Understanding panic attacks: Symptoms and treatment

What are panic attacks?

Panic attacks are unmistakable. You're involved in some ordinary aspect of life when suddenly your heart begins to pound and you hyperventilate, sweat, and tremble. You fear you are having a heart attack, or even dying. Then, 10 minutes or so later, it's gone. What just happened?

Unfortunately, there is no clear answer. You may have had a panic attack.  Panic attacks are fairly common, usually beginning between ages 15 and 25. If you have recurrent panic attacks - and for some sufferers, they recur again and again - and if a persistent fear of subsequent attacks occurs or if you change your behaviour significantly because of such attacks, you have panic disorder. Between attacks, sufferers live in dread of the next one.

Many people with panic disorder relate an attack to what they were doing when it occurred. They may assume that the restaurant, lift, or classroom caused the attack, and decide to avoid that situation. In these cases, panic disorder may lead to agoraphobia -- the fear of leaving home or being in public places -- though the relationship between the two conditions is unclear.

What causes panic attacks?

The underlying cause of panic attacks and panic disorder is not clear. There is evidence of both a genetic and a biochemical basis. There is also an association with phobias, such as school phobia or agoraphobia, as well as with depression, alcohol or cigarette abuse, suicide risk, and seasonal affective disorder - a type of depression that occurs during winter months.  

The sudden feeling of terror or doom often brings on hyperventilation - uncontrollable, rapid, shallow breathing. This in itself can cause many of the other physical symptoms by upsetting the balance of oxygen and carbon dioxide in the bloodstream.  

Panic disorder may begin after a serious illness or accident, the death of a close friend, separation from the family, or the birth of a baby. Attacks may also accompany the use of mind-altering drugs. Most often, however, a panic attack comes "out of the blue". It may even begin during sleep.  

Some medical problems and medications can cause panic attacks, including some antidepressants at high dosage. Panic disorder that begins after age 40 suggests depression or another underlying medical health disorder.

What are the symptoms of a panic attack?

If you have four or more of the following symptoms, you may be having a panic attack:

• Sudden high level of anxiety - with or without a cause
• Heart palpitations
• Sweating
• Shaking
• A ‘smothering’ sensation
• A feeling of choking
• Chest pain or discomfort
• Nausea
• Dizziness or faintness
• A sense of unreality
• A fear of dying
• Numbness or tingling
• Chills or hot flushes

An isolated panic attack, while extremely unpleasant, is not uncommon or life-threatening. Panic disorder and panic attacks are not the same thing. All panic disorders have panic attacks as a symptom but having a panic attack does not mean you have panic disorders. Panic attacks can be a symptom of other anxiety disorders as well.

You may think you're having a heart attack -- and it's true that the symptoms can be similar. However, most people having a panic attack have had one before, triggered by a similar event or situation.

The chest pain of a panic attack usually stays in the mid-chest area (the pain of a heart attack commonly moves toward the left arm). It is often accompanied by rapid breathing, rapid heartbeat, and fear. A panic attack usually lasts only a few minutes, comes suddenly and leaves suddenly, but leaves one exhausted.

What are the treatments for panic attacks?

The cause of most panic attacks is not clear, so treatment may be different for each person. Typically, it involves psychotherapy, cognitive-behavioural therapy, and/or medication. Alternative treatments like meditation and relaxation therapy are often used to help relax the body and relieve anxiety.

If you’re in the middle of a panic attack, some relief can come from taking anti-anxiety medications, at least in the beginning of medical therapy.

For preventive or maintenance care, psychotherapy offers support and helps minimise fear. In some cases, psychotherapy alone can clear up the disorder.

Cognitive-behavioural therapy helps people learn to deal with panic symptoms, using techniques like muscle and breathing relaxation. Patients also gain reassurance that panic will not lead to the catastrophic events they fear, since many people fear they are having a heart attack or going mad.

Antidepressants often help reduce anxiety and the frequency and severity of panic attacks. Even more frequently used medications are the selective serotonin reuptake inhibitors (SSRIs). This group of medications is often considered the first line of treatment for panic disorders.

How can I prevent panic attacks?

You can take steps to lessen the chance of having panic attacks and learn to manage them better. Learn to recognise a panic attack. When you sense the first symptoms, know that other symptoms may follow. You have survived them before and can do so again. Try slow, deep breaths.  

