Our latest Mental Health 101 explores panic. We look at the link between anxiety and panic and how CBT can help people break their panic cycle.
A panic attack is a short period of extremely intense anxiety, characterised by several unpleasant strong physical reactions and a fear that something catastrophic will happen as a result. Although panic attacks tend to subside within 30 minutes they can leave a lasting impact: fear of more panic attacks can lead people to limit what they do or where they go (commonly referred to as Agoraphobia).
Panic attacks tend to happen out of the blue, but can also be triggered by specific situations; for instance, enduring a plane ride if you’re phobic of flying, having a near miss in a car, or even feeling overwhelmed with excitement after getting good news.
Although everyone’s experience of panic will be unique, there are some common features that underpin all attacks: misinterpreting harmless symptoms of anxiety as dangerous and responding to those symptoms in a way that exacerbates them.
When we’re confronted with something that makes us anxious, our brain triggers the release of adrenaline and kick-starts the fight-or-flight response. This response, which helped keep our distant ancestors safe from predators, causes a host of reactions in our body, all designed to help us take flight (run away) or fight the danger. Our heart rate increases to pump blood to our limbs, digestion and salivation are paused, and our breathing becomes shallow to increase blood oxygen levels.
Numerous other bodily responses kick in, all designed to help us survive. And this happens so fast that our brain doesn’t stop to consider whether the danger is real. Most of us can relate to the experience of having a dry mouth before an important presentation or feeling butterflies in advance of a job interview - these are fight or flight symptoms, even though these situations aren’t dangerous.
In a panic attack, the first sign of trouble is usually experiencing this fight or flight response as tangible bodily sensations. These include palpitations, sweating, trembling or shaking, feeling short of breath, choking, chest pain, nausea, derealisation and feeling dizzy or faint. In panic, any of these innocuous symptoms are misinterpreted as imminently dangerous. For instance, palpitations can be misconstrued as a heart attack, dizziness as a stroke and derealisation as a sign of losing control.
Of course, believing that these physical sensations are a sign of imminent danger within your body, leads to high levels of anxiety. And of course, this anxiety feeds back, increasing the strength of the symptoms and adding more conviction to the idea that something is seriously wrong. Which leads to more anxiety and therefore more physical symptoms. A vicious cycle ensues, as symptoms, misinterpretations and anxiety all fuel each other and, as it builds up, it becomes a full-blown panic attack.
One thing our bodies are good at is self-regulation. Without intervening, our bodies would naturally bring our heart rate back to a resting state and regulate our breathing, and the rest of the fight or flight symptoms would also calm down. But in the midst of a panic attack, people forget that they can trust their body to do this, and they tend to overcompensate. A classic example of this is someone misinterpreting their shallow breathing as a sign of suffocation and taking huge gulps of air. This hyperventilation disturbs their body’s natural equilibrium, feeding the stress response and causing more fight-or-flight symptoms.
It’s also common for people to take drastic action to escape or prevent their worst fears from coming true. Imagine someone who’s convinced they’re having a heart attack - they might lie down until their heart rate resumes to normal. And someone who thinks they’ll pass out on a busy train due to lack of oxygen makes a sharp exit to get fresh air. The problem with these responses is that people don’t find out what would happen if they stayed in the situation, so next time they experience similar symptoms, they make the same catastrophic misinterpretations of them.
The thing is, people don’t pass out, die, or go crazy because of panic attacks – but the deliberate strategies people engage in to try to keep themselves safe will often be unintentionally unhelpful, and may maintain or exacerbate the anxiety problem. Essentially the response to the problem feeds the problem.
Even for people who intellectually know that anxiety isn’t dangerous, it hard be hard to hold onto this knowledge in the midst of a panic attack - the rational and emotional parts of the brain are on different pages. But the key message is that anxiety is not dangerous and, although a panic attack is extremely frightening and uncomfortable, it can’t do any lasting harm. The physical sensations inherent in a panic attack are actually a sign that your body is working as it is designed to.
Cognitive behavioural therapy (CBT) is a very effective approach to treating panic. It helps people break their panic cycle through learning to accept the symptoms of anxiety and to find alternatives to the catastrophic misinterpretations.
Our Tackling Panic series takes a CBT approach to panic, helping users to understand their own panic cycle and take steps to break it. To find out more about this series, or others in our suite of Series on anxiety disorders, click here.