Panic 101

One of the most frightening things that many of my patients experience is a panic attack – or worse, a series of them.  According to the DSM-5 (American Psychiatric Association, 2013), a panic attack is:

“An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur. Note: The abrupt surge can occur from a calm state or an anxious state:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feeling of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, lightheaded, or faint
  9. Chills or heat sensations
  10. Paresthesias (numbness or tingling sensations)
  11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  12. Fear of losing control or going crazy
  13. Fear of dying”

Many individuals who experience panic attacks present in hospital emergency rooms, afraid they’re having a heart attack. Others are convinced they’re losing control or going insane. In reality, panic attacks are uncomfortable physical and psychological experiences, but they aren’t dangerous, an important distinction to make.

One of the best things someone can do at the beginning of a panic attack is to try not to “panic about the panic.” It’s easier said than done, but this will only make things worse. A panic attack is the body signaling a false alarm. Responding to the alarm as if it’s real validates the symptom. Instead, labeling the symptoms as panic is a helpful first step, as is challenging some of the the catastrophic thoughts that arise (e.g., “I’m dying”). The more you are able to identify the symptoms as panic, accept them, and potentially distract, the sooner the panic attack will pass. Many become afraid that they’ll pass out/lose consciousness during a panic attack, but heightened physiological arousal is generally contraindicated with fainting.

Developing a sense of acceptance around panic – rather than fearing another attack – can go a long way toward recovery. Cognitive-behavioral therapy is an evidence-based approach used in the treatment of panic attacks. Patients might also find meditation, deep breathing, and regular exercise helpful. For some, medication is indicated, with the typical offerings being SSRIs (e.g., Zoloft, Lexapro), taken daily, or benzodiazepines (e.g., Xanax, Ativan), taken briefly or when having or anticipating symptoms. Some patients find that carrying around medication, without ever using it, can ward off panic attacks.

For help with panic attacks, or other symptoms of anxiety, please contact our team at Gatewell.