If you’ve ever experienced a panic attack, one thing is for certain: you never want to have one again. However, it’s not as easy as saying ‘wow, I’m never going to do that again.’ Panic attacks are a bit mysterious in their nature which can make them even more tormenting for those who experience them.
Not knowing why it occurred, what symptoms or bodily sensations lead up to a panic attack, and what happens during one can actually make them worse, leading to a downward spiral. Luckily, many mental health experts have outlined just about everything science currently knows. So, let’s learn about them.
What Are Panic Attacks?
Panic attacks are different for everybody including what causes them, how you feel during one, and how you treat your relationship with them. Broadly, panic attacks revolve around a sudden feeling of intense anxiety and impending doom that can occur almost instantaneously [1].
During a panic attack there are many abnormal physical sensations such as breathlessness, palpitations, chest pain, choking, dizziness, tingling, hot/cold flashes, sweating, faintness and trembling. If you have had any combinations of these along with feeling like you are in danger or the world is coming to an end, we can consider it a panic attack.
Panic Disorder
Experiencing a panic attack is not an anomaly, and in fact, panic disorder affects up to 5% of the population. Statistically speaking, in a room of 100 people, 5 of them are likely to have this disorder. Keep this in mind when you think that you are the only one suffering from panic attacks; you are not alone.
Panic disorder means that instead of a one-time experience, the attacks are recurrent. This is also accompanied by anxiety about future panic attacks, phobic avoidance (staying away from places you fear will trigger a panic attack), or really any other change in behavior due to the attacks [2]. If you haven’t noticed, the criteria are fairly broad which shows how much it can vary from person to person.
Having this condition is often accompanied by other psychological disorders such as bipolar disorder, depression, general anxiety disorder and so on. In general, being in a poor state of mental health puts you much more at risk for panic attacks and panic disorder.
What Causes Panic Attacks?
This leads us to think about what exactly causes panic attacks. There are a number of things that can cause them and there are likely many more triggers that we aren’t even aware of, so I will go over some of the most common.
Trauma
Many people experience panic attacks as the result of early-life trauma and PTSD. We become afraid that whatever caused the trauma will occur again. When we enter a situation that we believe will cause that traumatic event to happen again, a panic attack may be triggered [2].
Stress and Anxiety
Another common cause is having an overbearing amount of stress and anxiety in day-to-day life which can lead to a mental breakdown or attack. Related to this, the amount to which someone is sensitive to anxiety can alter the occurrence of attacks [2]. Someone who has developed an anxiety disorder may be much more sensitive to anxiety and experience more panic attacks.
Feeling Unsafe
Panic attacks most often happen outside of the home in a place that we feel is unsafe. This is exacerbated by loud noises and entrapment that might be experienced on a plane or bus. We may also feel unsafe in situations where we are being judged such as in a job evaluation [3]. Changes in bodily sensations (sudden warmth, heart rate increase, etc) may also be misinterpreted as ‘unsafe’ to your body and could lead to an attack.
Health Factors
Interestingly, having parents with panic disorder also makes you much more likely to experience this yourself [2]. Some other general lifestyle and health-related risk factors include stimulant/substance abuse, smoking, hypothyroidism, respiratory difficulty and hearing loss.
Trouble Assessing Threats
The main psychological reason underlying why we get panic attacks is that our brains have trouble assessing true threats [4]. This is especially true if the attack arises from a source of trauma but can also occur from fears out of the blue as well. Our brains determine that something poses a direct threat and we are in danger, setting off our fight-or-flight response.
However, the problem is unsolvable in the moment, resulting in a rush of anxiety that leads to a panic/anxiety attack [3]. Aside from being unsolvable, it is also unlikely that the situation we are in poses any real danger. Most panic attacks arise from either misinterpreting our environment or bodily sensations as a threat to our safety.
Fear of Future Panic Attacks
Unfortunately, simply having a panic attack can make you more susceptible to future panic attacks. It can be such a terrible experience, especially if it happens in a public place, that attacks themselves become what you’re afraid of instead of the initial trigger. This is called a fear of fear [2], where you become afraid of the anxiety that causes panic attacks.
Ways To Overcome Panic Attacks
Now that we know a bit about panic attacks and their causes, let’s get to the most important part: overcoming them. They can seem to creep up anytime, leaving you without control, but rest assured that there are ways that you can limit their occurrence or possibly eliminate them completely.
Consistent practice of various panic control therapies has been shown to be 70-80% effective and can last for up to two years [3]. With that said, if you suffer from panic attacks or panic disorder you should try to remain vigilant with your therapy and not test how long it will last.
It’s Necessary
Gaining the ability to stop panic attacks is crucial not only because of their inconvenience and unpleasant nature but also because how you react to them can make other parts of your mental health suffer as well. If you start changing your habits and avoiding situations that may cause an attack, you will likely become more and more isolated which could lead to heightened anxiety and other problems such as depression. This will only make your condition worse.
The best option to gain control is to work with a good mental health expert and have them walk you through therapy, but that is not always an option. Because of this, I will summarize (in no particular order) what the experts believe to be the best ways to stop panic attacks in a way that you can implement on your own.
Therapeutic Options
There are typically three routes you can take: therapy alone, medication alone, or a combination of the two. The question of whether or not to medicate to reduce anxiety and panic attacks should be taken seriously. Medications DO have some value in therapy especially if anxiety is blocking you from even attempting therapy.
Studies have shown that taking medication alone will help to stop panic attacks and reduce anxiety, but the patients never actually solved the underlying issues and there was a high risk of negative side effects or abusive behavior relating to the drugs [2].
“pharmacological treatments have short-term effects, and improvements do not persist after the end of the therapy. On the other hand, therapy has a long-term effect”
A combination of therapy and medication was shown to work best to help individuals lower anxiety and then overcome the underlying problems causing their panic attacks. However, after the risk of abuse and side effects of the drugs are factored in, some experts in mental health concluded that strict therapy led to the best outcomes [2].
Unfortunately though, taking a drug to overcome the problem is the ‘easiest’ route and is what most people follow, at least in the USA.
“Although the nature of the evidence [for behavioral therapy] is robust, such approaches are underused in the USA, compared with drug treatment”
So, now that we know that therapy is the best option, what do we mean by therapy?
Cognitive Behavioral Therapy
The most popular form of therapy for overcoming panic attacks and anxiety in general is cognitive behavioral therapy (CBT). CBT focuses on reversing misunderstandings (false interpretations of threat) you may have about your environment along with changing how you act in environments that seem ‘unsafe’ [5].
“CBT is the most widely studied and validated psychotherapeutic treatment for panic disorder”
Education About Panic Attacks
The actual therapy is very in-depth, so for time’s sake, I will give a general outline and let you decide if it is appealing enough to do more research on the how-to. The first step for CBT is educating yourself about panic attacks including what happens to your body and mind and what causes them [2]. This education includes correcting misconceptions about fear (how unlikely it is to occur) and correcting distortions you may have in how you think about them.
Controlling Behavior and Emotions
The next step is controlling how you act and think in situations when you are prone to panic attacks. One of the main techniques is becoming more present and gaining control of your body. This is done through attentional focus training where you try to gain the ability to focus on your surroundings as objects rather than abstract fears. For example, if you hear a loud noise on a bus, you just acknowledge that a loud noise occurred and move on rather than think about all of the terrible things that may have caused the noise.
Another purpose of CBT is to allow you to view your thoughts objectively and acknowledge the presence of negative thoughts, but don’t allow them to control you. You will also focus on how the negative thoughts affect you, thinking about advantages and disadvantages of keeping those thoughts. Often times you will realize that the negative thoughts harm you much more than they help.
In addition to this, you are encouraged to think objectively about bodily sensations that may have previously pushed you into a panic attack. For example, an increase in heart rate happens naturally many times throughout the day and doesn’t mean you will have a heart attack.
Fear Exposure Therapy
Sometimes you may not know what causes panic attacks, but if you can pinpoint the source, fear exposure therapy has been shown to be an effective option. In our minds, we have deeply rooted fear networks that tell us what we are afraid of and how to act. This occurs even if we know it is irrational [6].
Because of this, if we want to reduce panic attacks, the fear networks must be restructured. Experts in psychology have laid out the groundwork for doing this through exposure techniques. Facing your fears is no easy task and in the beginning it will likely be difficult, but with time and consistency, you will be able to overcome it.
“We have found that patients with comorbid panic attacks are generally successful in quickly reducing their fear”
Education About Your Fear
In order to reduce fear, two conditions must be met. The first is that you must become educated about your fear and begin to think about it in a way that is different than when you were afraid. Learn as much about your fear as possible so that when you experience it again there will be as few surprises as possible. This is much easier with the power of the internet where you can read and watch almost anything.
View the fear from all angles including how you think about it and the chances that your perceived negative outcome will occur. In reality, most of the things we are afraid of will never actually harm us and hopefully, you will come to that conclusion through learning. As a part of this process, try to watch videos of people interacting calmly around your fear or in the situation that you fear. Keep what you learned in your tool belt for the next step of the process.
Facing Your Fear
The second condition is that you must become more familiar with your fear in person, starting small and then working up to facing your fear. Thankfully, this part isn’t very technical but remember to stay safe. You don’t want to try facing your fear in its entirety right off the bat because failure means that your fear will only be strengthened.
Instead, take small steps logical steps that lead up to facing your fear. For example, if you’re afraid of being with large groups of people, start by hanging out with a couple friends. Do this a few times until you’re comfortable in that situation and then go a bit bigger, but not too much bigger.
Maybe hang out with a couple friends and a few of their friends that you aren’t as acquainted with. Repeat this building up over and over until you are to the point where you are facing initial fear. In the beginning, this would’ve seemed impossible, but now it is just another step like all the others you have conquered. Not all types of fear are this straightforward, but just try your best to implement the basic outline of the therapy.
Throughout the process, one of the best ways to remain calm is to practice breathing with your diaphragm. It may seem trivial, but this can have an enormous impact on taking you out of the fight-or-flight state of mind and into the calm. Briefly, breathing with your diaphragm means that instead of inhaling with chest muscles (how many of us breathe normally), you use your diaphragm and fill your lungs around your abdomen. I like to take about 4 seconds on my inhale, pause, and then 4 seconds on the exhale, repeating this cycle until I feel calm.
[Read more about how to face your fears and how to breathe with your diaphragm.]
Other Practical Ways To Reduce Panic Attacks
While CBT and fear exposure therapy were the two methods written about the most in the primary literature, there are also many other steps that can be taken to overcome panic attacks. Since panic attacks include a sudden onset of heavy anxiety and may also be caused by anxiety, techniques that reduce anxiety will only help us out.
Journaling
One of my favorite methods for reducing anxiety is journaling. Again, this method has been deeply researched and proven to help with anxiety. Here is a compilation of what has been shown to work.
Before you begin writing, think about something that makes you happy for as long as you like. Then, write about some troubling thoughts you may be having, but try to incorporate how the negative experience could benefit you. This may be difficult, but it is almost always possible to see some sort of silver lining.
In addition to this, take some time to write about a few things you are grateful for and why. I also like to write about goals and track progress. Completing goals is ultra-fulfilling and just makes you feel good. Doing this on a blank sheet of paper works, but if you want to check out a guided journal we made for reducing anxiety that is explained in more depth, head here.
[Check out an in-depth article on journaling]
Mindfulness Meditation
We saw earlier that a main focus of CBT is viewing thoughts objectively which also serves as a large part of mindfulness meditation. Meditation is also completely free and easy to implement if you have a few minutes of spare time. To do this, sit in a stable, comfortable position, keeping a clear mind and trying to remain in the present moment.
Once you feel that you have control of your thoughts, begin to notice your surroundings and any thoughts that come into your mind. Think about everything objectively and try not to think about the past or future. This has been shown by many studies to work wonders for reducing anxiety.
[Here is some more depth info on the effect meditation has on anxiety]
Conclusion
If you suffer from panic attacks, it might seem like you are alone without control. However, we now know that neither of those are true. Many people experience panic attacks and mental health experts have found ways for us to overcome them. Once again, if you have access to a therapist, take that option. If you are taking any type of medication, keep taking it and discuss your alternative options with a healthcare professional.
The methods listed above are some of the best according to the scientific literature, but I’m sure that there are many more that could work for you as well. The most important thing is that you have to be willing to try and practice consistently if you truly want to overcome your panic attacks.
References