How to Treat a Panic Attack?

STATISTICS AND SYMPTOMS 

The prevalence of panic attacks and panic disorders is unequivocally on the rise. According to the Anxiety and Depression Association of America (ADAA) and statistics gleaned from multiple government agencies and health authorities:

• Anxiety disorders are one of the most common mental illnesses in the US, affecting over 40 million people ages 18 and older. Approximately 18 percent of the population is affected annually.
• People suffering from anxiety disorders are up to five times more likely to go to the doctor and six times more likely to be hospitalized (for psychiatric disorders) when compared to the general population.
• Although anxiety disorders are treatable, only 37 percent of those affected receive treatment.
• PDs specifically affect between one and four percent of the general population.

Despite widely circulated misinformation regarding what constitutes a panic attack, clinical criteria includes an abrupt, intense onset of fear and discomfort that reaches peak intensity within four minutes, combined with at least four of the following physical and psychological indicators:

• Profuse sweating
• Accelerated heart-rate, palpitations, and pounding
• Chest pain, pressure, or discomfort
• Abdominal pain and nausea
• Sensations of choking or strangulation
• Uncharacteristic de-realization and de-personalization
• Chills or sweats
• Tingling/numbness (paresthesia)
• Trembling or shaking
• Paranoia and psychosis
• Disorientation
• Light-headedness
• Death fixation

Although most people experience anxiety in tandem with physical symptoms, such as an accelerated heart rate or gastrointestinal distress, panic attacks are differentiated from other anxiety symptoms and disorders by their suddenness, intensity, and duration. Due to this characteristic and debilitating intensity, people suffering from panic attacks and disorders are regular visitors to emergency rooms (ER), psychiatric facilities, and doctors’ offices. Contemporary treatment for panic attacks and panic disorders has improved significantly from former modalities and timeframes, which used to be only marginally effective and take months or even years to implement due to difficulty being properly diagnosed. Another factor which historically proved detrimental to treatment—and continues to pose a problem—is the stigmatization of mental health problems.  Due to this societal stigma and shame, many people fear telling others about their condition and consequently never seeking the help they so desperately need.        

TREATMENT MODALITIES

It is imperative for those suffering from chronic panic attacks to consult a physician about their symptoms during which time a comprehensive health history can be assessed. Depending upon the underlying cause—or causes—of the client’s panic attacks, the primary care physician may refer them to a psychiatrist or other mental health practitioner. In general, treatment for panic attacks (and panic disorder) involves a combination of appropriate psychotherapy and pharmacological intervention. One particularly popular therapeutic modality used in treating panic attacks is cognitive behavioral therapy (CBT)—an evidence-based method of challenging maladaptive patterns of thought, behavior, and reaction that is utilized with great success. Once clients learn healthier alternatives of cognitive processing, the frequency and intensity of their attacks begin to diminish and, even when they experience temporary setbacks, they are able to recover faster. 

Pharmacological interventions are considered a critical component of any treatment plan. The simple fact remains that many panic attacks and anxiety-related conditions are the result of innate chemical imbalances or the disrupted physiology that accompanies singular or polysubstance abuse. The following medications are deemed particularly effective:

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)—a class of medications primarily used to treat depression, SNRIs have also demonstrated evidence-based results for treating panic attack symptoms.
• Beta-blockers – a class of medications that help control anxiety-related symptoms such as rapid heartbeat.
• Selective serotonin reuptake inhibitors (SSRIs) – a class of medications primarily used to treat depression, but which can also be used to treat panic attacks and disorders.
• Benzodiazepines (Benzos) – a class of sedative medications that can help quickly de-escalate panic attack symptoms. However, benzos are extremely addictive and can quickly lead to dependence and resulting complications.

In addition to the aforementioned medications that require an authorized physician prescription, there are two specific methods which have proven helpful for those experiencing panic attacks. Learning these simple steps can work wonders by reducing, and in some cases, preventing the escalation of symptoms.

A.W.A.R.E.

