UNDERSTANDING ANXIETY AND PANIC ATTACKS.

What is anxiety?

Anxiety is something we all experience from time to time. Most people can relate to feeling tense, uncertain and, perhaps, fearful at the thought of sitting an exam, going into hospital, attending an interview or starting a new job. You may worry about feeling uncomfortable, appearing foolish or how successful you will be. In turn, these worries can affect your sleep, appetite and ability to concentrate. If everything goes well, the anxiety will go away.

This type of short-term anxiety can be useful. Feeling nervous before  an exam can make you feel more alert, and enhance your performance. However, if the feelings of anxiety overwhelm you, your ability to concentrate and do well may suffer.

The ‘fight or flight’ reflex

Anxiety and fear can protect you from danger. When you feel under threat, anxiety and fear trigger the release of hormones, such as adrenalin. Adrenalin causes your heart to beat faster to carry blood  where it’s most needed. You breathe faster to provide the extra oxygen required for energy. You sweat to prevent overheating. Your mouth may feel dry, as your digestive system slows down to allow more blood to be sent to your muscles. Your senses become heightened and your brain becomes more alert.

These changes make your body able to take action and protect you in a  dangerous situation either by running away or fighting. It is known as the ‘fight or flight’ reflex. Once the danger has passed, other hormones are     released, which may cause you to shake as your muscles start to relax.

This response is useful for protecting you against physical dangers; for example, it can help you run away from wild animals, attackers, fires etc   very quickly. The response is not so useful if you want to run away from exams, public speaking, a driving test, or having an injection. This is because, if there is no physical threat, and you have no need to physically run away or fight, the effects of adrenaline subside more slowly, and you may go on feeling agitated for a long time.

Severe anxiety

If the anxiety stays at a high level for a long time, you may feel that it is difficult to deal with everyday life. The anxiety may become severe; you may feel powerless, out of control, as if you are about to die or go mad. Sometimes, if the feelings of fear overwhelm you, you may experience a panic attack.

What is a panic attack?

A panic attack is an exaggeration of the body’s normal response to fear, stress or excitement. It is the rapid build-up of overwhelming sensations, such as a pounding heartbeat, feeling faint, sweating, nausea, chest pains, breathing discomfort, feelings of losing control, shaky limbs and legs turning to jelly. If you experience this, you may fear that you are going mad, blacking out, or having a heart attack. You may be convinced you are going to die in the course of the attack – making this a terrifying experience.

Panic attacks come on very quickly, symptoms usually peaking within 10 minutes. Most panic attacks last for between 5 and 20 minutes. Some people report attacks lasting for up to an hour, but they are likely to be  experiencing one attack after another, or a high level of anxiety after  the initial attack. You may have one or two panic attacks and never  experience another. Or you may have attacks once a month or several  times each week. For some people they seem to come without warning  and strike at random.

I’m walking to the village shop, then the earth shifts to one side, my heart’s hammering as if it will explode, my vision is blurred  and my hands are sticky with sweat. And I’ve no idea why.

Panic attacks can also come in the night and wake you up. These nighttime attacks occur if your brain is on ‘high alert’ (due to anxiety) and can detect small changes in your body which it then interprets as a sign of danger. Night-time attacks may be particularly frightening, as you may feel confused and are helpless to do anything to spot them coming.

Why do some people feel more anxious than others?

If you worry more than others, it could be because of your personality, current circumstances or your past or childhood experience; it could be a  mixture of these.

Past experiences

If something distressing happened to you in the past, and you were unable to deal with your emotions at the time, you may become anxious  about facing similar situations again in case they stir up the same feelings of distress.

Feeling anxious could also be something you learned early on in life; for example, your family may have tended to see the world as hostile and dangerous and you’ve learned to respond in the same way.

Some theories suggest that you may inherit a tendency to be more anxious, and so it is a part of your personality.

Everyday life and habits

On a day-to-day basis, caffeine, excess sugar, poor diet, drug misuse, exhaustion, stress and the side effects of certain medication can also mimic and trigger symptoms of anxiety.

Fear of losing control

You may worry about the future. Sometimes, if you feel you are not in control of many aspects of your life, you can start to feel anxious about events beyond your control, such as the threat of global warming, of  being attacked, of developing cancer, or of losing a job.

After a while, you can start to fear the symptoms of anxiety, especially feeling out of control. This sets up a vicious circle. You may feel anxious because you dread feeling the symptoms of anxiety, and then you experience those symptoms because you are having anxious thoughts.