• Take your time. It's important not to hope for a quick cure. Therapy takes time, and improvement comes in small steps.  
• Go easy on yourself. People who feel panic tend to be overly critical of themselves.  
• Learn to lower your level of everyday anxiety through a variety of techniques, including meditation and exercise.
• Learn other relaxation techniques, like deep breathing or guided imagery.
• Avoid stimulants, such as nicotine and caffeine, which can be found not only in coffee, but many teas, colas and chocolate.

Panic Disorder Treatment

Introduction

Panic attacks and panic disorder can be very disabling conditions for the people who suffer from them. Sometimes they can lead to avoidance of any activity or environment which has been associated with feelings of panic in the past. This can in turn lead to more severe and disabling disorders such as agoraphobia.

Panic attacks typically begin in young adulthood, but can occur at any time during an adult's life. A panic episode usually begins abruptly, without warning, and peaks in about 10 minutes. It can last anywhere from a few minutes to a half hour or longer. Panic attacks are characterized by a rapid heart beat, sweating, trembling, and a shortness of breath. Other symptoms can include chills, hot flashes, nausea, cramps, chest pain, tightness in the throad, trouble swallowing and diziness.

Women are more likely than men to have panic attacks. Many researchers believe the body's natural fight-or-flight response to danger is involved. For example, if a grizzly bear came after you, your body would react instinctively. Your heart and breathing would speed up as your body readied itself for a life-threatening situation. Many of the same reactions occur in a panic attack. No obvious stressor is present, but something trips the body's alarm system.

Treatment emphasizing a three-pronged approach is most effective in helping people overcome this disorder: education, psychotherapy and medication.

---

Psychotherapy

Education is usually the first factor in psychotherapy treatment of this disorder. The patient can be instructed about the body's "fight-or-flight" response and the associated physiological sensations. Learning to recognize and identify such sensations is usually an important initial step toward treatment of panic disorder. Individual psychotherapy is usually the preferred modality and its length is generally short-term, under 12 sessions. An emphasis on education, support, and the teaching of more effective coping strategies are usually the primary foci of therapy. Family therapy is usually unnecessary and inappropriate.

Therapy can also teach relaxation and imagery techniques. These can be used during a panic attack to decrease immediate physiological distress and the accompanying emotional fears. Discussion of the client's irrational fears (usually of dying, passing out, becoming embarrassed) during an attack is appropriate and often beneficial in the context of a supportive therapeutic relationship. A cognitive or rational-emotive approach in this area is best. A behavioral approach emphasizing graduated exposure to panic-inducing situations is most-often associated with related anxiety disorders, such as agoraphobia or social phobia. It may or may not be appropriate as a treatment approach, depending upon the client's specific issues.

Group therapy can often be used just as effectively to teach relaxation and related skills. Psychoeducational groups in this area are often beneficial. Biofeedback, a specific technique which allows the client to receive either audio or visual feedback about their body's physiological responses while learning relaxation skills, is also an appropriate psychotherapeutic intervention.

All relaxation skills and assignments taught in therapy session must be reinforced by daily exercises on the patient's part. This cannot be emphasized enough. If the client is unable or unwilling to complete daily homework assignments in practicing specific relaxation or imagery skills, then therapy emphasizing such skill sets will likely be unsuccessful or less successful. This pro-active approach to change (and the expectations of the therapist that the client will agree to this approach) needs to be clearly explained at the onset of therapy. Discussing these expectations clearly up-front makes the success of such techniques much greater.

---

Medications

A lot of people who suffer from panic disorder can successfully be treated without resorting to the use of any medication. However, when medication is needed, the most commonly-prescribed class of drugs for panic disorders are the benzodiazepines (such as clonazepam and alprazolam) and the SSRI antidepressants. It is rarely appropriate to provide medication treatment alone, without the use of psychotherapy to help educate and change the patient's behaviors related to their association of certain physiological sensations with fear.

Phillip W. Long, M.D. notes that, "Clonazepam (Klonopin, Rivotril) and alprazolam (Xanax), are the treatment of choice in the treatment of Panic Disorder. Clonazepam and alprazolam are preferred to antidepressant drugs because of their less severe side effects." He also states that it is preferred to try the anti-anxiety agents before moving on to the antidepressants because of the increased side-effect profiles. Xanax can be addicting for individuals and should be used with care. Treatment with either clonazepam or alprazolam should be discontinued by tapering it off slowly, because of the possibility of seizures with abrupt discontinuation.

---

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.

Patients can be encouraged to try out new coping skills and relaxation skills with people they meet within support groups. They can be an important part of expanding the individual's skill set and develop new, healthier social relationships.

