A panic attack comes unexpectedly and is experienced as an intense fear, along with symptoms such as palpitations, tremors, difficulty breathing, chest pain, dizziness. Here you can read more about this form of anxiety, and what can be helpful.

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Panic anxiety disorder is a condition in which you suddenly and unexpectedly have panic attacks with intense fear or discomfort. Panic attacks can occur from many times a day to only a few attacks per year. During the attack, you are afraid of going crazy, of dying, or of losing control of yourself.  

Norwegian Association for Cognitive Therapy writes:

A panic attack is an intense feeling of fear that something terrible will happen, and with a strong physical discomfort. Panic attacks occur in all forms of anxiety disorders. The main problem for those with panic disorder is that they constantly fear an impending panic attack.





 

Symptoms of a panic attack 

The following symptoms are common:

 





  1. High heart rate, palpitations
  2. Feeling of shortness of breath
  3. Chest pain
  4. Dry Mouth
  5. Sweat
  6. Dizziness
  7. Nausea
  8. Tingling or numbness
  9. Freezing and hot flashes
  10. Tremors or shaking
  11. Feeling of unreality
  12. Anxiety about going crazy or dying

A common sequelae is fear of certain situations or places (agoraphobia).

 

The panic attack: A frightened but harmless reaction

The Norwegian Association for Cognitive Therapy further writes:

What happens during such an alarm reaction is not dangerous. It is a normal reaction, no matter how unpleasant we experience it. The body actually works properly when there is danger on the move. 

A panic attack is a "false" alarm, which is maintained and amplified by catastrophic thoughts, where the reactions in the body are interpreted as danger signals. The first fear reaction can thus often not be controlled. It can come automatically in a situation where you feel insecure. But if you overcome your anxiety for anxiety, you can quickly regain control. 

 

Causes of panic disorder

The Norwegian Association for Cognitive Therapy writes:

Many people develop panic disorder during a period of life where they experience stress. These can be illness, death and financial problems. Some have also had difficult periods earlier in life. This can cause them to react particularly strongly when they encounter new problems.

If you do not have enough support in the environment, have problems coping with the stresses or have difficulty expressing your feelings, the stress will be all the greater. 

But the way you interpret body reactions probably matters the most. 

What one interprets as the causes of panic disorder also depends on what theoretical approach one has. There are various explanatory models in psychology. The different models do not have to be in opposition to each other - but can be mutually complementary. Also, it is not unlikely that there may be different causes of panic disorder from person to person.

 

Treatment for panic disorder

There are several treatments that have shown good effect in panic attacks. In a review article from the reputable Cochrane database they write (my translation):

The results of the review generally show that talk therapy is more effective than no treatment. There was no strong evidence to support one form of talk therapy over the other forms of talk therapy for panic disorder with or without agoraphobia in adults.

However, there was some evidence (of low quality) in favor of cognitive behavioral therapy (CBT), psychodynamic therapy and supportive psychotherapy over other conversational therapies for short-term recovery and short-term reduction in symptoms.

Which treatment is suitable for you who are struggling with panic disorder can vary depending on different conditions. Some therapies are best suited for single, while other therapies are suitable for others. In addition, panic disorder can occur in teams with other mental disorders (so-called comorbidity) such as depression, substance abuse problems, personality disorders and more, and it then becomes a question of finding an overall treatment that is beneficial for your particular situation.

 

Cognitive behavioral therapy for panic disorder

Cognitive behavioral therapy aims to change the misconceptions that underlie panic disorder. 

The starting point is a cognitive understanding of panic disorder, where a negative, self-reinforcing circle arises where panicked thoughts about bodily symptoms increase these bodily symptoms which in turn increase the panicked thoughts about what is happening, and so on (see figure below). It becomes almost like a nuclear reaction in the soul. One can put it bluntly that panic disorder is the psyche's natural atomic bomb. When the panic reaction first runs wild, it feels as if the soul's life is shaken to the intolerable.

The consolation of it all is that there is an off button for this seemingly atomic bomb-like anxiety reaction. The off button is to understand and accept that what is happening right here and now is not dangerous at all. So easy, and so difficult.

