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Panic attacks

Understanding panic, what causes it and what keeps it going

All of the panic symptoms described above are nothing more than an extreme form of fear. Fear is our body's natural response to a situation perceived as threatening. Fear can range from mild anxiety (which can be helpful when there is a goal, like passing an exam) through to full blown panic.

But why have fear at all when it's such an unpleasant feeling? In a way, it is a bit like pain. If you were to break your ankle, it would feel very painful, which would be a warning to you not to walk on it. If you heard a noise downstairs at night, you might feel frightened, which is a warning that you might have to deal with a dangerous situation. Fear is very useful. It prepares your body for action. This has been called the "fight or flight" response. So that when you feel fear, what is happening is that your body is preparing to fight or run away from the thing it feels threatened by, or possibly to stay completely still and wait for the threat to pass.

If we take the example of the noise downstairs. Say it is a burglar, as you fear. You may wish to stay absolutely still, so as to prevent the burglar from attacking you. You might want to go and challenge him or you might need to run away should he come after you. Your fear response would help with any of these. When you are frightened you breathe more quickly so that you can get lots of oxygen to your muscles. Your heart beats faster to pump the blood faster round your body. Your digestive system closes down to allow your body to concentrate on the more immediate threat. This is your body's normal healthy reaction to situations where your body feels under threat, it is your body's alarm system.

The problem with panic attacks is that usually they occur when there is no obvious physical threat there at all. Your body is reacting as thought it was about to be attacked when in reality it is not. In other words it is a false alarm. It is a bit like the annoying smoke detector which goes off at all the wrong times, because it is sensitive to small amounts of smoke. Or the burglar alarm that goes off because of the cat. Or even more annoying, the car alarm that is triggered by the wind. These are all alarms that can be triggered when there is in fact no danger. The same can be the case with your body's "alarm" system. Sometimes it can be triggered off when there is not real danger.

The problem is that our body's "alarm system" was designed many, many years ago, when the main threat was about survival. Now-a-days, it is rare that we are faced with the sort of life or death threats our ancestors faced. We have very different threats, mainly related to stress. Financial worries, overworking, moving house, divorce, to name but a few examples, can all be stressful, and can raise our anxiety levels to the point where our "alarm system" is triggered. It is a bit like a "stress" thermometer - which when it reaches a certain level results in panic. Whilst a panic attack may be unpleasant, it is not dangerous. Quite the opposite. It is a system designed to protect us not harm us.

SUMMARY: Understanding a Panic

Panic is a form of fear. It is our body's alarm system signalling threat. It prepares our body to fight or run away from danger. But as there is not physical danger it is a false alarm. A panic attack may be unpleasant but it is not dangerous.

What causes panic attacks to begin?

Panic attacks can start for a number of reasons.

• STRESS
  As mentioned, stressful events can cause anxiety to go up, which may lead to the alarm system being triggered. Are you aware of any stress in your life over the last few years? For example, work stress or being out of work, relationship problems, loss of a loved one, financial difficulties. Please list any stresses that you are aware of:
  
  
  
  
  
  
  If you feel you have had a lot of stress in your life recently, it might be useful to read the leaflet "Understanding and coping with stress".
• HEALTH WORRIES
  Panic attacks often begin when a person becomes over-concerned about their health. This can happen for various reasons. People with panic attacks sometimes have recently experienced the sudden death of someone they know or are close to. They then become very worried about their own health, and look for signs that they may be developing the same illness. They are often aware of medical 'mistakes' where serious illness has not been picked up, and so become worried that there is something seriously wrong. This leads to raised anxiety. The anxiety symptoms are then picked up as evidence of a serious illness, which can result in panic. Think back to when your panic attacks began. Do you know anyone who died suddenly, for example from a brain haemorrhage or an asthma or heart attack?
• OTHER HEALTH-RELATED REASONS
  Sometimes, panic attacks occur for the first time during a period of ill-health. For example some viruses can cause dizziness. Pregnancy or the menopause can cause changes in the way our body works that can lead to a first experience of panic. Consuming large amounts of caffeine, or low blood sugar can also lead to feelings of faintness. Can you think of any "health-related" reasons for your panic attacks?
• DIFFICULT EMOTIONS
  Panic attacks often begin when there are feelings from the past or present that are being "swept under the carpet". Maybe you have relationship problems, or something from the past you need to deal with?
• OUT OF THE BLUE
  Sometimes we just don't know why panic attacks begin. Some people even have their first panic attack when they are asleep! It may just be that certain people, in certain circumstances respond like the over-sensitive car alarm. Their alarm system is triggered when there is in fact no danger.