6 Alternative Treatments for Anxiety and Panic Attacks

How you can treat the causes of anxiety and panic attacks — not just the symptoms — and opt out of drug-based anxiety treatments.

Causes, Symptoms and Triggers

Anxiety is an emotional state characterized by apprehension, uneasiness, panic, fear or terror, dread, uncertainty, and/or worry. Physical symptoms that often accompany the feelings of anxiety include jitters, insomnia, fear, sweating, shortness of breath, rapid heart rate and/or heart palpitations, chest pain, decreased sex drive, nausea, and/or diarrhea.

Feelings of anxiety can become a greater health concern when the symptoms become excessive and persist indefinitely, cause emotional distress or when the symptoms start to interfere with normal activities of daily living. An acute form of anxiety disorder is often referred to as a panic attack — a sudden, intense bout of panic, fear and dread combined with shortness of breath, excessive sweating, rapid heartbeat and/or a feeling of looming death.

The exact causes of anxiety and panic attacks in a given patient are usually unknown. Anxiety attacks can be triggered by intense stress or a traumatic event, such as a death, accident, or divorce, while others have no identifiable root causes. Physiologic and hereditary factors may also play a role in anxiety. Certain substances or drugs, or withdrawal from such substances, can trigger anxiety. The most common triggers include caffeine, over-the-counter decongestants, asthma drugs, and withdrawal from alcohol, tobacco, caffeine, certain medications and other addictive substances including narcotics.

Complementary/Nondrug Treatment and Prevention 

In complementary or alternative treatments to psychotherapy and/or medication, your doctor may prescribe include several natural methods.

1. Natural medicine practitioners have used herbs including kava kava and St. John’s Wort as effective treatment alternatives to prescription anxiety drugs. Kava is well known for its calming effects and holds great promise in easing the symptoms of nervousness; however, the FDA has recently issued warnings on kava due to its adverse effects on the liver. Valerian root is another herb that is often used for its calming effects. St. John’s Wort is backed by more research on its safety and use as an anxiety treatment, and as a treatment for mild to moderate depression. Its effectiveness in treating anxiety is yet to be confirmed.
2. SAMe is another dietary supplement that has been used in treatment of anxiety.
3. Eliminating caffeine and alcohol, reducing your intake of sugar, sugary food products, refined carbohydrates and foods with additives and chemicals may help lessen anxiety symptoms. To minimize headaches and other withdrawal symptoms, make reduction of caffeine intake gradual. Instead of caffeinated beverages, try drinking tea made from chamomile (or passionflower, skullcap or lemon balm), which can relax you without causing drowsiness or addiction.
4. Calcium, magnesium, and vitamin B complex all contribute to the health and proper functioning of the nervous system. They also support the production of neurotransmitters, chemicals that help relay messages between nerve cells.
5. Exercising regularly and practice relaxation techniques such as meditation, yoga, t’ai chi or progressive relaxation are all nondrug remedies that can help relieve anxiety disorders. Your routine should include cardiovascular exercise, which burns lactic acid, produces mood-enhancing chemicals called endorphins, and causes the body to use oxygen more efficiently.
6. Controlled breathing techniques can help ease a panic attack. When an attack strikes, try this breathing exercise: Inhale slowly to a count of four, wait four counts, exhale slowly to a count of four, wait another four counts, then repeat the cycle until the attack passes.

 

 

---

Consult your doctor before using any health treatment — including herbal supplements and natural remedies — and tell your doctor if you have a serious medical condition or are taking any medications. The information presented here is for educational purposes only and is in no way intended as substitute for medical counseling.

10 tips on how to beat panic attacks: Wisdom from the Mayo Clinic

Dr. Cynthia Stonnington is the Chair of Psychiatry and Psychology at the Mayo Clinic in Arizona:  

1. ROCK CENTER: How prevalent are panic attacks?

DR. CYNTHIA STONNINGTON: So panic attacks are very common.  Actually, probably one in four people might have a panic attack in their lifetime.  Now that’s separate from having a panic disorder, where people have recurrent episodes of panic attacks … But anxiety, in general, is extremely common.  We need anxiety just to live and to function.  And so it's not surprising that anxiety disorders can occur frequently.

2. ROCK CENTER: Can you explain what happens in the brain during a panic attack?

DR. STONNINGTON: It's a primitive part of the brain. Obviously back in the day, when you might come across a tiger, you had to be alert to get yourself out of there. It’s a survival mechanism we still have and it’s still something we use to focus our attention and alert us to things we need to do. But today there might be a lot of false alarms.