What are the effects of anxiety?

Anxiety can have an effect on both your body and your mind.

Physical effects

Short-term effects:

  • Increased muscular tension can cause discomfort and headaches
  • Rapid breathing may make you feel light-headed and shaky, and give you pins and needles.
  • Rising blood pressure can make you more aware of a pounding heart.
  • Changes in the blood supply to your digestive system may cause nausea and sickness.
  • You may feel an urgent need to visit the toilet, and get ‘butterflies’ in your stomach.

Long-term effects:

  • Fear combined with tension and lack of sleep can weaken your immune system, lowering your resistance to infection.
  • Increased blood pressure can cause heart or kidney problems, and contribute to the chances of having a stroke.
  • You may experience digestive difficulties.
  • You may also feel depressed. (See Mind’s booklet, Understanding  depression)

Psychological effects

Anxiety can make you more fearful, alert, on edge, irritable, and unable to relax or concentrate. You may feel an overwhelming desire to seek the reassurance of others, to be weepy and dependent.

The way you think can be affected: if you fear that the worst is going to happen, you may start to see everything negatively and become very pessimistic. For example, if a friend is late, you may imagine and worry  that he or she has had an accident or doesn’t want to see you; even though your friend may simply be late because their train was delayed.

To cope with these feelings and sensations, you may feel tempted to start smoking or drinking too much, or misusing drugs. You may hold on to relationships that either encourage your anxious outlook or help you avoid situations you find distressing – and so stop you dealing with what’s worrying you.

Impact on work, leisure and relationships

If your anxiety is severe, you may find it difficult to hold down a job, develop or maintain good relationships, or simply to enjoy leisure time. Sleep problems may make your anxious feelings even worse and reduce your ability to cope. (See Mind’s booklet, How to cope with sleep problems.)

For some people, anxiety becomes so overwhelming that it takes over their lives. They may experience severe or very frequent panic attacks (see ‘Panic disorder‘) for no apparent reason, or have a persistent ‘free-floating’ sense of anxiety. Some people may develop a phobia about going out, or may withdraw from contact with people – even their family and friends. Others have obsessive thoughts or compulsive behaviour, such as endlessly washing their hands.

What type of anxiety disorders are there?

There are several types of anxiety and panic disorders, because people respond to anxiety and panic attacks in different ways. Some of the more common disorders are outlined below.

Phobias

Phobia is about irrational fear. If you have a phobia, your anxiety will be triggered by very specific situations or objects; such as spiders, heights, flying or crowded places, even when there is no danger to you. For example, you may know a spider isn’t poisonous or won’t bite you, but this still doesn’t reduce your anxiety. Likewise, you may know that it is safe to be out on a balcony in a high-rise block, yet, feel terrified to go out on it or even enjoy the view from behind the windows inside the building. (See Mind’s booklet, Understanding phobiasfor further information.)

Generalised anxiety disorder (GAD)

You may be diagnosed with generalised anxiety disorder if you have felt anxious for a long time and often feel fearful, but are not anxious about anything in particular. The strength of symptoms can vary.

Obsessive Compulsive Disorder (OCD)

Obsessive thoughts and compulsive behaviour are typical for this  disorder. You may, for example, have obsessive thoughts about being contaminated with germs or fear that you have forgotten to lock the door or turn off the oven. You may feel compelled to wash your hands, do things in a particular order or keep repeating what you are doing a certain number of times. (See Mind’s booklet Understanding obsessive-compulsive disorder.)

Post-traumatic stress disorder (PTSD)

If you have experienced or witnessed a very stressful or threatening event, e.g. war, serious accident, violent death or rape, you may later develop post-traumatic stress disorder. You are likely to experience flashbacks and have dreams about the event, and these are likely to trigger strong anxiety and feelings you experienced during the actual event. (See Mind’s booklet Understanding post-traumatic stress disorder.)

Panic disorder

Panic attacks may sometimes occur for no reason, and you may not be able to understand why. You may feel as if your mind has gone totally out of control . When you experience panic attacks that seem completely unpredictable and you can’t identify what has triggered them, you may experience panic disorder. Because the onset of panic seems  unpredictable, you may live in fear of having another panic attack. This fear can become so intense it can trigger another panic attack.

How can I learn to manage my anxiety myself?

