This guide is written by clinical psychologists from Newcastle, North
Tyneside & Northumberland Mental Health NHS Trust. Used here with
permission.
What is a panic attack?
Everyone knows what panic is, and it is common to feel panicky from time to time:
- You get the sense that you are being followed on your way home late at night.
- You discover you have had your wallet stolen.
- You are sitting an exam. You look at the paper and realise you don’t know the answers to any of the questions.
- Someone runs in front of your car and you almost hit them.
It would be normal in any of these situations to feel a sense
of panic. The feeling would be understandable and would pass fairly
quickly.
A panic attack is a bit like 'normal' panic, but different in a number of ways:
- The feelings are a lot stronger.
- The feelings seem to come 'out of the blue' and are not usually related to the sort of frightening situation described above.
As the feelings are unexpected and strong they can feel extremely frightening.
Panic
attacks affect people in many different ways, but there is usually a
frightening feeling that something really awful is about to happen. The truth is: nothing awful is going to happen, as panic attacks are not dangerous.
Lots
of people have panic attacks, although they can affect people in
different ways. Some people have only one, others may have them for
many years. Some people have them every day, some people only once in a
while. If you were to ask all of your friends if they had ever had a
panic attack, it is very likely that at least one or two will have had
the same experience. They are quite common and not a sign of serious
mental or physical illness.
Some non-serious physical conditions can cause symptoms similar to panic attacks. For example:
- Certain medicines taken together
- Thyroid problems
- Drinking too much caffeine
- Pregnancy
- Low blood sugar
If, after reading this guide, you are concerned that your
problem may have a physical cause and you have not yet had a check-up
from your GP, then it may be a good idea to make an appointment.
Summary
Panic attacks are very common. They are not dangerous and are not a sign of serious mental or physical illness.
This guide aims to help you reduce your panic attacks by helping you to:
-
Recognise whether or not you are having panic attacks.
-
Understand panic, what causes it and what keeps it going.
-
Accept that panic cannot harm you.
-
Learn techniques to reduce panic.
1. Recognising panic - how do I know if I am having a panic attack?
This
may sound obvious, but it isn’t. Sometimes panic feels so awful, and
comes so “out of the blue”, that people can’t quite believe that it’s
only a panic attack, and think it must be something more serious. The
feeling of a panic attack can be so unusual that you may not even
realise this is what is happening. One of the most important first
steps in overcoming panic attacks is recognising whether or not your
symptoms are caused by a panic attack.
Panic affects your body,
your mind and the way you behave. The following are some of the most
common symptoms experienced by people having a panic attack. Some
people have all of the symptoms, others just a few.
Your Body
(write down those that apply)
-
Heart pounding, beating fast or skipping a beat.
- Heart seems to stop, followed by a big thud, chest pains.
- Changes in your breathing, either gulping air, breathing fast or feeling short of breath.
- Pounding in your head.
- Numbness or tingling in fingers, toes or lips.
- Feeling as though you can’t swallow, feeling sick.
- Feeling as though you’re going to faint, wobbly legs.
Write down any other symptoms.
Your Mind
(write down any thoughts or feelings that apply)
- Feelings of utter terror.
- Feelings of unreality, as though you’re not really there.
- You feel anxious in situations where you had a panic attack before.
Frightening thoughts such as:
-
“I’m going to have a heart attack”
- “I will collapse or faint”
- “I’m running out of air”
- “I’m going mad”
- “I’m choking”
- “I’m going to be sick”
- “I’m losing control”
- “I’m going to make a complete fool of myself”
- “I’ve got to get out of here”
Write down any other frightening thoughts or feelings.
Remember these things never actually happen in a panic attack, but people sometimes think they will.
What you do / your behaviour
(write down any of these that apply to you)
-
You avoid situations that have caused panic or that you fear might cause panic, for example, going shopping.
-
You escape as soon as you can when panicking, for example, rushing round the supermarket to get out as soon as possible.
-
You prevent
what you think is going to happen by doing something to make yourself
safe, for example, gulping air if you think you are going to suffocate
or sitting down if you think you are going to faint, or lying down if
you think you are having a heart attack or scanning your body for
evidence of something being wrong.
-
You seek help. In
one study a quarter of all people having their first panic attack
called an ambulance or went to accident and emergency, they were so
convinced something dangerous was happening to them. Perhaps you have
done this, or called out the doctor?
-
You cope. People
often try to cope with a panic attack by doing things they have found
or have been told are helpful, for example, distracting themselves or
trying to relax.
Write down anything else you do or don’t do as a result of having a panic attack.
Whilst all of these things can help to stop a panic attack, as we shall see later, they can also become part of the problem.
If
you have ticked quite a few of these symptoms, thoughts and behaviours,
then it is likely that you are suffering from panic attacks.
Summary: recognising a panic attack
A panic attack is a strong feeling of terror that comes on very
suddenly. Physical symptoms include, pounding hearts, fast breathing,
shaking, wobbly legs. People often have lots of frightening thoughts
and think something awful is happening. They often try to avoid or
escape the panic. But panic is not dangerous or harmful.
2. Understanding panic - what causes it and what keeps it going?
All
of the panic symptoms described above are nothing more than an extreme
form of fear. Fear is our body’s natural response to a situation
perceived as threatening. Fear can range from mild anxiety (which can
be helpful when there is a goal, like passing an exam) through to full
blown panic.
But why have fear at all when it’s such an
unpleasant feeling? In a way, it is a bit like pain. If you were to
break your ankle, it would feel very painful, which would be a warning
to you not to walk on it. If you heard a noise downstairs at night, you
might feel frightened, which is a warning that you might have to deal
with a dangerous situation. Fear is very useful. It prepares your body
for action. This has been called the
“fight or flight” response.