3. ROCK CENTER: How much control do you have when a panic attack occurs?

DR. STONNINGTON: So when you first experience a panic attack there's nothing much you can do to stop it from coming on. It comes on.  And it goes into motion. You've got your heart rate going fast. You've got all the blood rushing from your head. You're breathing fast.  All those kinds of things are happening before you can even think of anything to do about it.

4. ROCK CENTER: So even though a panic attack is an event that happens in the brain, it’s not imaginary, right? The symptoms are very real, correct?

DR. STONNINGTON: It is definitely not imaginary, but if it's coming out of the blue, it’s pretty understandable why people might think they're having a heart attack or going crazy or something really pretty ominous. Because it's this rush of adrenaline, and all sorts of physical symptoms are happening at once.  And it's very scary.

5. ROCK CENTER: As significant, or perhaps more significant, is what’s going on inside someone’s mind during a panic attack …

DR. STONNINGTON: We jump to conclusions. And we can create this whole worldview that is based on a sort of primitive reaction. Part of it is probably because we are wired to respond to and believe whatever our body is telling us. So, if mentally you are experiencing extreme anxiety, if you're experiencing the physical sensations of anxiety, then it must be in response to something. Because you know you're not crazy, right?  So therefore it must be attached to something absolutely real.

6. ROCK CENTER: Let's talk about remedies. Panic attacks are manageable, correct? What tools do you have, as a physician?

DR. STONNINGTON: There's two approaches that we like to do -- potentially together. So, first of all, is something called cognitive behavioral therapy, and then there are effective medications.

7. ROCK CENTER: Why is cognitive behavioral therapy effective?

DR. STONNINGTON: You can really shift your view about panic attacks and your approach to it. And that makes a huge difference.  It really does.  Like, for example, NOT avoiding situations that provoke extreme anxiety. Very, very commonly people will associate a certain environment with causing their panic attacks. So then they start to avoid that place or that situation. And then what happens is they’re creating this vulnerable person; like they suddenly have to be hyper-vigilant. They're looking for landmines everywhere. And they're restricting their lives. And, intuitively, they may think they're doing themselves a favor, but they're actually making the anxiety level rise. So we try to get people to gradually expose themselves to those situations. And, at the end of the cognitive behavioral approach, learn to actually bring on a panic attack and then reduce it.

8. ROCK CENTER: Which medications can be helpful?

DR. STONNINGTON: The types of medicines that tend to be prescribed … as the first line … are SSRI’s -- selective serotonin reuptake inhibitors. And those are the ones that probably you've heard of: Prozac, Zoloft, Celexa, Lexapro … or now, in generic form, fluoxetine, sertraline, citalopram, and escitalopram.

9. ROCK CENTER: Isn’t half the battle just understanding what this is, right? Knowing that information is power?

DR STONNINGTON: Yes. Absolutely. But it can be a little tricky. Once you’ve had a panic attack, depending on your symptoms, you may want to rule out a heart attack or other medical conditions, and have a reasonable workup to do so. But once you understand what it feels like, what it is, and then perhaps understand some of the things that may have led up to it occurring, then the key is not to keep rushing to the emergency room to rule out a heart attack. Because that's just going to make the panic attacks more frequent.

10. ROCK CENTER: As you’ve indicated, there are established ways for people to build their confidence and manage this condition, yes?

DR. STONNINGTON:  And even if a panic attack comes on, you know you’ll survive. You know you’ll be okay. Because, truly, the most debilitating thing about a panic disorder is not necessarily the actual panic attack, but a person's response to it.  That’s what tends to be disabling. The key in treatment really is to get people out of that mindset: that in order to be okay they have to never have a panic attack.  So they have to get comfortable with the idea that it could happen and it may happen, and that thing that they can do is manage it skillfully. And you can really extrapolate that to pretty much anything that people experience that's recurrent. More often than not, it's their response to the symptoms or the disorder that gives them the biggest amount of trouble, rather than the actual symptoms, which can be managed.

For more information, please visit http://thebetterinfo.com/panic-miracle.htm

Symptoms of Panic Attacks & What to Do

Dr Michael McDonough, Consultant Psychiatrist and head of our Anxiety Disorders Service recently spoke about panic attacks on RTÉ Radio 1's John Murray Show. If you missed the show, you can listen to it here or you can read Dr McDonough’s blog below.

What is a panic attack?