In some ways it is less important to know what causes panic attacks to begin and more important to know what keeps them going.

What Keeps Panic Attacks Going?

As you will remember panic affects your body, your thoughts and your behaviour. All three work together to keep panic going.

• Physical
  Firstly, the physical symptoms can be part of the problem. For people whose breathing is affected by anxiety, something called hyperventilation can occur. This is basically just taking in too much air and not breathing it out. This is not dangerous but can lead to feelings of dizziness.
• Thoughts
  Secondly, our mind combined with the physical symptoms, anxious thoughts form a vicious circle, that keeps panic attacks coming back again and again. Also, focusing your mind on your body can lead to noticing small changes and seeing this as a threat.
  People often find it hard to believe that our thoughts can produce such strong feelings as fear. But isn't it time that if we believe something 100% then we will feel exactly the same way as if it were true. For example, if you truly believed there was a burglar in the house, when there wasn't, you would be just as frightened as if there really was a burglar in the house.
• Behaviour
  Thirdly, how a person behaves before, during and following a panic attack has a big part to play in whether panic attacks keep happening.
  • AVOIDANCE - if situations are regularly avoided, then a fear of these situations well develop, and panic may be more likely to occur when that situation can't be avoided.
  • ESCAPE - if, once a person starts to panic, they escape from the situation, then they are more likely to keep panicking in that situation. They may also believe that if they hadn't escaped, something awful would have happened.
  • PREVENT - we looked earlier at some of the ways people try to prevent panic attacks by trying to make themselves more safe. Common safety behaviours include:

  

People who have panic attacks often worry that the physical symptoms mean something different than they do, examples of some of the most common mis-interpretations are:

Another way thoughts can affect panic, is when someone starts to worry that they are going to panic in situations where they have panicked before this, unfortunately, this makes it more likely to happen again.

Carrying a paper bag to breath into Sitting down to stop fainting Lying down to stop a heart attack Going outside to stop suffocating

Scanning your body for something being wrong Checking out where toilets are in public places Holding on to something to stop you collapsing Carrying tablets "just in case" Always having someone with you

The circle then becomes something like this:

 

SUMMARY: Understanding Panic

• Panic is nothing more than an extreme form of fear
• Fear is our body's way of coping with threat-preparing us to fight or run
• Panic attacks can begin for a number of reasons - stress - health worries - during a mild illness - because of difficult emotions - out of the blue
• Panic attacks are kept going because of the vicious circle of - physical symptoms - thoughts - behaviour
• By avoiding, escaping or preventing panic attacks, you may
  • never find out that nothing terrible was going to happen
  • may dread going back into the situation, because you fear another attack
  • loose confidence in your ability to cope alone

Accepting that panic cannot harm you

We have spent a lot of time looking at recognising and understanding panic, because this should give you all the information you need to be able to accept that panic attacks are not harmful. If you can do this then you have come a long way to being able to end your panic attacks.

To what extent, sitting here now do you believe that your panic attacks mean that something awful is going to happen (0-100%), for example, heart attack, stroke, fainting, choking, suffocating?

%

Next time you have a panic attack, can you rate at the time how much you believe something awful is going to happen?

%

SUMMARY: Panic attacks are not harmful

Next: recognising panic

• Brad Cheek: last updated Dec 2006
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