What is a panic attack?
“As I sat there, I got flooded with an overwhelming sense of dread without warning. My heart started pounding so hard I could feel it in my throat, and my chest tightened as if an invisible weight was pressing down on me. Every breath felt shallow and desperate, like I was suffocating. My hands became sweaty, shaky and a wave of dizziness made things around me spin. I felt sick in my stomach and had chills all over with the fear that I might lose control, even die. The room seemed to close in on me, and despite knowing it was irrational, I couldn't get rid of the feeling that something terrible would happen.”
If you have had one or more of such experiences, you might be suffering from panic attacks. These episodes can be intensely frightening and may leave you feeling vulnerable and confused. It is important first to eliminate any possibility of medical reasons that could be causing these symptoms. Consulting a healthcare professional is crucial to rule out conditions such as heart problems, thyroid issues, or other medical concerns that might mimic the symptoms of a panic attack. Once medical causes are ruled out, a mental health professional can help you understand your experiences better and develop strategies to manage and reduce the frequency of these distressing episodes. Remember, seeking help is a vital step towards improving your well-being.
Panic attacks are brief, sudden surges of intense anxiety, with symptoms that are the same as intense fear. The fight-or-flight response is a normal human reaction that occurs in response to fear when a person is in physical danger to protect themselves.
This includes three major types of reactions:
- Physical responses such as increased heart rate, increased breathing rate, increased blood flow towards muscles and important organs, sweating, and muscle tension.
- Thinking responses such as searching for threatening information in anxious situations
- Behaviors such as avoidance of feared situations or changing your behavior in those situations.
What happens when I have a panic attack?
Our brain is incredibly good in detecting threats. These threats might be imminent, physical threats but also imagined ones. A panic attack is when our threat response is activated while there might not be an obvious, physical threat. If you experience any of the body symptoms of fight-or-flight for seemingly no reason, it can feel very frightening.
When we are anxious, the optimal levels of oxygen-carbon dioxide is disrupted because we begin to breathe too much. If the body cannot return carbon dioxide levels to the optimal levels, we experience further symptoms such as dizziness, light-headedness, headache, weakness and tingling in the extremities, and stiffness around the body. When someone is in panic, these physiological sensations can be quite distressing, as they may be perceived as being a sign of something dangerous upcoming, such as a heart attack. However these are largely related to the fight or flight response and fast breathing, not physical problems.
People who experience panic frequently develop a habit of scanning their bodies for any type of sensations described above. Any symptom, once recognized, might be interpreted as a sign of danger and a thinking process is initiated which might feed into the exacerbation of the initial symptoms. These types of thinking might include:
- Catastrophic thoughts about physical sensations (eg “My heart is beating fast, I feel a tightness in my chest - I might be having a heart attack!”)
- Over-estimating the possibility of having a panic attack (eg “I’ll definitely have a panic attack if I go to the cinema)
- Over-estimating the consequences of having a panic attack:thinking that the consequences of having a panic attack will be very serious or very negative. (eg “I will faint”, ”I will ridicule myself”, “Others will think I have a problem”)
When we feel anxious or expect to feel anxious, we often act in efforts to control our anxiety. One common way is by avoiding situations where we might panic. You might try to prevent panic attacks by avoiding:
- Situations where you’ve had panic attacks in the past
- Situations difficult to escape or get help from, like public transport, shopping centers, or driving in peak hour traffic
- Activities that might cause similar sensations, such as physical activity, drinking coffee, having sex, or getting emotional
Another way is to use "safety behaviors," such as ensuring you're near an exit, leaning against a wall. You might also try to distract yourself by doing something, like walking, listening to music. These behaviors are not harmful per se but complete dependence on them might elevate distress in case you might not be able to use them in one specific situation.
When can you have panic attacks?
Panic attacks can arise in a wide range of situations and sometimes seem to come out of the blue. Let’s take a look at those.
Life situations where the fear of losing becomes prominent, like actual or anticipated loss of loved ones, loss of one’s health or life, loss of status, relationships, opportunities, safety, protection or autonomy can provoke attacks. Moreover, major life transitions, like moving, starting or ending relationships, becoming parents, starting, changing, ending careers, are when the fear of loss and the associated anxiety can be felt deeply and can induce panic attacks due to the uncertainty and substantial adjustments involved.
Panic attacks don’t always stem from negative life experiences; surprisingly, positive experiences can also trigger them, leaving you wondering, "Everything is great, why am I having panic attacks now?" For example, getting married, while exciting and joyful, can bring intense stress and anxiety about losing autonomy, taking over responsibilities. Starting a new job often comes with the pressure to prove oneself, meet new expectations, and adjust to a new environment. Receiving a promotion, recognition or award, whether desired as a recognition of hard work, frequently comes with increased responsibilities and an expectation to keep the pace, leading to anxiety.
Similarly, having a baby, even though very much wanted, can trigger anxiety due to getting into an unknown territory with overwhelming responsibilities and changes in one’s life. Graduating from school, while an expected milestone, means transitioning to the next phase of life, like starting a career, which can be frightening, as a landmark into becoming an adult with increased responsibilities. Making a major purchase, such as buying a new house, car, or significant investment, can induce anxiety related to financial decisions and the pressure of making the right choice.
High-stress periods, like tight deadlines, major exams, or family conflicts, can trigger them due to heightened pressure and anxiety. Anticipating future events, such as a big presentation, a doctor’s appointment, or an important test, can trigger panic attacks due to the anxiety of upcoming pressures. Crowded or closed spaces, such as elevators, public transport, clubs, theatres can provoke attacks because of the perceived lack of escape routes and the overwhelming presence of others can intensify feelings of panic.
Social situations involving public speaking or meeting new people can trigger attacks, as the fear of being judged or negatively evaluated increases anxiety especially in those with social anxiety.
Panic attacks may also occur during calm moments, like watching TV or resting, when suppressed anxiety surfaces in the absence of distraction, and they can even happen during sleep, waking you up in a state of panic.
Reminders of past trauma can trigger attacks as your body reacts to the memory of the trauma. Sometimes, panic attacks happen without an obvious cause, adding to the unpredictability and fear surrounding them. Recognizing these triggers can help you and your healthcare provider develop strategies to manage and reduce the frequency of panic attacks.
Panic Attacks from the View of Existential Psychology
Existential psychology views panic attacks not merely as symptoms to be eradicated but as signals pointing to deeper existential concerns. Panic attacks can be manifestations of difficulties in dealing with existential givens of being a human.
Some common existential issues that can be the source of panic attacks are:
- absence of meaning & purpose in life
- difficulty in accepting inevitable loss, which may be actual or anticipated, concerning loved ones, one’s health, status, money, identity but also one’s opportunities/dreams
- conflicts arising from one’s ability to choose and the responsibilities that come with those choices
- conflicts arising from one’s giving up on their autonomy and/or authenticity to secure relationships, status, financial gain
- difficulty in tolerating painful emotional experiences (rage, helplessness, humiliation, despair, guilt)
- conflicts between the desire of being free, autonomous and the desire of connection and intimacy.
These existential themes can create an intense sense of anxiety when not addressed and might manifest in panic symptoms.
Existential-Integrative Therapy of Panic Attacks
Η υπαρξιακή-συνθετική ψυχοθεραπεία συνδυάζει προσεγγίσεις για την ανακούφιση των συμπτωμάτων βραχυπρόθεσμα και την εξερεύνηση των βαθύτερων υπαρξιακών συγκρούσεων μακροπρόθεσμα. Προτεραιότητά της είναι η αντιμετώπιση των άμεσων συμπτωμάτων, καθώς θα χρειαστείτε υποστήριξη για την ανάπτυξη τρόπων διαχείρισης του άγχους σας πριν εξερευνήσουμε τις υποκείμενες υπαρξιακές συγκρούσεις. Προσφέρονται ασκήσεις αναπνοής, ασκήσεις γείωσης και εξατομικευμένες στρατηγικές χαλάρωσης για να σας βοηθήσουν να διαχειριστείτε τα άμεσα συμπτώματα πανικού.
The therapy then looks into your thoughts, beliefs, emotions and behaviors that trigger and maintain the panic attacks. Identifying these will help you to understand what contributes to your anxiety and eventually keep you from confronting deeper conflicts.
The therapy later gradually shifts to exploring and understanding the deeper, existential issues, underlying the panic symptoms. This latter phase involves helping you face and work through the underlying main existential conflict, eventually reaching a resolution and enabling you a more satisfactory engagement with life.
References:
Center for Clinical Interventions (n,d). Information sheets – Panic. Retrıeved from Panic Disorder Self-Help Resources – Information Sheets & Workbooks (health.wa.gov.au)
Schneider, K. J. (Ed.). (2008). Existential-integrative psychotherapy: Guideposts to the core of practice. Routledge/Taylor & Francis Group.