There are many things you can do to reduce your anxiety to a more manageable level. Taking action may make you feel more anxious at first. Even thinking about anxiety can make it worse. Therefore, a common – and natural – response to anxiety is to avoid what triggers your fear. For example, if you are afraid of spiders, running away every time you see  one, is likely to increase your fear. Avoiding an exam because you feel anxious is likely to make you feel worse. Therefore facing up to anxiety, and how it makes you feel, can be the first step in breaking the cycle of fear and insecurity.

At the onset of panic, I keep telling myself that I have been here before and that I get through it again. It will pass if I try to keep as calm as I can.

Controlling the symptoms

You may find that your symptoms can be controlled by breathing and relaxation techniques. Books and CDs on the topic are available both online and from bookstores to help you with this – also see Mind’s booklet How to manage stress for some exercises. Several self-help programmes on relaxation are available online, or you could attend a relaxation class. In some areas there are also classes in anxiety management (see ‘Useful contacts’).

Assertiveness training

Being assertive means you can stand up for yourself while also respecting other people and their opinions.

Learning how to handle difficult situations and to assert yourself can make you feel more confident and, therefore, more relaxed. Some people find that learning self-defence makes them feel safer. To find out about local classes, ask at your library or look on the internet.

I have found that activities that involve ‘putting myself out there’ – e.g. dance classes that involve having to perform on stage for an end of year show or exam – very helpful in developing confidence and assertiveness, especially as they make you stand up straight and ‘walk tall’ rather than ‘hide’.

Complementary therapies

Some people may find that complementary therapies help them to relax, sleep better, and deal with the symptoms of anxiety. Yoga, meditation, aromatherapy, massage, reflexology, herbalism, Bach flower remedies, homeopathy, and hypnotherapy are some of the methods people have found helpful. Many chemists and health shops stock different remedies and may be able to offer advice.

I find chamomile tea helpful when feeling very anxious. It calms my body down without the horrible side-effects of medication. Massage has also been very helpful. Listening to a relaxation CD everyday was also a life-saver during a period of extreme anxiety.

Mindfulness-based cognitive therapy (MBCT) is recommended by NICE (National Institute for Health and Clinical Excellence) for recurrent   depression. Some people find that it can also help with anxiety. MBCT is based on Mindfulness-based stress reduction (MBSR). This was developed to help people with a range of disorders, including chronic pain, hypertension and heart disease, as well as emotional distress such as anxiety and panic. The treatment is usually done in groups and includes learning how to be more aware and mindful about what you are experiencing. It will teach you techniques for how to deal with your problems, including yoga, relaxation and meditation.

(See ’Useful contacts’ for organisations that can provide further information and list of registered practitioners).

A healthy lifestyle

Exercise uses up the adrenalin and other hormones that are produced under stress, allowing muscles to relax. It can therefore help you to cope with anxiety and feelings of tension, and may help you sleep better. Walking and swimming allow you to be active at your own pace and you can do them alone or in company.

Eating a healthy diet and getting plenty of sleep can also make a big difference to your ability to cope with stress (see How to manage stress). You may find it easier to relax if you avoid stimulants such as coffee, cigarettes and alcohol.

Talking

Talking to a friend or family member about what’s making you anxious can help. You may find that they have encountered a similar problem and can talk you through it; however, just having had someone listen to you and showing that they care, can help in itself.

What sort of treatment can I get?

If you find that anxiety is affecting your ability to cope with everyday life and want help, your GP can help you find out what options are available. The most common forms of treatment offered are talking treatments and medication. You may also be offered, for example, exercise on prescription.

Talking treatments

Talking treatments (counselling and psychotherapy) can help you to understand and deal with the causes of your anxiety and to find strategies for coping (see Mind’s booklet Making sense of talking treatments).

There are different types of counselling and psychotherapy available in groups or individually. Some types help with how you are feeling; others look into reasons why you may be experiencing anxiety; some may do both. Most services offer time-limited counselling or therapy – usually between 6-12 sessions, and usually one session a week. Some GP surgeries – and many voluntary organisations – offer a variety of counselling and psychotherapy services.

If you want to try a talking therapy, your GP can provide information and refer you to a local service. Also see ‘Useful contacts’ for organisations listing local practitioners.

When the GP said he could help, I didn’t believe him at first, I’d felt so embarrassed telling him what was happening to me. He said he’d wished I’d made an appointment sooner as severe anxiety like mine can usually be tackled, even ‘cured’.

Cognitive Behavioural Therapy (CBT)
CBT is recommended by NICE for anxiety and panic disorders. It is a  short-term therapy that is increasingly available on the NHS. CBT encourages you to develop new ways of thinking and to work out strategies for managing anxiety, so you feel in control.

