You think you are dying, or at least having a heart attack or stroke. You feel overwhelming fear, you’re dizzy, sweaty, nauseous. You hear a roaring in your ears, feel a pounding in your heart, tingling fingers or chest pains… This is how a panic attack feels. In a word, terrifying.
“All reason shuts down when you are having a panic attack,” says Johannesburg-based clinical psychologist Dr Colinda Linde. “Fear is largely processed in the primitive brain, which houses reflexes and our survival instinct. So panic is experienced at a ‘reflex’ level, and is actually a false activation of the survival or ‘fight/flight’ instinct.”
What causes it?
“There is a collection of factors that lead to some people developing panic,” says Dr Linde. “A sensitivity to anxiety may be genetic. Traumatic childhood experiences, an imbalance of the neurotransmitters dopamine and serotonin, as well as ongoing stress, can also contribute to your susceptibility. The problem usually starts in early adulthood, with women affected twice as often as men.”
For three people in 100, panic becomes a life-altering disorder. Frequent attacks, avoidance of places or situations that cause you anxiety, reluctance to leave home or agoraphobia (fear of going outdoors) are all telltale signs.
Can it be treated?
“Panic is a known entity and it is treatable,” says Dr Linde. “It is a learned fear of internal sensations, but that means you can unlearn the response and relearn how to cope when the symptoms arrive, seemingly out of the blue.”
Because panic often mimics a heart attack, you should see a doctor if you have a strange “turn,” to rule out medical problems. Once your condition has been identified, you are in a better position to cope.
The most effective treatment is a combination of antidepressant medication (the same chemical messengers are involved in panic and depression) and cognitive behaviour therapy (CBT), in which the therapist helps the person recreate the symptoms of an attack in a safe setting, gradually de-sensitising them to the physical sensations. Once they stop perceiving panic as the threat, the attacks diminish.
What to do when panic strikes
When you feel panic arise, try to keep moving. For example, if you push something heavy or walk briskly, you use large muscle groups, which helps to dissipate adrenaline. “You don’t want to stop and give in to the panic,” says Dr Linde, “because that fixes the place or experience as something to be avoided in the future, which perpetuates the problem. If you are in the car, drive slowly in the emergency lane, but don’t stop. It’s much harder to get back on the bike if you fall off and stay off, than if you get back on and cycle slowly. You don’t want to let the panic win.”
Where do you fall on the anxiety scale?
Test your level and learn ways to manage your daily stress:
Over the last fortnight, how often have you been bothered by the following problems?
For each item below, assign a score of:
0 if you have not experienced this symptom at all
1 if you have experienced this symptom on some days
2 if you have experienced this symptom on more than half the days, or
3 if you have experienced this symptom nearly every day.
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid, as if something awful might happen
Add your points from all seven items to get a total score.
Total score of 0 – 4: minimal
You are likely to experience some anxiety from time to time, but do not find it problematic in your daily life.
Total score of 5 – 9: mild
You are likely to worry and/or experience mild physical symptoms of anxiety. Intrusive thoughts may begin to become distracting, causing stress.
Take action
- Change your thoughts We all have moments when we increase or maintain our own worry by thinking unhelpful thoughts. Identify inaccurate, destructive thoughts and how they affect your feelings, emotions and behaviour.
- Practise self-care Good nutrition, sleep, and exercise are important to wellbeing, resilience and healthy stress management.
- Stay connected Social support is vital to managing stress. Maintain connections to family and friends.
- Do something – walk, listen to music, read a book or explore in your journal how you might address the stressors in your life.
Total score of 9 – 14: moderate
You may have an anxiety disorder that warrants further assessment. Chronic moderate anxiety can cause headaches, stomach upset, and tense muscles in the neck, back and shoulders.
Take action
- Take a deep breath Inhale to a count of 4, filling your belly first and then your chest, gently holding your breath to a count of 4, and slowly exhaling to a count of 4. Repeat several times.
- Practise mindfulness and acceptance It is normal to experience some degree of anxiety when stressors are unfamiliar, unpredictable, or imminent. Anxiety, in itself, feels bad, but is not inherently harmful and does pass. Think of it as a wave: allow it to come in, experience it, and ride it out.
- Challenge your thoughts Ask yourself: is this worry realistic? Is this likely to happen? What would be so bad about the worst possible outcome? Could I handle that?
- Practise positive coping statements For example, “Anxiety is just a feeling, like any other feeling.” This helps to build persistence and resilience.
Total score of 15 or more: severe
You may experience panic attacks that make work, relationships and everyday tasks difficult.
Take action
- Slow your breathing Diaphragmatic breathing, tai chi and yoga can reduce stress by encouraging the relaxation response.
- Learn skills Progressive muscle relaxation is a guided relaxation technique in which you tense and release different muscle groups in order to develop greater awareness and control over these bodily experiences. Biofeedback training involves heightening awareness of, and gaining greater control of, your physiological processes using instruments that measure heart rate variability (HRV), brainwaves (EEG), skin temperature/conductance and/or muscle tension. There are some great, affordable biofeedback Smartphone apps.
- Face your fears Avoidance of the causes of your anxiety can maintain it. Challenge yourself to face your fears and learn that the feared situation is not nearly as frightening or dangerous as it seems.
- Seek professional help. A clinical psychologist using cognitive behavioural therapy can help you to manage your anxious thoughts and feelings.
Source: Quiz supplied by the South African Depression and Anxiety Group (SADAG). Originally written by Dr. Deibler for DoctorOz.com