A panic attack is a sudden onset of intense anxiety or terror without any obvious threat. It is a misfiring of the so called “fight flight or freeze” adrenalin reaction.

Typical symptoms of Panic Attacks

Panic attacks can include usually four or more of the following:

• Pounding heart
• Sweating
• Shaking
• Shortness of breath which can include:
• Feeling of choking
• Chest pain
• Nausea/ tummy cramps
• Feeling dizzy or unsteady
• An out of body or unreal feeling
• Shivers or hot flushes
• Pins and needles

Panics can be full blown or milder “near” panics and they usually build to a crescendo in 10 minutes. Often the person understandably makes a catastrophic interpretation of what’s happening

• “I feel dizzy - I will faint” 
• “I feel like I’m not really here - I’m going mad” 
• “I can’t breathe properly - I’m going to suffocate”

Panics burn out after several minutes but lingering effects may last hours. 

What is panic disorder?

Panic Disorder may be diagnosed when there are recurrent panics that disrupt a person’s life. Once someone has one they understandably fear another will happen which can often generate new episodes. 

What might a panic attack feel like?

An example of a typical agoraphobic panic:

Get on train – wary of getting trapped, stuck – start to feel tense, sweaty – try to calm self down – stand near exit – hold onto something to steady self – reinforces the idea that something bad is on the way – train stops between stations – I am trapped – try to catch breath – rapid breathing – makes dizzy – fear of fainting – feel unreal –  intense terror – fear I am dying – leave at next station

Do panic attack symptoms vary?

The physical symptoms tend to be much the same but the focus of fear tends to vary for different people. Some fear collapsing, others a heart attack or others a feeling of losing control

Trigger situations that provoke the panics can vary also

• fear of being far from home - agoraphobia
• night time panics
• confined spaces
• worry induced panic
• or panic triggered by trauma memories 

How do you know it is a panic attack and does not have a physical cause?

By looking at the symptoms and the fact that the main sensation is fear.

A few medical problems can mimic panic but the signs are usually fairly obvious of the medical problem. 

Common examples are: 

• Overactive thyroid or adrenal gland
• Certain kinds of seizures
• Heart palpitations
• Lung problems like asthma

Most people suspect a medical cause with their first panic and go to A/E or to their GP

Some are misdiagnosed has having a medical or heart problem though there is more awareness of panic now than there used to be.

Can panic attacks be a symptom of another mental health problem?

Yes very much. Less than half have isolated so called panic disorder.

Panics often accompany depression and if mood and energy is low this should be considered as a possible underlying cause. When we are down we tend to be more anxious and more vulnerable to panic feelings 50% develop agoraphobia – a fear of being away from safety usually home 

Panic may also be a sign of another anxiety disorder such as  

• social anxiety
• obsessive-compulsive disorder
• a phobia or even 
• post-traumatic stress disorder

In one third of people, the panic is mixed with alcohol or drug misuse

How common are panic attacks?

Panic attacks are very common, 7-9% of the population suffer from them and twice this amount if milder panics are included. 

Who is more likely to suffer from panic attacks?  

• Panic attacks are more common in women with a ratio of 3:2. 
• Most panic problems start late teens early 20s but they can occur at any age. 
• Often associated with stressful events, life upheavals or traumas either past or present such as: 
• Loss of employment or being widowed or separated 
• Early life adversity or abuse. 

What is the best way to deal with a panic attack?

Breathing and relaxation training is no longer considered the best approach. They tend to subtly maintain the idea that panic is dangerous or life threatening. 

We now recommend for typical panic:

To “go with it”. This is similar to the meditational idea of “detached acceptance”. Test out whether the panic will really harm you by riding it out. Stay in the situation if you can until panic subsides. Learn that although very unpleasant panic isn’t dangerous and won’t cause lasting harm.

However each person is different. If panic is linked with another problem like past trauma or abandonment feelings or depression then it may not be best to tough it out. A more compassionate therapeutic approach may be needed initially. This highlights the importance of a careful assessment

When do you need to start looking for expert help?

If panics are causing significant disruption to your life they should be addressed early, the earlier the better.

A brief focused therapy using Cognitive Behaviour Therapy aims to break the maintenance cycle and is very effective for typical panic. It usually takes 4 to 10 sessions.

But as mentioned earlier, it is important to note that panic can indicate a more complex underlying problem so a careful mental health assessment is needed to start with.

Where can I get a mental health assessment?

Expert assessments can be done by mental health teams or CBT therapists and can be set up through GPs.