CBT is usually offered as face-to-face therapy; however, some CBT programmes are available as online programmes that you can use as a self-help aid. The availability of CBT has developed fast under the government-funded programme ‘Access to Psychological Therapies  (IAPT). However, in some areas the service is still patchy. (See Mind’s   booklet Making sense of cognitive behavioural therapy for more information and see BABCP in ‘Useful contacts’ for a list of practitioners.)

Medication

NICE suggests that for particular kinds of anxiety, such as panic, social phobia and obsessions, GPs should prescribe antidepressants, especially certain SSRIs (selective serotonin reuptake inhibitors).

Antidepressants
SSRI antidepressants are usually better tolerated than some other drugs, but, in some cases, they may increase anxiety and can cause problems with sleeping. Your GP should give you the recommended dose for anxiety, and he or she should monitor your progress. If SSRIs don’t work or aren’t suitable, you may be offered a tricyclic antidepressant, such as imipramine or clomipramine.

All these drugs may take several weeks to work, and may cause side effects, which your doctor should discuss with you. When you stop taking the drugs, you may experience withdrawal symptoms, such as dizziness, tingling, stomach upsets or headache. It is therefore important to reduce the dose slowly.

Beta-blockers
Doctors may also suggest beta-blockers to deal with symptoms such as palpitations, although the success of this treatment is variable. They may also help with anxiety in particular situations; for example, sitting an exam or flying.

Tranquillisers and sleeping pills
Doctors usually prescribe tranquillisers and sleeping pills  (benzodiazepines) only as a temporary measure for severe or disabling anxiety, as some people become dependent on these drugs and have difficulty coming off them. They are given at the lowest possible dose, for the shortest possible time, and not longer than about four weeks. The side effects can include feeling sluggish, unable to concentrate, and not caring about anything. Withdrawal symptoms may occur, if you take them for any length of time. These can seem worse than the original feelings of anxiety. Withdrawal should be done slowly. Long-term use of tranquillisers has also been linked with having panic attacks.

Tranquillisers can’t tackle the cause of your problems, but they can bring some relief, until other forms of treatment can be put in place.

To find out more about medication, see Mind’s booklets Making sense of   antidepressantsMaking sense of sleeping pills and minor tranquillisers and Making sense of coming off psychiatric drugs.

Exercise on prescription

Many GPs can prescribe exercise for a variety of problems, including mental health problems. If you are prescribed this, you will be referred to a qualified trainer who can help set up exercises and a training     programme that suits you.

Options

Don’t be afraid to ask questions about the problems you are experiencing, the treatments suggested, their side effects, possible alternatives and how long it might take to feel better.

If none of the treatments offered to you make a difference, your GP can refer you for specialist help. This could be through your Community  Mental Health Team (CMHT), which is made up of a number of different healthcare professionals who can assess you and offer you a treatment plan.

How can friends and family help?

This section is for friends and family who wish to support someone they know who is experiencing anxiety or panic attacks.

If you have a friend or relative who experiences high levels of anxiety, it can help if you are able to think about how you feel yourself when you are anxious. This might help you to understand how they feel when they are  going through a bad time.

Being supportive can be a question of finding the right balance. You need to accept the person as they are, and not push them into situations that are beyond them. Yet, at the same time, it can be helpful to encourage them to overcome small challenges. In this way, they can build up their self-confidence and feel in control. It may be a good tactic to try and strike a bargain with your friend or relative. If they will agree to go to a relaxation class, for instance, you could promise to travel with them and meet them afterwards.

One thing that really helped me overcome the fear of going out as a result of panic attacks, was being made to go out for walks or to a cafe with a friend… rather than let me stay in, I was made to face my fears… Although I sometimes felt very panicky, it gradually became easier and easier…

If someone is distressed, they may need reassurance that it’s OK to cry. Letting out feelings can relieve tension. Laughter is relaxing – helping your friend to have fun may be one of the most useful things you can do for them. They may also need support in finding appropriate channels to express anger, even if this is just bashing a few cushions about.

Some people may be embarrassed at not feeling in control. They may blush or shake, and need reassurance that this is not obvious to others. Sometimes, physical closeness, such as a touch or a hug, can be very comforting. A gentle massage to neck or shoulders may also be soothing.

People with severe anxiety may feel very negative about themselves. Keep reminding them of their good points.

Useful contacts

Anxiety Care
tel. 07552 877 219
web: anxietycare.org.uk
Helps people to recover from anxiety disorders.

Anxiety UK
tel. 08444 775 774
web: anxietyuk.org.uk
Support, help and information for those with anxiety disorders.

British Association for Behavioural and Cognitive Psychotherapies (BABCP)
tel. 0161 705 4304
web: babcp.com 
Can provide details of accredited therapists.

British Association for Counselling and Psychotherapy (BACP) 
tel. 01455 883 300
web: bacp.co.uk
For Information about counselling and therapy. See website or sister website, itsgoodtotalk, for details of local practitioners.

The British Psychological Society
tel. 0116 254 9568
web: bps.org.uk 
Produces a directory of chartered psychologists.

The Complementary Medical Association (CMA)
tel: 0845 129 8434
web: the-cma.org.uk
Has a register of professional practitioners and training courses.

Institute for Complementary and Natural Medicine (ICNM) 
tel. 020 7922 7980
web: icnm.org.uk
Has a register of practitioners.

Mindfulness Based Cognitive Therapy
web: mbct.co.uk 
Information about the therapy, classes in Mindfulness and training.

NICE (National Institute for health and clinical excellence)
web: nice.org.uk 
Information and guidelines on recommended treatments for different disorders.

No Panic
helpline: 0800 138 8889
web: nopanic.org.uk 
Provides a helpline, step-by-step programmes, and support for those with anxiety disorders.

Samaritans 
24-hour helpline: 08457 90 90 90
email: jo@samaritans.org
web: samaritans.org 
Emotional support for anyone feeling down or struggling to cope.

UK Council for Psychotherapy (UKCP)
tel. 020 7014 9955
web: psychotherapy.org.uk 
Has a voluntary register of qualified psychotherapists.

One of the most frightening things you may find yourself experiencing is a panic attack and it is very difficult to fully explain how it feels unless you have experienced one. The very first panic attack often seems to come completely unexpectedly and can even occur whilst you are doing something that you do every day like driving to work, shopping, walking the dog, watching TV, cooking etc. Suddenly you are struck by a barrage of frightening and uncomfortable symptoms and you are convinced that something terrible is going to happen to you there and then.

 If You Are having A Panic attack NOW
  • Remember that although your feelings and symptoms are very frightening they are not dangerous or harmful.
  • Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.
  • Do not fight the feelings or try to wish them away. The more you are willing to face them, the less intense they will become.
  • Do not add to your panic by thinking about what “might” happen. If you find yourself asking “what if?” tell yourself “so what!”.
  • Stay in the present. Notice what is really happening to you as opposed to what you think might happen.
  • Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds.
  • When you find yourself thinking about the fear, change your “what if” thinking. Focus on and carry out a simple and manageable task such as counting backward from 100 by 3’s or snapping arubber band on your wrist.
  • Notice that when you stop adding frightening thoughts to your fear, it begins to fade.
  • When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.
  • Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

General Information

Panic attacks can start for many reasons such as stress, overworking, bereavement, family, an accident, childbirth, following surgery and so on but at the time panic strikes for the first time, you think you are doing fine and there seems to be no apparent reason at all. If you have subsequent panic attacks, they too may seem to be unpredictable and random. There is now emerging evidence that anxiety and panic may have a genetic link.

People that have never had a panic attack assume that that it is just a feeling of nervousness or anxiety, but in reality the attacks are far more frightening and overwhelming. If nervousness is a 3 on a scale of 1-10, then a full blown panic attack is 11.

What often happens next is that you begin to associate the Panic attack with the activity or place you were at the time so you start to avoid that situation. This is where the problems begin as each time you are forced into the situation that caused the attack, you automatically assume that it will happen again and start to re-live the feelings and this can lead to agoraphobia and limiting of activities and leading a normal life.

Panic disorder can be frightening, disabling and frustrating, both to recover from and to live with someone suffering with it.

Often the sufferer will not go out as they say they ‘know’ they are going to faint or ‘have a heart attack’. See the “Symptoms” section for explanations of these feelings and the reasons for them. Please read the “Help yourself” section for some really useful information on how to cope.

As panic can strike very quickly, and often the trigger is not apparent, there is usually little warning that it is about to happen. It is not surprising therefore, that many sufferers avoid situations that they think or ‘know’ might cause the panic attacks to happen. This leads to fears of situations or places that last caused anxiety and so the sufferer avoids them at all costs! This is agoraphobia. The problem here is that it can take months, even years, to re-educate the individual that it is their thoughts and assumptions that are to blame for these attacks and not the place at all but it still takes a long time to return to such places.