For many people, self-help in panic disorder can be effective. But if you should have tried with your own help to overcome the panic disorder without success, it is wise to seek professional help - because this is a terribly tiring mental illness - against which there is definitely good treatment.

 

To control panic attacks

If one is to use cognitive behavioral therapy, the principle for gaining control over panic disorder is to actively break into the panic circle. It is primarily about replacing the catastrophic thoughts with more balanced thoughts about what is going on. But it can be easier said than done, and in practice will be something you do when the panic reaction has started - that is, you must try to relate in a new way to the physical symptoms and discomfort once it has occurred.

The Norwegian Association for Cognitive Therapy writes about this:

To control your panic, you may want to avoid activities that lead to fearful body reactions, whether it's breathing problems, heavy heartbeat or dizziness. In fact, we would suggest that you induce these symptoms intentionally through a systematic exercise program. 

However, if you are pregnant, have a heart condition or other illness, we advise you to talk to a doctor. If you are in any doubt about whether this can be dangerous, consult a doctor first.

 

Examples of exposure for panic attacks

There can be many ways to create such an exercise program, and if you are already going to talk therapy, you can create one in team with your therapist. But it is also quite possible to use such a scheme as self-help, although it is always wise to keep in mind that you may need support from other people when embarking on difficult things - as it may just be to get started with such a scheme.

A main principle is that you seek out situations / take actions that create the bodily reactions that you associate with panic disorder, and that you learn to interpret them as harmless - when they happen.

The Norwegian Association for Cognitive Therapy mentions the following examples of training situations that can be good for this purpose:

 

  1. You may feel dizzy if you get up quickly. You can swing around several times, for example while sitting in a swivel chair. You can rotate several times in a standing position in the middle of the room.
  2. You can get choking sensations by holding your hand in front of your mouth and breathing "through" it.
  3. You can cause tremors in your body if you tense all your muscles as hard as you can for one minute while sitting in a chair. If you tighten the muscles at the ribs, you will feel a pressure in your chest that you may have associated with a possible heart attack. Pressure on the chest can also be achieved by holding the breath for half a minute.
  4. You can cause chest pain by filling your lungs with air, then trying to inhale even more air.
  5. You can provoke feelings of unreality by staring for one minute at a fluorescent tube, for two minutes at your mirror image or for three minutes at a point on the wall.
  6. You may experience visual disturbances if you look into the light bulb for a few seconds, then look at an open wall.
  7. Drinking two or three cups of strong coffee can cause tremors, internal agitation, heat waves and sweating. 

Through the exercises you will be given the possibility to show that these are harmless reactions that you can control. 

 

Psychodynamic treatment of panic disorder

From a psychodynamic perspective, panic disorder can be symptoms of underlying difficulties that are virtually visible through the panic disorder, and which are simultaneously obscured through the anxiety. In other words, panic disorder is not the problem itself, but a symptom of a deeper psychological problem.

The main idea is that through the psychodynamic treatment you get better insight into the underlying difficulties, and through dealing with these you also overcome the panic disorder. 

Supporters of psychodynamic therapy like to emphasize that there is scarce research evidence for the positive long-term effects of cognitive approaches to the treatment of panic disorder.

Some case examples are mentioned to illustrate what panic disorder can be about (my translation, and original text is somewhat simplified):

 

  1. A case example: An experience that it was functional to be ill

    An example is a female patient with panic disorder who had an unconscious desire to get emotionally closer to her brother. This brother was dismissive of her, and even had a physical weakness. An important premise in the unconscious desire to get closer to the brother was that this should happen through the woman herself being ill, injured and weakened.

    It emerged during the psychotherapy that she had completely forgotten and repressed the memories of how her childhood had become strong, negatively affected by her brother's physical illness. She gradually began to remember these things, and at the same time there was a dramatic worsening of the panic symptoms. This happened in connection with her being admitted to a prestigious educational program.

    The woman became aware that her success on the educational front had triggered anxiety that she would lose the underlying, unconscious desire to be sick and injured - just like her brother - and the aggravated panic attacks had had the function of maintaining her view of herself as one as a weak and injured person.

