a strong or irregular heartbeat, may be present. Panic may trigger shakiness or trembling in the hands, heads, voice, legs, trunk. (Table 1 about here) Whether the perceived threat is real or imagined, our smart minds and bodies execute a set of operations that increase the probability that we will survive the threat. The predictable sequence of how mind and body work together to protect us from perceived threat is often referred to as the fight or flight response. The term, fight or flight describes two very effective defenses: We can fight back to prevent the danger from overcoming us or we can run away to find safety. These defenses are automatic and not something we will process consciously. Create Your Own Panic Attack You can cause physical symptoms of panic in your body by doing this simple exercise: 1. 2.
Set a time for 90 seconds. During the 90 seconds, breathe three times harder or faster than normally. Don't
stop until the end of the 90 seconds. 3. Take a few minutes and scan your body for any of the signs of autonomic nervous system reactivity shown in Table 1. For example, you may be able to feel your heart beating, pounding or racing (a palpitation). Perhaps you are short of breath, feeling dizzy, or experiencing some tingling or numbness in your extremities or any of the other physical symptoms of panic attack. The physical sensations you created by trying this breathing exercise are identical to the symptoms that your autonomic nervous system creates when you experience a panic attack. The only difference is that the breathing exercise was done consciously; the autonomic nervous system
works unconsciously, or from a place in your mind and body that cannot be accessed by your awareness. The Wisdom of the Autonomic Nervous System (ANS) When a panic attack strikes, it may alleviate some of your worries to remember that the physical symptoms you feel will not kill you. Rather, the symptoms are natural responses of the autonomic nervous system (ANS). The physiological action causing the symptom has beneficial features that help you survive in the event of a genuine threat to your life (see Table 2). For example, during the fight/flight response, your blood vessels will constrict, causing the heart to beat stronger and faster, pushing more oxygenated blood to the large muscle groups of the body. The biceps of the arms are enervated by that oxygen and are prepared to fight off any predator. Your hamstrings and quadriceps (thigh muscles) are also enervated, and are prepared to carry you away from danger. Conversely, less blood is pumped to the skin, triggering a cooling response so the body is not overheated by the actions of the autonomic nervous system (aka fight/flight system). Your skin may start to sweat, and the sweat makes you slippery so that a predator might have a harder time holding you down. (Table 2 about here) Learn to Control Panic by Grounding Dr. Bessel A. van der Kolk, author of The Body Keeps Score: Brain Mind and Body in the Healing of Trauma, said, “In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them.� One way you can tame an oncoming panic attack before is to shift your mind away from worry and stress and onto whatever is going on around you at the present moment. This strategy is called grounding. Simply put your feet squarely on the floor or lie down on the floor. Sense the ground under your feet or your body. Take some deep breaths. Imagine the weight of your body, the weight of your troubles surrendering to gravity and sinking deeply into the ground beneath you. Think of five things that you see, four things that you hear, three things you can touch, and two things you can smell. Notice how it feels to relax. Explore if you can feel safe or protected as you let the weight of your body or the weight of your trouble just drain away from your body into the ground. Continue relaxing until the sense of
threat that is pushing your fears goes away. Welcome any sensations of warmth, heaviness, tingling or numbness in your hands or other places in your body, as such signals that your body is relax, and hence are called relaxation signals. While the sense of panic tells you that the autonomic nervous system is on alarm; the sensations of relaxation tell you that the autonomic nervous system is at rest. Panic no longer controls you, but you control panic.
Tables
Table 1. Signs and Symptoms of Panic Attacks SIGNS AND SYMPTOMS OF PANIC ATTACKS Heart palpitations, heart pounding or racing Sweating Trembling or shaking Shortness of breath Sensation of choking or fear of choking Chest pain or discomfort Nausea or upset stomach Feeling dizzy or light-headed Hot or cold flashes Numbness or tingling Feelings of unreality or detachment from self Fear of losing control or going crazy Fear of dying
Table 2. Beneficial Effects of Autonomic Nervous System (ANS) Arousal Vs Symptoms of Panic Attack SYSTEM & ORGANS
ACTION
BENEFIT for FIGHT/FLIGHT
CONTRIBUTION TO PANIC ATTACKS
Cardiovascular System (heart and blood vessels)
Blood vessels constrict, causing heart to pump faster and harder.
Pushes more oxygen through the body
Heart palpitations, pounding and racing
Pumps more blood to large muscles of the body.
Muscles need for fight (biceps) and flight (thighs) are innervated with fresh oxygen.
Sensation of being hot
Pumps less blood to the skin
Skin is cooled so that it is not overheated by fight and flight.
Sensation of coldness and perspiration
Pumps less blood to digestive system
Digestion is an unnecessary expenditure of oxygen and energy; stomach contractions are slowed down.
Nausea/upset stomach
Breathing speeds up, which produces more oxygen
Gets more oxygen to body parts needed for fight or flight
Chest tightness
Respiratory system (lungs)
Breathlessness Dizziness Lightheadedness Numb or tingling fingers
Digestive organs
Secretions of stomach enzymes decreased
Slows down digestion
Nausea or upset stomach