Getting appropriate and quick medical help is not easy and the slide from anxiety to panic and then to agoraphobia can progress quickly without intervention and support.

Talking from experience, I avoid public transport because of several incidents in taxis where I was terrified and therefore starting associating any public transport with fear and panic. The problem then ‘spread’ to include trains, buses and eventually I was unable to get in the car with someone else driving. This is still a problem today. I do drive myself but the problems do not stop there!

I was once told that if you ‘sit out’ a panic attack to see how bad it can actually get, it will reach a point where it can’t get any worse and you ‘automatically’ start to calm down.

If you suffer from severe anxiety or panic attacks, but don’t know it, you can end up going to numerous doctors and Accident & Emergency departments with a variety of symptoms and self diagnoses, only to be told that there is nothing medically wrong with you and you are not given any help, information or solutions. This leads you to the conclusion that you may have some terrible mysterious condition that could kill you one day and that the doctors aren’t managing to find it. With each test and subsequent treatment that is performed and is deemed normal, your conclusion is strengthened and your fears (and panic attacks) get worse. This can lead to house-bound agoraphobia.

Don’t give up! Read the other sections on this site to learn and understand what is happening and how to access the help you need.

What is Panic Disorder?

A panic disorder is diagnosed when a person has four or more panic attacks in one month, or one panic attack followed by a month of fear of having another attack. Panic disorder is the next step up from panic attacks and it is generally recognised that it takes longer to recover once you are diagnosed as having panic disorder rather than with isolated panic attacks.

What are the long-term effects of the condition? If a panic disorder is not effectively treated, a person may not be able to function at work or at home. This can have a negative effect on relationships, education and other important parts of a person’s life.

Understanding the problem

The body has a natural ‘fight or flight’ response to danger. When a person perceives some threat or danger, the autonomic nervous system is stimulated. This helps a person escape from danger. During a panic attack, the body’s automatic nervous system is triggered for no apparent reason – a false alarm, but it feels so real.

Once you’ve got the diagnosis that you are suffering from panic attacks or panic disorder – what next?

It is essential that you understand the diagnosis and its implications. The good news is that it is not terminal and there is a way to recovery, but it may be a long uphill struggle and it could take years to recover. Ok, so this is the worst case scenario but a realistic one and it would be naive to suggest that you are likely to recover in a few weeks. Yes, people do recover within a few weeks but then there are sufferers that take years to overcome all effects of panic. I have been suffering since 1993, so I know that it is hard work.

The biggest problem for most people is that they are embarrassed by the illness (like I am) and they see it as some kind of mental of psychiatric disorder or weakness that is not something you want to be telling people about. If you can learn to accept that the disorder stems from malfunctioning of the central nervous system receptors then you are well on your way to recovery.

The rewards are well worth the effort but you MUST be prepared to work at the problem and accept help.

When caught in its early stages, further (more complicated) conditions can be avoided, including depression, alcohol abuse and agoraphobia, so it is essential that you and your doctor recognise the condition early on and start treatment immediately.

Hindsight is a wonderful thing and I suffered from panic attacks for nearly a year before the doctor officially diagnosed it and then I could begin treatment. I first went to the doctor and explained all my symptoms and I was told “to eat more brown bread”! This may sound funny but each time I went back I was just fobbed off and went away thinking that something must be wrong because it wasn’t normal to feel the way I did.

Once I was aware of what I had to deal with, I began treatment but it was too late to control the panic attacks and I did go on to suffer from panic disorder and agoraphobia.

Steps for sufferers to take

STEP ONE Have a complete medical examination to see if there is any physical condition that could be causing your symptoms. Explain the symptoms to your doctor and ask him if he would do full blood tests – this will rule out anything such as diabetes, thyroid problems etc. Get your eyes tested as well to make sure your sight is not causing those worrying dizzy spells and headaches. If necessary, ask to be referred to an ear specialist to make sure the dizziness is not caused by an ear infection or something similar.

You could ask for an E.C.G. to make sure the pounding heart is quite normal.

Do not go to your doctor and demand all these tests, however, be advised by what he suggests and accept that he will give you all the test he deems necessary.

You will not be able to start your recovery if you are still convinced that there is something physically wrong, so this step is very important. There may be many more visits to the doctors each time a new physical symptom appears but a general health check will allay a lot of the fear.