So that when you feel fear, what is happening is that your body is
preparing to fight or run away from the thing it feels threatened by,
or possibly to stay completely still and wait for the threat to pass.
If
we take the example of the noise downstairs. Let us suppose it is a
burglar, as you fear. You may wish to stay absolutely still, so as to
prevent the burglar from attacking you. You might want to go and
challenge him or you might need to run away should he come after you.
Your fear response would help with any of these. When you are
frightened you breathe more quickly so that you can get lots of oxygen
to your muscles. Your heart beats faster to pump the blood faster round
your body. Your digestive system closes down to allow your body to
concentrate on the more immediate threat. This is your body’s normal
healthy reaction to situations where your body feels under threat. It
is your body’s alarm system.
The problem with panic attacks is
that usually they occur when there is no obvious physical threat there
at all. Your body is reacting as though it was about to be attacked
when in reality it is not. In other words it is a false alarm. It is a
bit like the annoying smoke detector which goes off at all the wrong
times, because it is sensitive to small amounts of smoke. Or the
burglar alarm that goes off because of the cat. Or even more annoying,
the car alarm that is triggered by the wind. These are all alarms that
can be triggered when there is in fact no danger. The same can be the
case with your body’s “alarm” system. Sometimes it can be set off when
there is no real danger.
The problem is that our body’s “alarm
system” was designed many, many years ago, when people had to cope with
dangers in order to survive. Nowadays, we are rarely faced with the
sort of life or death threats our ancestors faced. We have very
different threats, mainly related to stress. Financial worries,
overworking, moving house, divorce for example, can all be stressful,
and can raise our anxiety levels to the point where our “alarm system”
is triggered. It is a bit like a “stress” thermometer - which when it
reaches a certain level results in panic. Whilst a panic attack may be
unpleasant, it is not dangerous. Quite the opposite. It is a system
designed to protect us, not harm us.
Summary: understanding panic
Panic is a form of fear. It is our body’s alarm system signalling
threat. It prepares our body to fight or run away from danger. But as
there is no physical danger it is a false alarm.
A panic attack may be unpleasant but it is not dangerous.
What causes panic attacks to begin?
Panic attacks can start for a number of reasons.
Stress
As mentioned, stressful events can cause anxiety to go up, which may
lead to the alarm system being triggered. Are you aware of any stress
in your life over the last few years? For example, work stress or being
out of work, relationship problems, loss of a loved one, financial
difficulties. Please list any stresses that you are aware of.
Health worries
Panic attacks often begin when a person becomes over-concerned about
their health. This can happen for various reasons. Sometimes people
with panic attacks have recently experienced the sudden death of
someone they know or are close to. They then become worried about their
own health, and look for signs that they may be developing the same
illness. They are often aware of medical ‘mistakes’ where serious
illness has not been picked up, and so become worried that there is
something seriously wrong. This leads to raised anxiety. They then
think the anxiety symptoms are evidence of a serious illness, which can
result in panic. Think back to when your panic attacks began. Do you
know anyone who died suddenly, for example, from a brain haemorrhage,
heart attack, etc?
Other health-related reasons
Sometimes panic attacks occur for the first time during a period of
ill-health. For example some viruses can cause dizziness. Pregnancy or
the menopause can cause changes in the way our body works that can lead
to a first experience of panic. Consuming large amounts of caffeine, or
low blood sugar can also lead to feelings of faintness. Can you think
of any 'health-related' reasons for your panic attacks?
Difficult emotions
Panic attacks often begin when there are feelings from the past or
present that are being “swept under the carpet”. Maybe you have
relationship problems, or something from the past you need to deal with?
Out of the blue
Sometimes we just don’t know why panic attacks begin. Some people even
have their first panic attack when they are asleep! It may just be that
certain people, in certain circumstances respond like the
over-sensitive car alarm. Their alarm system is triggered when there is
in fact no danger.
In some ways it is less important to know what causes panic attacks to begin and more important to know what keeps them going.
What keeps panic attacks going?
As you will remember, panic affects your body, your thoughts and your behaviour. All three work together to keep panic going.
Physical
Firstly, the physical symptoms can be part of the problem. For example,
for people whose breathing is affected by anxiety, something called
hyperventilation
can occur. This just means someone is taking in too much air and not
breathing it out. This is not dangerous but can lead to feelings of
dizziness, and is often taken as further evidence that there is
something seriously wrong.
Thoughts
Secondly, the physical symptoms and anxious thoughts form a vicious
circle that keeps panic attacks coming back again and again. Also,
focusing your mind on your body can lead to noticing small changes and
seeing this as a threat.
People
who have panic attacks often worry that the physical symptoms mean
something different from what they really do. Examples of some of the
most common are.
People often find it hard to believe that our thoughts can produce such
strong feelings as fear. But if we believe something 100% then we will
feel exactly the same way as if it were true. Another way thoughts can
affect panic, is when someone starts to
worry that they are
going to panic in situations where they have panicked before. This,
unfortunately, makes it more likely to happen again, and often leads to
avoidance.
Behaviour
Thirdly, how a person behaves before, during and following a panic
attack has a big part to play in whether panic attacks keep happening.
The avoidance, escape, and safety behaviour described earlier all add
in to the vicious circle.
The vicious circle of panic
These physical symptoms, thoughts and behaviours forms a vicious circle which keeps the panic attacks occuring over time.
The vicious circle can look like this:
