What happens to me during a panic attack?

When there is real danger, or when we believe there is danger, our bodies enter a fight/flight/freeze response.

If we become anxious in situations where there is no obvious danger, we may misinterpret our response as indicating there is something physically wrong with us (e.g., a heart attack).

Alternatively, we may know we are responding to a psychological stressor, and a fear of being out of control may worsen our experience.

Either option may lead to hyperventilation, a release of adrenaline, and blood being diverted to major muscle groups in preparation for fight/flight/freeze. As a result:

• Your thoughts may begin racing in an effort to evaluate potential danger

• Vision becomes more focused, again to look for danger

• Dry mouth and nausea may occur as your digestive system refocuses energy to major muscle groups in preparation for fight/flight

• Your heart may beat more quickly to increase blood flow to major muscle groups

• Your hands may become cold because of the blood flow diversion

• Muscles may become tense or shaky

• Taking in more oxygen than we need can lead to feeling dizzy or lightheaded

Panic attacks may take a while to build up, but they typically last about 10 minutes.

If you are in a situation that requires your full attention, such as driving, you should pull over until you recover. However, it is important to know that, although all of these physiological changes can be highly distressing, none of them are fatal.

Why do I have panic attacks?

People who regularly experience panic attacks are typically dealing with an underlying emotional difficulty that should be addressed in individual psychotherapy.

While many people have emotional problems to be worked through, people who have panic attacks may also be particularly attuned to small biological changes that most people are unaware of, for example slight changes in heart rates or breathing. You may notice a perfectly normal, almost imperceptible change that fills you with fear that it is the sign a panic attack starting or that something is very wrong with you.

Often times, people who have panic attacks tend to struggle with acknowledging their emotions. Emotions may be unconsciously repressed and only recognized when their physical signals are noticeable.

People who have panic attacks may also tend to engage in catastrophic thinking, meaning they automatically assume the worst-case scenario. They may also tend to engage in fortune telling – feeling sure they know what will happen based on previous experiences. They also may over-estimate the impact of a panic attack. This may lead to thoughts like:

• “My heart skipped a beat – this could be the first sign of a heart attack!"

• “If I do something that has made me panic in the past – I will definitely have a panic attack again. No doubt about it.”

• “If I have a panic attack – I will humiliate myself and everyone will lose respect for me” or “If I have a panic attack – I will definitely put myself in a dangerous situation and be seriously injured”

Why do I keep having panic attacks?

When we feel anxious or expect to feel anxious, we act in a way to control our anxiety.

One way we may do this is by avoiding situations where we might panic, such as:

• Situations where we have had panic attacks in the past

• Situations from which it is difficult to escape, or where it might be difficult to get help, such as public transport, shopping centers, driving in peak hour traffic

• Situations or activities that might result in similar sensations, such as physical activity, drinking coffee, having sex, emotional activities such getting angry

When we avoid situations we associate with panic attacks, we lose the opportunity to try a new coping skill, see ourselves succeed, and gain confidence in our ability to overcome panic attacks.

Obviously it's much easier said than done to put yourself in an anxiety-provoking situation. This is why people typically go to therapy to receive help and support in doing this hard work.

Another response to panic attacks may be to engage in safety behaviors, such as:

• Making sure we have an escape route in stressful situations

• Carrying anti-anxiety medication

• Seeking reassurance from others that we are safe

There is nothing fundamentally wrong with safety behaviors in the short-term, but they may lead to more anxiety if a circumstance arises where we do not have these behaviors available to us. The goal is to be able to use these behaviors on occasion, but not to be dependent on them.

So how do I overcome panic attacks?

The primary goal is to identify the underlying issue causing panic attacks and work through it.

In addition, we can focus on recognizing the initial signs that one is likely to occur. We then bring in changes to our thinking, behaviors, and lifestyle to support ourselves in managing panic attacks.

We can shift our thinking if we start to notice the signs before we enter a panicked mindset. For example, being able to say, "I can feel that I am anxious and that my body is starting to shift into panic mode. I've been here before and survived it. I know I can survive it again." Soothing yourself with reassuring thoughts, which are based in reality, can reduce your anxiety.

We can also focus on behavioral changes. These are particularly helpful if our thoughts are racing and it would be unrealistic to rely on logical thinking. For example, mindful breathing exercises can help prevent hyperventilation. Progressive muscle relaxation can help you feel more in control of your body and reduce anxiety. Distracting yourself with grounding exercises that draw your attention away from your body and to your external environment can help.

We also want to think about lifestyle changes to reduce your anxiety levels. We might want to evaluate job stress, eating habits, sleep quality, self-care activities, and, of course, the underlying emotional concerns causing your panic attacks.

This is difficult work. Feel free to reach out if you'd like to further discuss panic attacks and how to overcome them.