Increasing numbers of GPs have good expertise in anxiety but not all GPs are familiar with the latest developments in this area so it’s helpful to do your own research on what proven therapies are available.

What types of treatments are available?

Sometimes serotonin boosting antidepressants are used especially if depression is present but good psychotherapy is the preferred treatment for most. Valium like sedatives are best avoided.

Some individuals require longer term therapies to address underlying problems with confidence, relationships or past traumas.

This long term therapy tends to be taken on by therapists with a different training to the standard CBT therapy mentioned before It is important to note also that some people have addictions to alcohol or sedative drugs and panics are a symptom of drug or alcohol withdrawal. These individuals obviously need their addiction addressed first.

Dr. Michael McDonough | Anxiety Disorders Service

Throw away that paper bag... you CAN control panic attacks

Rapid breathing, chest pains, sweating, hot or cold flushes and numbness in the hands, feet or other body parts are a few of the terrifying symptoms of a panic attack.

One in ten of us will experience one at some point, according to the Royal College of Psychiatrists, and many claim it feels as if they are about to die or ‘go  mad’. But they can be overcome with some therapeutic exercises...

Art attack: Edvard Munch's famous The Scream was inspired by a panic attack suffered by the artist

RECOGNISE THE CAUSE

Although it’s not known why some suffer panic attacks, experts believe they are the result of a ‘fight or flight’ response in which the body is flooded with the stress hormone adrenaline, which increases the heart rate and blood pressure.

This is a useful physical response to danger as it readies the body for action. In a panic attack, however, the onset is abrupt with no obvious trigger.

Lasting about 20 minutes, they can occur sporadically, and for no reason, but are a symptom of anxiety disorder, a mental health condition characterised by irrational overwhelming feelings of tension, uncertainty and fear. 

INVESTIGATE BEHAVIOUR THERAPY

A form of counselling known as cognitive behavioural therapy (CBT) is accepted to be the gold standard of treatment for anxiety, and effective for 70 to 90 per cent of patients. It can reduce panic attacks through control of the earliest symptoms, or make them disappear instantly, depending on the severity. Unlike other talking therapies, such as psychotherapy, CBT focuses on the difficulties a person is experiencing now rather than delving into their past, encouraging them to identify and take control of thought processes that trigger attacks.

Hormone overload: Experts believe panic attacks are the result of a 'fight or flight' response

START THE HOMEWORK TODAY

Claire Taylor, a psychotherapist and CBT specialist, says there are many CBT techniques you can try at home to alleviate panic attacks. The first stage is identifying and understanding the nature of the problem. 

‘Panic attacks can be linked to a trauma – from bereavement or bullying to a one-off incident,’ she says.

‘I treated a rugby star who suffered an asthma attack in a scrum that left him in hospital. He became so scared of having another attack in that situation that he suffered panic attacks when thinking about rugby – irrational but it was ruining his life.

‘After an attack, the sufferer should step back and analyse what happened, looking at it in a positive way. For the rugby player this meant focusing on how many hundreds of times he’d been in a scrum and not had an asthma attack. It’s about making the problem smaller in your own head.’

PRACTISE ‘BELLY BREATHING’

Most people get warning signs that an attack is about to happen, including a racing heart, disorientation and a sense of needing to get out of wherever they are. 

According to Taylor, controlled breathing is key at this point. A  normal breathing rate for an adult at rest is eight to 16 breaths per minute. But in a state of heightened anxiety, we take rapid, deep breaths.

This is sometimes called hyperventilating and leads to low levels of carbon dioxide in your blood, which causes many of the symptoms of a panic attack.

‘Sufferers should place one hand on their chest and one on their stomach,’ says Taylor. ‘As they breathe in, the chest should stay still while the stomach is pushed out, counting slowly to exhale for a couple of counts longer than they inhale.’

REMEMBER: YOU WILL NOT DIE

‘When an attack happens, it’s important to control your thoughts immediately,’ says Taylor. ‘Repeat a simple mantra to yourself such as, “My heart will stop racing, I’m not going to die, I can overcome this.” ’

FIND YOUR HAPPY PLACE

Between attacks, keeping a mood and thought diary aids a shift to positive thinking. ‘Write a list of people, things or memories that make you happy. It could be a place that holds lovely memories where you felt in control. Read this list morning and night.

'The more positive energy you generate, the less likely you are to have a panic attack.’

DON’T RELY ON CRUTCHES 

Nicola Turner, a clinical psychologist specialising in CBT, says there are also techniques that can reduce the risk of an attack. 

