Panic attacks: Recognizing and managing panic attacks and preventing future attacks

When you are in a stressful situation, such as giving a presentation at work or being confronted by an angry driver on the road, your body responds in a physical way. You may notice your heart is beating quickly, you start to sweat or tremble, and your muscles tense. This is your body's autonomic nervous system, or "fight-or-flight" response, kicking into gear.

This response was a great survival technique for our ancestors when exposed to life-threatening situations — preparing them to flee from danger or fight off a threat. It can be useful for modern-day humans too, such as when you quickly swerve out of the way to avoid being hit by an oncoming car.

Unfortunately, this inherited stress response can be triggered without warning in susceptible people, causing a panic attack. Panic attacks cause overwhelming fear and challenging symptoms that are out of proportion to any actual threat or danger. Understanding the signs of a panic attack and learning coping strategies can help you manage a difficult episode.

What is a panic attack?

A panic attack is an episode where a person experiences a sudden wave of fear and anxiety, often in a situation where there is no real threat or danger. The incident can last anywhere from several minutes to an hour, and is usually accompanied by physical symptoms, such as sweating and a racing heartbeat.

If you suffer from panic attacks, this may be a sign of another mental health issue such as panic disorder. However, not all people who experience a panic attack will go on to develop panic disorder. Panic attacks can also occur in people with other mental health conditions such as depression, social anxiety disorder, and post-traumatic stress disorder.

Panic disorder

People with panic disorder suffer from recurrent panic attacks. Other features of panic disorder include persistent

• worry about future attacks
• fear of losing control
• concern the panic attacks will cause harm (such as triggering a heart attack).

Eventually this fear leads to changes in your everyday life. For example, you might avoid traveling or social events out of fear you will have another attack. These avoidant behaviors start to negatively impact your job, relationships, hobbies, and overall well-being.

Panic disorder is a common mental health condition that is estimated to affect nearly 5% of the US population.

Symptoms of panic attacks

Panic attacks occur suddenly and abruptly — you may feel only slightly anxious or even calm before it starts. The main symptom of a panic attack is an intense feeling of fear or discomfort. This feeling usually lasts for several minutes but subsides within an hour.

Panic attacks are also accompanied by physical signs and symptoms of anxiety. These include:

• rapid heart rate
• sweating
• trembling
• feeling short of breath
• chest pain or discomfort
• nausea or an upset stomach
• feeling dizzy or faint
• numbness or tingling sensations in the body
• feeling you are losing control
• feeling detached from your body or reality
• feeling like you might die.

What can trigger a panic attack?

Panic attacks can occur in the absence of any cause or trigger. As a result many panic attacks are unexpected, and you cannot always predict when they will occur.

In other cases, panic attacks may be triggered by external stressors. Someone with panic disorder may perceive these stressors as more serious than the actual threat they represent.

Examples of potential triggers include:

• social situations such as parties and meetings
• individual performances such as giving a speech
• situations, objects, or activities that cause fear or anxiety such as heights, airplanes, or needles
• traumatic events such as physical or emotional trauma
• reminders or memories of prior traumatic events.

In addition, certain activities and substances can stimulate the body in similar ways to actual acute stress and prime your fight-or-flight response, causing panic-like symptoms that can trigger a full-blown panic attack. Examples include:

• excessive intake of caffeine
• alcohol abuse and withdrawal
• intense physical exercise.

Treatment and preventing future panic attacks

If you think you are having panic attacks, seek evaluation with your doctor or a mental health professional. He or she will determine if you have an anxiety disorder such as panic disorder. Your doctor can also identify or rule out medical conditions, such as heart or thyroid problems, which could be causing or contributing to your symptoms. Treating underlying medical conditions such as a cardiac arrythmia or thyroid problem can sometimes eliminate the panic attacks.

Common treatment options for panic attacks, panic disorder, and other anxiety disorders include:

• Cognitive behavioral therapy (CBT). A form of psychotherapy, CBT teaches you coping behaviors that can be used before and during a panic attack. You'll learn to reframe your thoughts and implement behavior strategies that lessen the frequency and severity of panic attacks over time.
• Antidepressants. Even if you don't have depression, these medications can reduce the symptoms of anxiety. It can take several months to achieve their maximum benefit, but they can eventually help to prevent panic attacks.
• Anti-anxiety medications such as benzodiazepines. These medications can be taken during a panic attack to rapidly improve symptoms. They can also prevent panic attacks, and are often prescribed to be taken twice a day in people with panic disorder. Benzodiazepines can be habit-forming and should only be taken as prescribed by your doctor.

Research suggests that breathing exercises, meditation, light- or moderate-intensity exercise, and muscle relaxation techniques can help prevent panic attacks when practiced regularly. The workbook Mastery of Your Anxiety and Panic, by David H. Barlow and Michelle G. Craske, provides descriptions of practices that can help to reduce symptoms.

In addition, grounding techniques can help you to cope during an attack. Grounding techniques refer to strategies that help you stay present and attuned to your body. You gain a sense of control by focusing on the "here and now" rather than your negative emotions and symptoms. A few helpful techniques include:

• Practice deep breathing. Place your hand gently on your belly. Take a deep breath in through your nose and out through your mouth. Focus on breathing slowly and deeply, noticing your hand rising and falling with each breath.
• Redirect your focus. Concentrate on an object in your immediate environment or on another task in your head. Consider repeating a mantra to yourself or reciting the lyrics to your favorite song.
• Use guided imagery. Visualize a place you find safe, peaceful, and relaxing.