Deconstructing the Panic Attack; re-obtaining control

Every week I see new and older patients who are experiencing panic attacks.  When they occur, and especially when they are new, they are terrifying and frightening because the body is out of control and the brain goes into panic mode.  That panic mode actually is what causes more panic attacks so we have to understand what’s happening in the body to regain control.

First lets talk about the panic attack itself and what’s happening.  Many people who experience one get very frightened about this bodily reaction to stress and begin to think about what could be causing it.   In prehistoric times, the person who had the highest anxiety was often the person in a group most likely to survive.  The high alert of the anxious person made them the first one to spot danger and flee, so they would likely be at the front of the pack rather than vulnerable at the end of the pack.  Anxiety and a high alert sensitivity was a reaction that ensured our survival.  The trait was passed on and many of us have this heightened alert reaction.  That by itself would not be a bad thing, except for the fact that we live in a society that is very highly charged and busy.  We emphasize achievement far too much and never talk about the benefits of relaxation here.  We always praise people for what they’ve accomplished, never for how well they relax.  With this overemphasis on achievement, along with all the stimulation surrounding us, Americans barely leave their desks at work for a meal, sometimes don’t even take vacations, but for sure we become forgetful that such a thing as relaxation is important and necessary for our bodies.  Even though we know we don’t feel well without sleep, we sacrifice our sleep hours for more stimulation and achievement.  In some of the sleep studies with rats that have been done, all that was necessary to kill a rat was to deprive it of sleep for one month.  Humans can obviously survive with diminished sleep much longer,  closer to 5-6 months without sleep.   But we devalue how important sleep is and over-value accomplishments.

The combination of life stresses, lack of knowledge of how to relax, and overwhelming stimulation can eventually lead the body to rebel in a panic attack.  Panic attacks can include shortness of breath, crushing chest pain, shaking, sweating, dizziness, pounding heart, and many other physical symptoms.  The person experiencing one for the first time often feels they are having a heart attack or have other physical issues and often go to the ER on multiple occasions and their primary doctor.  Once all the medical tests come back clear, the diagnosis of panic attack is made.  If someone has already been in treatment with someone in the psychiatric profession, that diagnosis is made much easier and with less time and expense.   The primary treatment for panic disorder is an antidepressant medication.  These medications often completely control and prevent the reoccurrence of these attacks.  Working with a therapist is important to recognize the early signs and learn self calming skills to deal with them.

First and foremost, what you think when you’re having a panic attack is important.  If you allow your mind to run wild and react and think “I’m having a heart attack, I’m dying, I will have a car accident” or any other frightening reaction, that worsens the panic attack and their frequency.   The most important thing to do while experiencing these and waiting for the medication to help is to go somewhere you can be alone for a few minutes, or just sit down where you are and concentrate on slowing down your breathing. NO ONE HAS EVER DIED FROM A PANIC ATTACK AND PANIC ATTACKS ARE NOT FATAL.  The worst thing that can happen is that you might pass out from hyperventilating.  Your body is programmed to breathe.  No matter how you feel, you don’t stop breathing because you pass out.  So the most important thing is to tell yourself exactly this :  “I’m having a panic attack.  I will sit down and relax and try to calm my breathing and this will pass in a few moments.”

People often want to take sedatives to help when they’re experiencing panic attacks.  These don’t work that well for a few reasons.  One is that the panic attack itself usually subsides in a few minutes and the sedatives take 20-30 minutes to work.  So by the time they are working, the panic attack is already over. The sedatives can become overused, and people accidently become mentally and physically dependent on them, and that creates a new issue to be stressed over – how many pills you have and what happens when you run out?   Sedatives aren’t  really  helping the underlying problem, however they do help the person who is having panic attacks feel they have something which helps them feel more in control.  And feeling in control is important.

Now lets talk about your brain for a minute.  We have lots of emotional reactions in life and connections are formed in the brain from those memories.  Feelings can be triggered by those memories.  When you start fearing the next panic attack, that can actually contribute to it’s onset.  So connections in the brain and in our memories have to be retrained. This is part of what you’re learning about in therapy, how to calm yourself.  Talking to yourself rationally during the panic attack is a new skill you need to develop.  And changing the connections and memories can be achieved by incorporating calming techniques into your life.  In my opinion, one of the most important and dynamic you can retrain your brain and gain far more control over your thought processes is by practicing Mindfulness.  Mindfulness training can be learned by taking a full course (google “MBSR free”) or signing up for a class where it is taught.  You can buy and read books on Mindfulness Training, and you can easily go on YouTube and search Mindfulness and choose from a wide variety of techniques you can practice.  Yoga, Tai Chi, and meditation programs will also help you gain control over your thoughts and improve your self calming skills.  Practicing these skills for 30 minutes three times a week for six weeks actually causes helpful physical changes in your brain.  Practicing these skills and incorporating them into your routine is very important to your health.  The healthier your brain will be, the healthier your body and thus your life will be.  It doesn’t matter how you start, it’s just important to get started in learning how to self calm and improve your life quality.  And make the time to get a good night’s sleep!  Our brains need this to be healthy!

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Deconstructing the Panic Attack; re-obtaining control

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