This increasingly popular acronym for addressing panic attacks is an excellent place to start for those seeking an easy-to-navigate, cost-free method. All panic attacks eventually end, no matter what you do, but this method of dealing with a panic attack will make it more bearable than struggling or resisting it.  The following steps are an integral part of the process and can be effectively employed in a wide variety of situations:

• Acknowledge and Accept—this first step involves courageously admitting that you are afraid and beginning to panic. It also involves understanding that although you may not be in actual physical danger, the fear you are beginning to experience is very real.

• Wait and Watch—once panic symptoms begin, waiting is critical because it encourages non-reactivity and healthy detachment until appropriate action can be taken. One of the very worst things a panic victim can do is take immediate, fear-based action. Watching is an extension of this process and allows sufficient time for a panic victim to consider healthy, effective action in response such as writing their thoughts and feelings in a journal.

• Actions—at this point, specific actions can be utilized to great effect. For example, belly breathing, positive self-dialogue, strategic muscle tension release (some clients find yoga, tai chi, or meditation helpful), and a variety of other client-specific mind/body activities can be extremely effective in stopping the anxiety/fear cycle.

• Repeat—clients frequently find that after an initial panic attack subsides, they re-encounter the same feelings, although with less intensity. At this point, repeating the aforementioned steps can provide immediate and lasting relief.

• End—this final part of the process is dedicated to consciously remembering that all panic attacks, regardless of their frequency or severity, come to an end.

GROUNDING TECHNIQUES

Grounding is a very simple, effective modality that can be used when the paralyzing grip of anxiety takes hold.  It helps bring one back to the present moment, the only time and place where feelings of safety and emotional control reside.  One of the simplest grounding techniques is known as a countdown process. A simple, five-step process known as the 5-4-3-2-1 technique adheres to the following outline:

• Name five things that you see in your immediate surroundings, for example, a table, clouds, door, lamp, etc.

• Name four things that you can feel, for example, your hands resting on your lap, a cool breeze, the sensation of your feet on the floor.

• Name three things you can hear, for example, a barking dog, television channel, air conditioning noise, etc.

• Name two things you can smell, for example, food cooking, fresh cut grass, etc.

• Name one good thing about yourself, for example, you can say, “I am kind.”

MEMORY QUIZ

For many people, re-acclimating to the present moment when overcome with anxiety is easier when playing a memory game. This is accomplished by asking yourself—not externally, but within your own mind—questions with numerous possible answers. For example:

• How many state capitals can you name?
• Name as many words as you possibly can that start with the letter “c.”
• Starting with 100, count backwards by 3’s.

SQUARE BREATHING TECHNIQUE

Breath control can help decrease anxiety dramatically by calming the mind down.  When people are in the throes of anxiety, they either hold their breath or breathe too fast. Refocusing on the breath brings your attention back to the present. Practice this technique by drawing the shape of a square with your index finger in front of you, keeping your eyes fixated on the finger and doing the following actions for each side of the square:

• First side, breathe in (inhale) for three seconds
• Second side, hold your breath for one second
• Third side, breath out (exhale) for three seconds
• Fourth side, hold for one second

If you are suffering from anxiety, panic attacks, or panic disorder, never lose hope or feel that treatment isn’t possible. Emerging evidence proves that anxiety-related conditions are all highly treatable and respond well to early, aggressive intervention. Call a mental health practitioner or substance abuse professional today and begin the process of seeking the help you need. The quality of your future depends upon the decisions you make today!

Sources:

Pharmacy and Therapeutics. Current Diagnosis and Treatment of Panic Disorders. Jan, 2013.

Dialogues in Clinical Neuroscience. Treatment of anxiety disorders. June, 2017.

Frontiers in Psychiatry. Reducing the Symptomology of Panic Disorder: The Effects of a Yoga Program Alone and in Combination with Cognitive-Behavioral Therapy. Dec, 2014.

Frontiers in Psychiatry. The Bergen 4-Day Treatment for Panic Disorder: A Pilot Study. June, 2018.

International Journal of Neuropsychopharmacology. Evidence-based pharmacotherapy of panic disorder: an update. April, 2012.

JAMA. Panic Disorder. March, 2011.