If the doctor does find a physical condition that is causing the symptoms then you may find that once it is treated and cleared up, the panic attacks will stop.

Above all, if you are given a clean bill of health, you MUST believe that panic attacks are not going to kill you and the symptoms are just temporary and will, in time and with some effort, recede and go away.

STEP TWO Not everyone develops panic attacks because they are stressed, tired, over-worked, anxious, worried, or even after suffering traumatic life events. Panic attacks have been known to run in families and can strike every walk of life.

Take a look at your personality to see if you have any high-anxiety personality traits that could be contributing to your anxiety. You may need to seek the help of a therapist to work on these feelings.

I was once told that many sufferers of anxiety/panic tend to have low self-esteem and self-worth. Working with a therapist to increase the opinion they have of themselves can help reduce the panic and anxiety.

STEP THREE Take a close look at your lifestyle and make changes that will help in the long-term. This could be something as simple as watching your diet and trying to cut out different food groups to see if the symptoms are eased.

I stopped drinking tea, coffee and any soft drinks containing caffeine in September 2000 and it has had a dramatic effect on my panic attacks. I also tried cutting out all dairy products and found that this had no effect on the panic attacks so it was reasonable to consider that they weren’t contributing in any way.

Seriously consider how much alcohol you are drinking. Write down how many units you drink in a typical week and then write down why you had a drink at a particular time. Do you find that you are drinking to alleviate the symptoms of the panic attacks? Do you always reach for the bottle when you have had a bad day at work?

Take up exercise on a regular basis – walk up the stairs instead of taking the lift.

What about your job? Are you bored, unhappy or so stressed at work that you are constantly running on adrenalin? Would it be so bad if you got a different job that you enjoyed doing?

STEP FOUR Learn to live with the panic attacks but NEVER give in. It could be a long struggle, but some people make remarkably quick recoveries and never suffer attacks again. Others may suffer for years and never really make a full recovery. Accept that you are a panic attack sufferer and do everything you can to overcome it – do not allow it to rule you life.

TAKE CONTROL OF YOUR LIFE TODAY!

Spontaneous Panic – What is it? How to deal with it?

Copyright Notice
© Reproduced with kind permission of ‘No Panic’. Please do not copy this article without their prior permission
By Professor Kevin Gournay, MPhil, PhD, CPsychol, AFBPsS

Most people with anxiety states are simply more alert and aroused than the general population. The chemical processes which underlie anxiety are complex but essentially lead to the body being put into an optimum state of preparedness. One way of looking at anxiety is that the body goes into this state of preparedness without a rational external reason. For many anxiety sufferers there is a simple cure which activates an attack. This may be the sight of a spider, the thought of going shopping or talking to a large group of people. Attacks of anxiety like this can be managed by the exposure based approaches which have been shown to be so effective. Therefore gradually facing one’s fears and avoided situations in graduated doses of difficulty, perhaps with some attempt to change how you think about such situations, will lead the body eventually becoming used to those situations and no longer producing the state of arousal.

However, some sufferers seem to experience surges in arousal for no apparent reason. I have come across a very large number of patients who have become physiologically very aroused and hence develop an anxiety state although there is no particular source of anxiety in their lives. Perhaps these people are more prone to produce adrenalin than some people and for some reason their system becomes more prone to spontaneous panic attacks. The other group of people who are more prone to spontaneous panic attacks are those who repeatedly encounter anxiety linked to a particular phobia or obsession. In these cases the repeated episodes of anxiety have a generalised effect and after a while the body seems to just produce surges of adrenalin for no apparent reason.

What then does one do about this?

To begin with, one must look at simple factors which pre-dispose sufferers to panic attacks. Being hungry or tired can often be a factor and simply eating regularly and getting plenty of sleep is one remedy likewise, some people report that they are more prone to these apparently spontaneous panic attacks after indulging in alcohol the day before. This association has been known for some time but, it is becoming clearer that large numbers of anxiety sufferers can develop panic attacks in response to alcohol. More recently I have seen a number of patients who have developed such spontaneous panic attacks in the aftermath of taking illicit drugs such as Marijuana or Ecstasy. In the latter cases I have seen a worrying number of young people who have developed the severest states of panic disorder after even an isolated intake of this drug.

