If you have never had a panic attack, it’s difficult to grasp just how terrifying they are. While many people use the term "panic attack" to describe feeling very anxious, true panic attacks are far more intense – they're episodes of sheer terror. More terrifying still, by DSM-5 definition (the official diagnostic manual of psychiatry and psychology), they seem to strike out of nowhere, without an obvious trigger or danger present.
Due to the intense symptoms of panic attacks, people may believe they are having a heart attack, losing mental control, or experiencing a psychotic break. What makes panic attacks particularly insidious is how they often begin: subtle physical sensations – like a slight change in heart rhythm, a mild feeling of lightheadedness, or a minor tightness in the chest – are automatically misinterpreted as catastrophic signs of imminent disaster. This misinterpretation triggers the body's emergency response system, creating a cascade of intensifying physical symptoms that seem to confirm the initial fear.
For example, someone might notice their heart skip a beat (a normal occurrence), interpret this as a sign of an impending heart attack, become frightened, and experience increased heart rate and chest tightness as a result. These new sensations are then seen as "proof" that something is terribly wrong, creating a vicious cycle of escalating physical symptoms and catastrophic thoughts.
The Trap of Avoidance
When someone experiences a panic attack, their body's fight-or-flight response kicks into high gear, creating intense physical sensations like racing heart, shortness of breath, and dizziness. While these sensations are uncomfortable, they're not dangerous. However, our natural response to run from or avoid these feelings can create a problematic cycle, as follows:
1. Experience panic in a situation
2. Leave or avoid similar situations
3. Feel immediate relief
4. Learn that avoidance "works"
5. Become more likely to avoid in the future
6. Never learn that the situation is actually safe
7. Panic becomes more entrenched
“Safety Behaviors” Maintain Panic
Similar to avoidance, but active rather than avoidant, safety behaviors are actions people take to prevent or cope with panic attacks. While they might provide short-term relief, they ultimately maintain anxiety by preventing new learning. Here are some common examples:
- Always carrying anti-anxiety medication "just in case"
- Only going to certain places with a "safe person"
- Checking for exits when entering buildings
- Always sitting near the door in meetings
- Avoiding exercise because it causes similar physical sensations
- Constantly monitoring your heart rate or breathing
- Only driving on certain roads or at certain times
- Always keeping water nearby to prevent choking
- Avoiding caffeine or other substances that might trigger symptoms
Medication and The (Possible) Problems with Benzodiazepines
While benzodiazepines (like Xanax or Ativan) can provide rapid relief from panic symptoms, there is some disagreement as to whether they should be a first-line for treatment for panic disorder. The most crucial problem is that benzodiazepines may interfere with the natural learning and recovery process that's essential for overcoming panic disorder. When someone takes a benzodiazepine at the first sign of panic, they don't learn that they can cope with and survive the uncomfortable sensations. Additionally, having benzodiazepines available typically becomes a psychological crutch, with people feeling unable to face challenging situations without the medication on hand – transforming the medication itself into a safety behavior that maintains anxiety. While there are other concerns with these medications, including physical dependence, tolerance development, and withdrawal symptoms, it's their interference with learning and their role as a safety behavior that is most problematic for long-term panic treatment.
Selective Serotonin Reuptake Inhibitors (SSRIs) offer a different approach to medication treatment for panic disorder. Unlike benzodiazepines, SSRIs don't provide immediate relief from panic symptoms. However, this may actually be an advantage in treatment, as it means they don't reinforce the cycle of escape and avoidance that maintains panic. Please consult a qualified psychiatrist to determine the best course for you.
How Cognitive Behavioral Therapy (CBT) Helps
CBT is considered the gold standard treatment for panic disorder. Here's how it works:
1. Education
- Understanding the fight-or-flight response
- Learning that panic symptoms, while uncomfortable, are not dangerous
- Recognizing how avoidance maintains anxiety
2. Cognitive Restructuring
- Identifying and challenging catastrophic thoughts
- Developing more realistic interpretations of bodily sensations
- Building confidence in coping abilities
3. Exposure Work
- Gradually facing feared situations without safety behaviors
- Intentionally triggering panic symptoms (like rapid breathing or spinning) to learn they're manageable
- Staying in anxiety-provoking situations until anxiety naturally decreases
4. Lifestyle Changes
- Regular exercise to build tolerance for physical sensations
- Stress management techniques
- Healthy sleep habits
Recovery is Possible
While overcoming panic attacks takes courage and persistence, full recovery is absolutely possible. The key treatment for panic attacks is to work with a qualified mental health professional who can guide you through evidence-based techniques while providing support and encouragement along the way.
Remember that setbacks are a normal part of the recovery process. Each time you face your fears instead of avoiding them, you're building resilience and moving closer to freedom from panic.