    The panic disorder was overcome through the therapy, and the woman was able to change some of these previously repressed feelings only after she had consciously recognized the problem through the therapy.

  2. Case example: A defensive reaction against unacceptable wishes

    Ms W., an 18-year-old woman, was driving from one city to another to attend her eighteenth birthday party when she experienced her first panic attack. The anxiety attack was so severe that she had to drive off the road, call her mother in the city she was driving in, and ask her mother to pick her up on the highway.

    The whole process of getting her mother to pick her up took several hours, and in the meantime Ms W.'s company had to be closed. The moment she experienced the panic attack, Ms W. had thought a lot about her eighteenth birthday being very important to her: it symbolized her "total independence" from the family and a new opportunity to "get rid of them."

    Through psychotherapy, it became clear to her that the thought of becoming 18 years old and "independent" of the family was experienced as if she was going to emotionally take the lives of her parents and siblings. This fantasy was so conflict-filled for her that she had her first panic attack.

    The panic symptoms represented both her deep desire to be alone and independent, the fear of loneliness this brought with it, and a strong psychological defense against this whole desire. The panic attack now made this whole company and everything that it emotionally represented impossible. It also served as a form of self-punishment for her "terrible" thought of freeing herself from the family.

  3. Case example: A struggle between repressed anger and the fear of being abandoned

    Mr. D., a 45-year-old man, came to psychotherapy with severe symptoms of panic disorder, particularly focused on chest pain for fear of having a heart attack, and in addition with a weak arm and an accompanying fear of having a stroke. The first evaluation revealed that the father had died of heart disease and that his mother had suffered a devastating stroke.

    When he began to discuss some of the difficult experiences with his parents when he was growing up, he was choked with tears and despair. In particular, Mr. D. remembered the experience of being humiliated by his parents, especially by his father, whom he called "Dumbo" in front of his friends. Through this nickname, the father had indicated that the patient was stupid and that he was to blame for many of the family's difficulties.

    Mr. D. therefore felt furious at his parents, but he was told that if he ever expressed his anger, he would be sent away to live with a woman named "Mrs. Cruela, that is, with a naughty woman, where bad children had to live. He felt trapped between humiliation, anger and fear of being rejected. Remembering these painful experiences proved to be at least as troublesome for the patient as the panic attack itself, and he had always struggled to understand how his parents could treat him this way.

    He eventually became convinced that there was a connection between his problematic fear of being abandoned and the symptoms of panic when he discovered that the panic attack as it was was triggered by the experience of his wife leaving him, in favor of being with his friends. 

 

Although these are only isolated examples, the point of the authors is that panic disorder is not just a meaningless mental disorder, but that anxiety can have an underlying dynamic and a deeper meaning. According to the authors, anxiety is related to something unconscious and connected in the emotional life, where the panic anxiety both reveals and obscures the whole thing.

As among review article from Cochrane points out, psychodynamic treatment can be an effective form of treatment for panic disorder, but it is likely that different forms of treatment will suit different people.  

 

Medical treatment for panic disorder 

Studies have also been done on the use of medication in the treatment of panic disorder, and then preferably in combination with cognitive behavioral therapy. 

 

Guided self-help for panic attacks

Another treatment approach for panic disorder is the use of self-help programs or self-help techniques. Some evidence has also been found that this form of treatment may be useful.

 

Self-help stories for panic attacks

Here are some videos on self-help techniques and understanding to help with panic disorder.

Sources:

  1. http://nhi.no/sykdommer/psykisk-helse/angsttilstander/panikklidelse-oversikt-3086.html
  2. http://www.senterforkognitivpraksis.no/artikler/hva-er-panikkangst.html
  3. http://www.sinnetshelse.no/artikler/panikklidelse.htm
  4. http://www.helsebiblioteket.no/pasientinformasjon/brosjyrer/panikkanfall
  5. http://www.kognitiv.no/wp-content/uploads/2014/11/Trening-ved-panikklidelse.pdf
  6. http://www.kognitiv.no/psykiske-lidelser/ulike-typer/angst/panikklidelse/
  7. http://www.cochrane.org/CD011004/DEPRESSN_psychological-therapies-treatment-panic-disorder-or-without-agoraphobia