Panic attacks / Panic Disorder
Panic attacks are relatively common and can be a part of a variety of other psychological issues eg phobias. Panic disorder is simply fearing having a panic attack in the future. It is possible to experience panic attacks without a 'diagnosis' of Panic disorder being appropriate - this can sometimes be the case with asthma. Equally, simply "having panic attacks" may evolve over time into panic disorder.
Panic disorder is essentially a constant fear of future panic attacks that lasts for more than 1 month.
There is a probable link between the phase after using drugs (when neurones are highly activated) and the first panic attack. Prolonged stress probably has a similar effect.
The treatment approach should examine lifestyle issues, stress management, phobias and anxiety symptoms.
The trigger attack / panic response can be similar in nature to that found with phobias.
Hypnotherapy in combination with behavioral and cognitive techniques can break the stimulus response cycle.
What happens during a panic attack?
Panic attacks are associated with physical symptoms that include the following:
- Shaking / trembling
- Feeling that your heart is pounding or racing
- Chest pain
- Shortness of breath
- Feeling that you are choking
- Out-of-body feeling / sense of things not being real (Depersonalisation / derealisation)
- Tingling or numb feeling in your hands, or feet
- Chills or hot flushes
These symptoms are caused by an increase in stress combined with inappropriate breathing patterns ie hyperventilation. Hyperventilation in effect floods the body with oxygen which in turn generates physical sensations are are often perceived as being threatening, which in turn increases the stress response, which in turn tends to increase the rate of breathing and so on.
As the panic escalates a person may also have an extreme fear of losing control, of being observed and losing control, going "crazy" or dying during a panic attack. It is very rare for a person to have all of these symptoms at once. However, the presence of at least 4 symptoms and they developing abruptly and reaching a peak within 10 minutes strongly suggests that a person is experiencing panic attacks.
Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lungs, intestines or nervous system. The similarities between panic disorder and other diseases may add to the person's fear and anxiety during and after a panic attack. It is not uncommon for people to have reported to casualty departments several times as a result of misinterpreting panic attack symptoms with symptoms of serious physical illness.
Second by second the following tends to happen during the course of panic escalation:
- A stressful situation is encountered
- Adrenaline, noradrenaline and cortisol levels increase
- Rate of breathing increases
- Oxygen level increase and there is an increase in blood alkalinity
- This results in vaso-constriction (also an effect of cortisol)
- Vaso-constriction reduces higher cognitive functioning (the ability to logically reason reduces)
- Vaso-constriction also results in reduced ability to excrete CO2
- Multiple sensations are experienced
- Locus of focus is drawn to the sensations
- Stress levels increase as internal dialogue becomes negative
- The body is scanned to identify other symptoms of dis-ease
- Sensations are amplified psychologically
- Action is taken to get out of or escape the stressing situation
- The stressing situation becomes associated with the panic state
If the escape behaviour is not actioned the panic state tends to subside naturally in about 20 minutes. (This feature of the panic response is utilised at some level in most forms of therapy at one stage or another).
Given that the symptoms may in fact be due to some form of organic disease it is essential that all physical causes are eliminated before commencing any form of psychological treatment. If you think that you are experiencing panic attacks you should consult your GP in the first instance.
It is important that physiological causes for panic attacks have been eliminated by a GP or consultant. Physiological causes include some forms of epilepsy, mitral valve prolapse, hyperthyroidism and hypoglycemia.
When the panic attack response has become conditioned over time we begin to fear future occurences and become anxious in anticipation. This generates a negative self-fulfilling prophecy that can itself generate a panic attack. Panic attacks combined with anticipatory fear / anxiety is known as panic disorder. Agoraphobia may or may not be present.
Panic disorder is a common condition in which a person has episodes of intense fear or anxiety that occur suddenly (often without warning). These episodes - called panic attacks - can last from a few minutes to several hours. They may occur only once in a while, or they may occur really quite frequently. The cause, or "trigger," for these attacks may not be obvious or there may be a series of very specific triggers.
Just the fear of having a panic attack is often enough to trigger the symptoms. This is the primary basis for a condition known as agoraphobia. Those with agoraphobia find it difficult to leave home (or another safe area) because they are afraid of having a panic attack in public or not having an easy way to escape if the symptoms start.
Click here for the The Diagnostic & Statistical Manual of Mental Disorders definition of panic attacks and panic disorder.
Diagnostic and statistical manual criteria (DSM)
Click here for full research paper details
Research: Awake-Alert Hypnosis in the Treatment of Panic Disorder
American Journal of Clinical Hypnosis 47:4, April 2005 http://asch.net/membersonly/journals/ajch-47/iglesias2.pdf
Research: Self-hypnosis for anxiety associated with severe asthma: a case report
Ran D Anbar http://www.biomedcentral.com/1471-2431/3/7
Research: Rational self-directed hypnotherapy: a treatment for panic attacks.
Der DF, Lewington P. University of British Columbia.
Eye Movement Desensitization and Reprocessing in the Treatment of Panic Disorder With Agoraphobia
Clinical Case Studies, Vol. 6, No. 1, 44-63 (2007), Isabel Fernandez Italian Association for Cognitive Behaviour Therapy and Elisa Faretta H. Bernheim Italian Institute of Clinical Hypnosis and Psychotherapy