‘Stress can cause panic attacks and the fear of having another attack can become greater than the anxiety itself, so relaxation is key,’ she says. ‘Be aware of tension in your body.’

‘Many withdraw socially as a result of attacks, avoiding places where they’ve suffered one before while arming themselves with ‘‘crutches’’ should an attack happen again, such as a paper bag to blow into. I encourage them to remove these crutches and return to the place of an attack, concentrating on their breathing and positive affirmations to increase confidence.’

ACCEPT ATTACKS MAY RETURN

Even when symptoms or attacks are under control, you should never take your eye off the ball, according to Nicky Lidbetter, a clinician and CEO of charity Anxiety UK.

‘I’ve seen so many abandon the CBT techniques once they’ve overcome their panic attacks, only for the problem to return,’ she says. 

‘Lifestyle adjustments are also vital. Too much caffeine and sugar in the diet creates unstable blood sugar which can cause a panic attack.

Adopting a balanced diet is very powerful, as is exercise to use up adrenaline and release mood-enhancing endorphins and increase self-esteem – a lack of which is at the core of many anxiety disorders.’ 

http://thebetterinfo.com/panic-miracle.htm

How to Treat Panic Attacks

A panic attack is a sudden and intense feeling of fear or apprehension that occurs in the absence of any actual danger, but can be quite debilitating and even contribute to further anxiety. Panic attacks are characterized by a range of symptoms that can include sweating, heart palpitations, shortness of breath, trembling, choking sensations, and feelings of impending death.

Clearly, panic attacks can be extremely problematic for those who suffer from them. Sometimes, people will become so afraid of having a panic attack in a public place that they begin avoiding the things that trigger their attacks altogether. For example, a person who fears having a panic attack might avoid leaving their house, which can eventually lead to agoraphobia.

While many people experience a panic attack at least once in their lives, recurrent panic attacks might be a sign of panic disorder. According to theAnxiety and Depression Association of America, an estimated six million people experience panic disorder in a given year.

However, there are a number of different treatment options that can be effective.

Medications

Medications are often used to treat panic disorders and have been shown to be both safe and effective. The pharmacological treatments that are prescribed by doctors and psychiatrists include antidepressants and anti-anxiety medications. Katharina Star, About.com's Guide to Panic Disorder, has more information on the medications used to treat panic attacks.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy, also known as CBT, can also be highly effective in the treatment of panic attacks. CBT may be used alone, or in conjunction with medications. During CBT, the therapist helps the client identify thought patterns that contribute to panic attacks. Once these harmful thoughts have been identified, the clients can then focus on altering their destructive thoughts and learn to engage in more helpful behaviors.

Panic Attacks and Panic Disorder

A panic attack is a sudden surge of overwhelming anxiety and fear. Your heart pounds and you can’t breathe. You may even feel like you’re dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems. They may even cause you to withdraw from normal activities. But panic attacks can be cured and the sooner you seek help, the better. With treatment, you can reduce or eliminate the symptoms of panic and regain control of your life.

Understanding panic attacks

Paula’s story

Paula had her first panic attack 6 months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.

Paula had her next panic attack three weeks later, and since then, they’ve been occurring with increasing frequency. She never knows when or where she’ll suffer an attack, but she’s afraid of having one in public. Consequently, she’s been staying home after work, rather than going out with friends. She also refuses to ride the elevator up to her 12th floor office out of fear of being trapped if she has another panic attack.

In many cases, panic attacks strike out of the blue, without any warning. Often, there is no clear reason for the attack. They may even occur when you’re relaxed or asleep.

A panic attack may be a one-time occurrence, but many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape.

You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are many effective treatments and coping strategies you can use to deal with the symptoms. 

Signs and symptoms of a panic attack

Panic attacks often strike when you’re away from home, but they can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or sitting on the couch at home.

The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour.

A full-blown panic attack includes a combination of the following signs and symptoms:

Shortness of breath or hyperventilation Heart palpitations or a racing heart Chest pain or discomfort Trembling or shaking Choking feeling Feeling unreal or detached from your surroundings

Sweating Nausea or upset stomach Feeling dizzy, light-headed, or faint Numbness or tingling sensations Hot or cold flashes Fear of dying, losing control, or going crazy

Is it a heart attack or a panic attack?

Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that people think they’re having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, heart palpitations, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.

