Breaking The Panic Cycle

In this lesson, you will learn about when Dr. Zucker had a full-blown panic attack and why it did not become a problem.

You will learn:

• Why she was vulnerable to having a panic attack at that particular time

• Reasons why it did not become a recurring problem for her, given all of the knowledge she had about panic attacks and panic disorder

• How things could have gone very differently for her if she did not realize that she was having a panic attack

This lesson provides a real-world example of the importance of the material in this course. It demonstrates how some fundamental knowledge about panic attacks can go a long way for prevention.

In this lecture, students will learn why people have panic attacks in the first place and how their purpose is to help people deal with a stressor. Dr. Zucker will discuss why, for some people, panic attacks become more problematic.  She provides an overview of the behaviors, like avoidance, that make panic attacks more likely to occur. If you haven't seen a doctor recently, Dr. Zucker also talks about why it is important to get a medical check-up. If you struggle with panic, having that medical information can be used to help you overcome attacks.

What is a panic attack?

• A sudden rush of physical sensations, such as a racing heart, difficulty breathing, numbness and tingling, hot flushes, and maybe feelings of unreality

• Your body's response to stress

• It is an activation of the fight or flight response, which was designed to protect you.

• However, people often get panic attacks and don't know why or what it is. As a result, they might have scary thoughts about the body sensations they are experiencing and think something is wrong with their body (assuming they are dying, having a heart attack or stroke, losing their mind, losing control, or are about to faint).

People get repeated panic attacks when they do things that reinforce the belief that these panic attacks are dangerous or something to be feared. Examples:

• Having catastrophic thoughts about the attacks

In this lesson, Dr. Zucker reviews issues that could make you vulnerable to having a panic attack in the first place.

Factors that could cause panic attacks include:

• Biological

• Genetic

• Psychological

• Life stressors (including "happy" events, like getting married, having a baby, or being promoted)

People with repeated panic attacks tend to have high levels of a trait called anxiety sensitivity. People with high anxiety sensitivity misinterpret symptoms of anxiety as being dangerous. Anxiety sensitivity is an essential concept concerning panic attacks that you will learn more about it later in this course.

To understand more about your individual vulnerability to panic attacks, you can fill out The Panic Attack Vulnerability handout in the lesson. Understanding why you might be susceptible to panic attacks can be beneficial.

People who have recurring panic attacks tend to have two types of errors in their thinking surrounding the attacks:

• Catastrophizing: assuming that something awful is going to happen as a result of the attacks

• Probability overestimating: overestimating the probability that something terrible will happen

Panic attack negative thoughts make the attacks worse and more likely to occur.

Following this video, I have a series of short videos addressing how to manage common fears people have during panic attacks. Watch the ones that are most relevant to you. You can refer to the handout called Correction of Panic Attack Thinking Errors.

A fear of dying, having a heart attack, or having a stroke are very common fears among people with panic attacks.

• Remember that people do not die during panic attacks. You might feel like you are dying, but this is an activation of the fight or flight response that was biologically designed to protect you.

• The more you can dispel this fear, the less scared you will feel during an attack. Also, these attacks will likely occur less frequently and be less intense when they do occur.

Going to a doctor and talking to them about your fears is a great way to help you reduce these fears. You can ask them about your specific risks and how to tell the difference between a medical crisis and a panic attack.

Although a panic attack might feel like you are about to faint, what happens in your body is actually the opposite of fainting.

• When you faint, your blood pressure drops and you fall so blood can reach your brain.

• A panic attack is the activation of the fight or flight system. It gears you up to do something, not to collapse.

If you have fainted before and if it does feel similar to a panic attack, know that even though they might feel the same, it is extremely rare to faint during a panic attack.

Many people fear "losing their mind," "going crazy," or becoming psychotic.

• You might feel temporarily out of touch with things, and things around you might seem weird or unreal.

• However, a panic attack originates from anxiety, and psychosis might have anxiety as a component, but that is just one factor of many.

• Psychosis and anxiety are based in different parts of the brain and involve different neurotransmitters.

• These weird symptoms during a panic attack are due to your brain trying to protect itself during a time of high anxiety.

These strange feelings can sometimes be related to substances, such as marijuana. When using marijuana, some people experience this derealization as an effect of the drug, which can feel scary and trigger panic.

Some people feel like they will do something out of control when they have a panic attack because their body feels so out of control.

• When you are in a state of panic, you often are hyper-aware.

• Remind yourself that panic attacks are an activation of the fight or flight system.

• Panic attacks gear you up to take action in some way. If that action were some disorganized or out-of-control behavior, it would not make sense for the fight or flight response to have evolved in this way.

People with recurring panic attacks tend to have high levels of anxiety sensitivity.

• Anxiety sensitivity is the tendency to interpret anxiety symptoms as catastrophic or threatening in some way.

• Examples:

  • Worried that an increase in heart rate is a sign of an impending heart attack,

  • Afraid when your mind can't focus on something, you are going crazy.

People with panic attacks and high anxiety sensitivity tend to focus excessively on their body sensations.

• Symptoms become much more apparent when there is a focus on them.

• People with panic attacks might be unaware of their excessive body awareness.

• Too much body focus puts you in a state of being alert.

  • It's almost as if you are saying to yourself, "I need to monitor my body to keep myself safe."

  • You are telling yourself that these panic attacks are dangerous and that you must be on the lookout for them.

To address this issue of anxiety sensitivity and body monitoring:

1. Be aware of when you are being overly conscious of your body.

2. When you notice that you are paying too much attention to your body, you can say to yourself, "I don't need to pay attention to these sensations. Monitoring my body reinforces the symptoms and keeps me in the cycle of anxiety and panic."

3. Redirect your attention to something in your environment, such as looking at something in the room that you are in or something outside the window. You can feel the material of the fabric of the chair you are sitting on or the sounds around you.

Some people monitor their bodies in another way: a watch to monitor heart rate, a pulse oximeter to monitor oxygen, or a home blood pressure machine.

• If a doctor has not told you to monitor yourself and you are susceptible to panic attacks, consider not using these devices.

  • These devices reinforce your fear of panic attacks, keeping you in a heightened state of alertness.

• You can also ask yourself, "If someone did not have panic attacks and wasn't overly anxious about their body in that way, would they be doing this behavior?"

  • Ideally, you want to become someone who is not worried about having another panic attack, so it's important to start acting like that person!

Some may need more support by finding a therapist who practices interoceptive exposures.

• These are a series of exercises designed to bring on body sensations that are experienced during panic attacks.

• With repeated practice of these exercises, if these symptoms occur naturally, you will be less scared of them, making them less likely to cause fear and panic attacks.