Panic attacks are sudden episodes of fear that trigger intense physiological reactions in the body. They are ultimately produced by the build-up of stress hormones in the body (stress hormones are stimulants). The main stress hormones involved are adrenaline, noradrenaline, and cortisol. This is what gives us that feeling of anxiety. It is what makes us feel nervous and jittery. It is what causes our anxiety and our anxiety symptoms. The release of stress hormones into your blood stream can be triggered by a multitude of things (imagining worst case scenarios, drinking coffee, overreacting to things, fighting your symptoms, etc.)
During a panic attack you may experience the following:
- Shaking or Trembling
- Choking Sensations
- Shortness of Breath
- Going red in the face / Feeling Hot
- Heart palpitations or feeling like your heart skipped a beat
- Feelings of losing self-control
- Feelings of unreality
- Feeling like things around you are strange, or feeling detached from what is going on around you.
- Feeling like you may lose control
- Feeling as like you may go crazy
- