Panic Attacks and Panic Disorder Symptoms, Treatment and Clues to Self-Help

If you have had a sudden surge of anxiety and fear then you know what it feels like to have a panic attack. Your heart is tight, you cannot breathe and you may even feel like you are dying or losing your mind. Panic disorder which occurs with the frequency of panic attacks and prolonged anxiety/fear periods are condition that requires professional treatment. Panic attacks, which can lead to panic disorder and other problems if left untreated, can even cause you to withdraw from activities that interfere with normal daily life. But panic attacks are treatable conditions and the sooner you get help the better the results. With the right treatment and self-help techniques, panic symptoms can be reduced or eliminated. On this way you can regain your confidence and take back control of your life.


What is a panic attack?

A panic attack is a violent wave of fear that is characterized by sudden and debilitating symptoms. Panic attacks usually occur without any warning and sometimes without a specific trigger. Occurring unexpectedly, anywhere; Panic attacks, a mix of anxiety, fear, and intense anxiety, can happen when you relax and even sleep.

A panic attack can be a one-time event but many people experience recurring panic attacks. Recurrent panic attacks are often triggered by a specific situation such as crossing a bridge or public speaking – especially if the event has previously caused a panic attack. Situations that often cause panic trigger the fight-or-flight response of the body, making it feel in danger and in a situation that it cannot escape.
You may experience one or more panic attacks or you can be completely happy and healthy. In addition, another disorder such as panic disorder, social phobia or depression may have an effect on the occurrence of your panic attacks. Whatever the cause panic attacks can be treated. There are many strategies you can use to cope with symptoms and effective treatments.


Panic attack signs and symptoms

Panic attack signs and symptoms develop suddenly and usually peak within 10 minutes. Most end within 20-30 minutes, although they rarely take more than an hour. Panic attacks can occur at any time, regardless of a specific time and environment. You may come across it while shopping in the store, walking down the street, driving or even sitting on the sofa at home.

Panic attack symptoms include:

  • Shortness of breath or hyperventilation (breathing faster than usual)
  • Heart palpitations
  • Chest pain or a feeling of tightness
  • Trembling
  • Feeling like you are choking
  • Breaking away from the environment, feeling unreal
  • Sweating
  • Nausea or stomachache
  • Dizziness, darkening of the eyes or fainting
  • Numbness or tingling sensation
  • Hot or cold sweat
  • Fear of dying, losing control or going insane


Signs and symptoms of panic disorder

Many people experience only one or two panic attacks, regardless of episodic episodes or the development of complications, and if this is the case, you don’t have to worry because experts say 1-2 times in a lifetime are often the most common panic attacks. They underline that it is not an outside situation. But on the other hand, some people can develop panic disorder. Panic disorder is characterized by repeated panic attacks; these attacks are integrated with persistent anxiety caused by major changes in behavior or having more attacks.

You may suffer from panic disorder if you have the following symptoms:

Sudden and frequently recurring panic attacks not related to a specific situation

Fear / anxiety of having another panic attack

  • Acting differently due to panic attacks such as avoiding places where you have panic attacks before

Even though a single panic attack lasts only a few minutes, the effects of this experience can leave a permanent mark. If you have panic disorder, recurrent panic attacks can cause emotional loss. The intense fear and terror you feel during attacks can negatively affect your self-esteem and cause serious disruptions in your daily life. As a result of this condition, the following symptoms of panic disorder are observed:

Anxiety of Expectations– In between panic attacks, you feel anxious and nervous, as opposed to acting normally as your personality demands. This anxiety arising from the fear of experiencing panic attacks in the future is actually “the fear of fear” and can often occur and be rendered extremely ineffective.

Phobic avoidance – You begin to avoid certain situations or environments. This feeling may be based on the belief that the situation you want to avoid caused your previous panic attacks or you may be avoiding places where escape may be difficult or where help is not possible for fear of having a panic attack. When it reaches the extreme, phobic avoidance turns into agoraphobia (fear of open spaces).


Agoraphobia Panic Disorder

Agoraphobia was characteristically thought to include fear of public and open spaces. However agoraphobia is believed to develop as a complication of panic attacks and panic disorder. Although agoraphobia can develop at any point, it usually occurs one year after your first recurrent panic attacks.

If you are agoraphobic, you are afraid of having a panic attack in places where escape is difficult or embarrassing. You may also be afraid of having a panic attack where you can’t get help. Because of these fears, you start avoiding them in order to avoid further exposure to similar situations.

For example, you can start avoiding some of the situations listed below:

  • Crowded places such as shopping malls or sports grounds.
  • Cars, planes, subways and other forms of travel.
  • Social gatherings, restaurants or other situations that would be ashamed of having a panic attack.
  • Physical exercises that are feared to trigger panic attacks.
  • Certain foods or drinks that can cause panic, such as alcohol, caffeine, sugar or special medications.
  • Going anywhere without someone who makes you feel safe. In more severe cases, you may only feel safe at home.


Panic attacks and causes of panic disorder

Although the exact causes of panic attacks and panic disorder are unclear, this tendency is thought to be inherited. It also appears that there is a link with important life transitions such as graduating and entering business life, getting married or having a baby. Severe stress, such as the death of a loved one, divorce, or job loss, can also trigger panic attacks.

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

  1. Mitral valve shift; a minor heart problem that occurs when one of the valves in the heart does not close properly
  2. Hyperthyroidism (overactive thyroid gland)
  3. 3.Hypoglycemia (low blood sugar)
  4. Use of stimulants (amphetamines, cocaine, caffeine)
  5. Stopping medication


Panic Disorder Treatment

Panic attacks and panic disorder can create very uncomfortable conditions for people who suffer from them. Sometimes they can lead to avoidance of any activity or environment associated with panic feeling in the past. On the other hand, more severe disorders such as agoraphobia may occur.

Panic attacks usually begin in young adulthood but can occur at any time in an adult’s life. A panic attack usually begins suddenly without warning and reaches a peak in about 10 minutes. It can last from a few minutes to an hour and a half or longer. Panic attacks are characterized by a rapid heartbeat, sweating, tremors, and shortness of breath. Other symptoms may include chills, flushing, nausea, cramping, chest pain, tightness in the throat, difficulty swallowing and dizziness.

Panic attacks are more common in women than men. Many researchers believe that the body’s natural fight-or-flight response to danger is also a factor. For example, if a grizzly bear chased behind you, your body would react instinctively to it. Your heart and breathing would speed up and be physically prepared for a life-threatening situation. Many of the same reactions are seen in panic attacks. There is no obvious source of stress but something tries to lower the body’s alarm system by tripping.

Treatment that emphasizes a three-pronged approach is most effective in helping people overcome this disorder: education, psychotherapy and medication.
Before starting any treatment for panic disorder, a person must undergo a thorough medical examination (eg physical) to determine other possible causes of the disturbing symptoms. This examination is quite necessary because some other conditions, such as an excess of thyroid hormones, certain types of epilepsy, or cardiac arrhythmia (heart rhythm disturbances) can cause symptoms similar to panic disorder.


Psychotherapy in the Treatment of Panic Disorder

Education is often the first factor in the psychotherapy treatment of this disorder. The individual can be informed about the body’s “fight-or-flight” response and related physiological senses. In the treatment of panic disorder, it is aimed that the patient be aware of their cognition and learn to replace them with alternative thoughts. Recognizing these senses and learning to identify them is a general introduction to the treatment of panic disorder.

Individual psychotherapy is generally the preferred method, and short-term therapy is often less than 12 sessions. Education, support and emphasis on teaching more effective coping strategies are often the main focus of treatment. Family therapy is often useless and inconvenient.

Therapy can also teach relaxation and daydreaming techniques that can be used during panic attacks to reduce immediate physiological distress and the accompanying emotional fears. During an attack, discussing the patient’s irrational fears (usually feelings of dying, fainting, shame) is appropriate and highly beneficial in the context of a supportive therapeutic relationship. Cognitive or rational-emotional therapy in this area is one of the best effective methods. A behavioral approach that emphasizes gradual exposure to situations that trigger panic is often associated with anxiety disorders such as agoraphobia or social phobia. Given the patient’s particular problems, this may or may not be suitable as a treatment approach.

Group therapy can often be used effectively to teach relaxation and related skills, and psychoeducational groups in this area are often helpful. Biofeedback is a special technique that allows the individual to receive audible or visual feedback about the body’s physiological responses while learning relaxation skills as well as an appropriate psychotherapeutic intervention.

All relaxation skills and tasks taught in a therapy session should be strengthened by the patient’s unique daily exercises. If the individual is unable or unwilling to complete their daily tasks in practicing certain relaxation or imagination skills, training on such skills may result in less success than the therapy that emphasizes them. This proactive approach to change (and the therapist’s expectations that the individual will accept this approach) should be clearly explained at the beginning of treatment. Discussing these expectations openly increases the success of these techniques even more.


Cognitive-Behavioral Therapy (CBT)

Combining cognitive therapy that can alter or eliminate thought patterns that contribute to the patient’s symptoms. This therapy also includes behavioral therapy aimed at helping the patient change his behavior.

Typically, the patient undergoing cognitive behavioral therapy meets with the therapist once or three hours a week. In the cognitive part of therapy, the therapist conducts careful research for the thoughts and emotions that accompany panic attacks. These mental events are discussed in terms of the “cognitive model” of panic attacks.
The cognitive model states that individuals with panic disorder often have cognitive distortions (thought errors) they are not aware of and these can lead to a cycle of fear. It is believed that the cycle should work as follows: First, the individual feels a potentially alarming sensation such as a rapid heartbeat, chest pain or a mild nausea. This feeling, which can be triggered by some anxiety an unpleasant mental image, a trivial illness, or even exercise causes the person with panic disorder to worry. Initial anxiety triggers even more unpleasant emotions, which increases anxiety and leads to thoughts about catastrophe. The person thinks they are “having a heart attack” or “out of their mind”. As a result of this vicious circle, a panic attack occurs. The entire cycle may only take a few seconds, and the individual may not be aware of the first sensations or thoughts.

Supporters of this theory state that, with the help of a specialist therapist, people with panic disorder can recognize the first feelings and thoughts they feel in this series and learn to change their reactions to them. Expressions such as “This horrible feeling is getting worse” or “I’m going to have a panic attack now” or “I’m going to have a heart attack”, “instead of typical thoughts” that help reduce anxiety and prevent panic attacks, “I just feel uneasy now but it will pass immediately” is taught. This is taught to achieve. Changing thought patterns by teaching such special procedures allows the patient to have more control over the problem.

In cognitive therapy, conversations between the patient and the therapist usually do not focus on the patient’s past as in some forms of psychotherapy. Instead, the conversations focus on the challenges and achievements the patient currently has and the skills that the patient must learn.

The behavioral part of cognitive behavioral therapy may include a systematic training in relaxation techniques. By learning to relax properly, the patient can gain the ability to reduce the common anxiety and stress which often sets the stage for panic attacks.

Breathing exercises are often included in behavioral therapy. The patient learns to control their own breathing and avoids hyperventilation  – a faster and deeper than normal breathing pattern that can trigger or aggravate panic attacks.

Another important aspect of behavioral therapy is being aware of one’s inner sensations and adapting to them. During this process, the therapist helps a person become more aware of the inner sensations associated with panic. The therapist can then encourage them to develop a sense of panic attack in a way that is unique to each individual, for example, exercising to increase heart rate, rapid breathing to trigger fainting and breathing problems or turning around to cause dizziness. Exercises to stimulate feelings of unreality can also be used. Then, the therapist asked the patient to deal with these emotions effectively and his anxious thoughts like “I’m going to die”, “Just a little dizziness; teaches him to replace it with more appropriate phrases such as “I can handle it:

Another important aspect of behavioral therapy is “in vivo” or real-life exposure. Together with the patient, the therapist determines whether the patient avoids certain places and situations and what kind of avoidance causes problems for the patient. They focus on avoidance behaviors that seriously hinder and interfere with the life of the individual and they work hand in hand. For example, while the fear of driving may be paramount to a patient, not being able to go to the grocery store can be a fearful dream for another.

Some therapists may go to an agoraphobic patient’s home to practice the first sessions. Often times, therapists can take their patients to shopping malls and other places they avoid. Or they can accompany a patient who is trying to overcome their fear of driving.

The patient gradually approaches a situation he is afraid of showing the courage to continue despite his increasing anxiety level. Thus, the patient realizes that, no matter how frightening these feelings are not dangerous and pass. With every attempt, the patient faces as much fear as he can bear. With the help of this step-by-step approach and the therapist’s encouraging advice, patients are increasingly able to manage their fears and cope with situations that previously seemed unattainable.

Many therapists assign “some homework” to the patient between sessions. Sometimes patients spend just a few sessions in one-on-one contact with the therapist, and then continue to work on their own, with the help of a guide prepared for them.
Cognitive behavioral therapy usually takes at least 12 weeks to be effective. Some people may need longer treatment times to learn and practice skills. This type of treatment, which has been reported to have a low rate of deterioration, is effective in eliminating panic attacks or reducing their frequency. It also reduces anticipatory anxiety and avoidance of feared situations.


Other Therapy Treatments

There are other types of psychotherapy treatments available for panic disorder. Psychodynamic therapy is a form of “talk therapy” that requires the therapist and the patient to work together and tries to identify the emotional conflicts underlying the patient’s problems.

Although psychodynamic approaches can help alleviate the stress that causes panic attacks. They are not sufficient to directly stop the attacks. In fact, there is no scientific evidence that this therapy per se is effective in helping people overcome panic disorder or agoraphobia. However, if the patient’s panic disorder occurs more widely and with pre-existing emotional disturbances, psychodynamic therapy can be a useful addition to the overall treatment program.

Another treatment option is the psychotherapy group. Such groups usually meet once a week with other people struggling to overcome their panic disorder or phobias. Among the topics discussed in these weekly meetings; the progress made, encouraging the changes experienced and benefiting from the guidance of a trained therapist who leads the group.


Drugs Used in Panic Disorder Treatment

Many people with panic disorder can be successfully treated without resorting to any medication. However when medication is needed, the most commonly prescribed medications for panic disorders are benzodiazepines (such as clonazepam and alprazolam) and SSRI antidepressants. It is seldom preferred to administer medication alone without using psychotherapy to help correct and change the patient’s behavior towards some of the physiological senses associated with fear.

There are several medications that are generally used long-term to treat panic disorder: Clonazepam (Klonopin, Rivotril) and alprazolam (Xanax). Clonazepam and alprazolam are generally preferred by most doctors because they have less side effects than antidepressant drugs. Zanaks (Xanax) should be used with caution as it can be addictive. Since abrupt termination of clonazepam or alprazolam treatment may increase the likelihood of seizures, treatment should be discontinued gradually by tapering the drugs.

In this treatment approach, a prescribed medication is used to both prevent panic attacks and reduce their frequency and severity, and to reduce anxiety associated with it. When patients realize that their panic attacks are less frequent and less severe, they can now show courage to keep up with situations that previously pushed their limits. This way, they benefit from medication as well as exposure to previously feared situations.

Selective serotonin reuptake inhibitors (SSRIs) are currently the first step of drug therapy used in the treatment of panic disorder. Other commonly used drugs are tricyclic antidepressants, high potency benzodiazepines, and monoamine oxidase inhibitors (MAOIs). The drug to be used is determined by considering the safety, benefit and personal needs and preferences of the patient.

Self-help tips for dealing with panic attacks

Because few professionals are involved in treating this disorder, self-help methods are often overlooked by the medical community. There are many support groups in communities around the world that are dedicated to helping people with this disorder share common experiences and feelings. Reading self-help and self-help books helps the individual combat feelings of panic. Individuals can easily use these methods in their daily lives because they provide various techniques and coping suggestions against panic feelings.

Patients can be encouraged to try new coping and relaxation skills they have learned with people they meet in support groups. In this way, they can be an important part of developing new and healthier social relationships.

No matter how weak or out of control you feel about your panic attacks, remember that there are many things you can do to benefit yourself. The following self-help techniques can make a big difference in helping you overcome panic:

Learn about panic and anxiety. Even just learning more about panic can be helpful in relieving your boredom. Research on the anxiety experienced during panic attacks, panic disorder, and fight-or-flight response. You will realize that the feelings you feel when you experience the panic moment are actually normal and you do not lose your mind.

Avoid smoking, alcohol, and caffeine. These can trigger panic attacks in sensitive people. If you need help quitting smoking, see. Stop Smoking. Also, watch out for medications that contain stimulant ingredients, such as diet pills and alertness-inducing medications.

Learn to control your breathing. Hyperventilation brings with it many emotions (such as tightening of the chest and fainting) that occur during a panic attack. On the other hand, breathing deeply can alleviate panic symptoms. By learning to control your breathing, you can easily calm yourself when you start feeling anxious and if you know how to control your breathing, you are less likely to relive the feelings you fear.

Practice relaxation techniques. When done regularly, activities like yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response – the opposite of the stress response associated with anxiety and panic. These relaxation practices not only provide relaxation but also increase feelings of happiness and calmness.

Meet face to face with family and friends. Anxiety symptoms can get worse when you feel lonely so stay with people who care about you. If you think you don’t have anyone to hold on to, look for ways to meet new people and make supportive friendships.

Exercise regularly. Exercise is a natural anxiety reliever, so try to move around for at least 30 minutes a day (three 10-minute sessions are equally good). Rhythmic aerobic exercises that allow you to move your arms and legs such as walking, running, swimming, or dancing, can be particularly effective.

Get a good night’s sleep and get enough rest. Insufficient or restless sleep can further increase anxiety, so try to get seven to nine hours of restful sleep. If you have trouble sleeping, getting advice on getting a good night’s sleep can be helpful.

How to help someone who has a panic attack

It can be scary to see a friend or loved one who has a panic attack. They may breathe abnormally fast and deeply, feel faint, tremor, sweating, nausea, or think they are having a heart attack. Even if you think it’s unreasonable for your loved one to panic in the current situation, know that the danger is actually quite real to them. By simply saying calm, you cannot make them minimize their fears. However by helping your loved one survive this situation in the safest possible way, you can make him less afraid of the next attack.

Calm yourself first. Staying calm, trying to understand and acting without judgment will help your loved ones get rid of the effects of panic more quickly.

Focus on their breathing. Find a quiet place for the person with the panic attack to sit and direct them to take slow, deep breaths for a few minutes.

Do something physical. Raise and lower your arms together or kick your feet quickly on the ground. Taking action that requires this type of movement can help an individual cope with stress.

Keep their minds busy with something else. For example, ask the person with a panic attack or feel they are about to say five things they see around them or talk calmly about your commonalities.

Encourage them to ask for help. When the panic attack is over, the individual may feel very uncomfortable and embarrassed. In such a situation, encourage support by providing morale and support.