Sometimes, spontaneous panic attacks are not really spontaneous. There is a great deal of research which shows that sometimes the arousal which occurs when one gets angry can be misinterpreted as anxiety and sometimes a panic attack may actually be a feeling of anger which presents itself a little later after the original event which caused the problem. Sometimes, there are other factors which may produce anxiety which are not so obvious. For example, one patient of mine recently developed spontaneous panic after seemingly making a good recovery from her agoraphobia. I asked her to keep a diary and eventually we isolated the cause of these “spontaneous” panics.

She had recently taken a new job and the bus journey to work which she was enjoying for the first time in many years passed a funeral parlour on a daily basis. She therefore glanced at the funeral parlour on the way to work and this activated a very long-standing fear of death, and cancer in particular (she had had four close family members die while she was a teenager). Thus, it became clear that this lady’s “spontaneous” panic was not really so spontaneous and she is in treatment for her long standing fear.

However, some panics appear to be genuinely spontaneous. The first thing to do is to keep a diary and record these panics, trying to also not what may have come before them so as to isolate a cause. Secondly, keep a note of what you eat and drink. In some cases, panic may be triggered by the intake of alcohol (as mentioned prior) or lots of strong black coffee. If a diary keeping exercise does not reveal a cause, think about ways of gradually reducing your base “level of arousal”. Although things like relaxation training and Yoga may be helpful, it is worth considering adding regular systematic exercise to your routines. There is a great deal of evidence which shows that regular exercise, a minimum-of 20 minutes, 3 times a week, can reduce states of high arousal. It is also worth looking at your pattern of breathing and seeing whether you are hyperventilating. It may be that you are breathing rather rapidly from the top of your chest and, some tell-tale signs are presence of pins and needles, yawning and sighing, feeling tired or having muscle cramps. The remedy for this malady is slow, but not deep, diaphragmatic breathing. The ‘No Panic’ help-line will assist you, if required, in learning some simple breathing exercises.

Finally remember that panic can do you no real harm. Obviously, therefore one needs to look at how one thinks about such panics and whether there is a pattern of catastrophic thinking. Therefore, if for example you think during a panic attack that you might die of a heart attack or stroke, this needs to be treated as an irrational though and you should practice writing down your irrational thoughts and countering them with rational responses. Thus, as you go along, you should record the irrational though and think about every other reasonable way of considering the situation In the cases of someone who’s thoughts are of their heart stopping, one might respond by saying anxiety puts the body into an optimum state of preparedness, one’s heart muscle is in a very healthy condition during increased arousal. Or one may say I have had these panic attacks on numerous occasions and I have had the same though and I am still alive!! Such simple self-help methods can often be successful however, if spontaneous panic and catastrophic thinking is a problem which will not respond to self-help strategies you should consider asking for a referral to a suitable cognitive behaviour therapist and, again, it may be worthwhile asking the help-line for advice. In some cases, medication can be useful but, although not a last resort, I would certainly not consider medication until the person showed themselves to be resistant to self-help and professional cognitive behavioural intervention. I would be very interested to hear from any of you who have developed your own strategies for dealing with spontaneous panic.

What to Do if a Family Member Has an Anxiety Disorder

Copyright Notice
© Adapted from Sally Winston, D.Psy., The Anxiety and Stress Disorders Institute of Maryland, Towson, MD, 1992
Sally Winston, D.Psy
  1. Don’t make assumptions about what the affected person needs – ask them.
  2. Be predictable – don’t surprise them.
  3. Let the person with the disorder set the pace for recovery.
  4. Find something positive in every experience. If the affected person is only able to go partway to a particular goal, such as a movie theater or party, consider that an achievement rather than a failure.
  5. Don’t enable avoidance: negotiate with the person with panic disorder to take one step forward when he or she wants to avoid something.
  6. Don’t sacrifice your own life and build resentments.
  7. Don’t panic when the person with the disorder panics.
  8. Remember that it’s all right to be anxious yourself – it’s natural for you to be concerned and even worried about the person with the disorder.
  9. Be patient and accepting, but don’t settle for the affected person being permanently disabled.
  10. Say: “You can do it no matter how you feel. I am proud of you. Tell me what you need now. Breathe slow and low. Stay in the present. It’s not the place what’s bothering you, it’s the thought. I know that what you are feeling is painful, but it’s not dangerous. You are courageous.”

Don’t say: “Relax. Calm down. Don’t be anxious. Let’s see if you can do this (i.e., setting up a test for the affected person). You can fight this. What should we do next? Don’t be ridiculous. You have to stay. Don’t be a coward. Pull yourself together”.

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