Signs and symptoms of panic disorder

Many people experience panic attacks without further episodes or complications. There is little reason to worry if you’ve had just one or two panic attacks. However, some people who’ve experienced panic attacks go on to develop panic disorder. Panic disorder is characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.

Signs and symptoms of panic disorder

You may be suffering from panic disorder if you:

• Experience frequent, unexpected panic attacks that aren’t tied to a specific situation
• Worry a lot about having another panic attack
• Are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked

While a single panic attack may only last a few minutes, the effects of the experience can leave a lasting imprint. If you have panic disorder, the recurrent panic attacks take an emotional toll. The memory of the intense fear and terror that you felt during the attacks can negatively impact your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:

• Anticipatory anxiety – Instead of feeling relaxed and like yourself in between panic attacks, you feel anxious and tense. This anxiety stems from a fear of having future panic attacks. This “fear of fear” is present most of the time, and can be extremely disabling.
• Phobic avoidance – You begin to avoid certain situations or environments. This avoidance may be based on the belief that the situation you’re avoiding caused a previous panic attack. Or you may avoid places where escape would be difficult or help would be unavailable if you had a panic attack. Taken to its extreme, phobic avoidance becomes agoraphobia.

Panic disorder with agoraphobia

Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks. With agoraphobia, you’re afraid of having a panic attack in a situation where escape would be difficult or embarrassing. You may also be afraid of having a panic attack where you wouldn’t be able to get help.

Because of these fears, you start avoiding more and more situations. For example, you might begin to avoid crowded places such as shopping malls or sports arenas. You might also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.

Situations or activities you may avoid if you have agoraphobia:

• Being far away from home
• Going anywhere without the company of a "safe" person
• Physical exertion (because of the belief that it could trigger a panic attack)
• Going to places where escape is not readily available (e.g. restaurants, theaters, stores, public transportation)
• Driving
• Places where it would be embarrassing to have a panic attack, such as a social gathering
• Eating or drinking anything that could possibly provoke panic (such as alcohol, caffeine, or certain foods or medications)

Adapted from: American Academy of Family Physicians

Although agoraphobia can develop at any point, it usually appears within a year of your first recurrent panic attacks.

Causes of panic attacks and panic disorder

Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, and having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger a panic attack.

Panic attacks can also be caused by medical conditions and other physical causes. If you’re suffering from symptoms of panic, it’s important to see a doctor to rule out the following possibilties:

• Mitral valve prolapse, a minor cardiac problem that occurs when one of the heart’s valves doesn't close correctly.
• Hyperthyroidism (overactive thryroid gland)
• Hypoglycemia (low blood sugar)
• Stimulant use (amphetamines, cocaine, caffeine)
• Medication withdrawal

Treatment for panic attacks and panic disorder

Panic attacks and panic disorder are treatable conditions. They can usually be treated successfully with self-help strategies or a series of therapy sessions.

Cognitive Behavioral Therapy

Cognitive behavioral therapy is generally viewed as the most effective form of treatment for panic attacks, panic disorder, and agoraphobia. Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering the panic attacks. It helps you look at your fears in a more realistic light.

For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.

Exposure therapy for panic attacks and panic disorder

In exposure therapy for panic disorder, you are exposed to the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. You may be asked to hyperventilate, shake your head from side to side, or hold your breath. These different exercises cause sensations similar to the symptoms of panic. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.

If you have agoraphobia, exposure to the situations you fear and avoid is also included in treatment. As in exposure therapy for specific phobias, you face the feared situation until the panic begins to go away. Through this experience, you learn that the situation isn’t harmful and that you have control over your emotions.

Medication treatment for panic attacks and panic disorder

Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn't treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.

The medications used for panic attacks and panic disorder include:

• Antidepressants. It takes several weeks before they begin to work, so you have to take them continuously, not just during a panic attack.
• Benzodiazepines. These are anti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution.

Self-help tips for panic attacks and panic disorder

Learn about panic. Simply knowing more about panic can go a long way towards relieving your distress. So read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.When it comes to panic attacks, professional treatment and therapy can make a big difference. But there are many things you can do to help yourself, too:

• Avoid smoking and caffeine. Smoking and caffeine can provoke panic attacks in people who are susceptible. As a result, it’s wise to avoid cigarettes, coffee, and other caffeinated beverages. Also be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.
• Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you develop a coping skill that you can use to calm yourself down when you begin to feel anxious. If you know how to control your breathing, you are also less likely to create the very sensations that you are afraid of.
• Practice relaxation techniques. When practiced regularly, activities such as yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity. So make time for them in your daily routine.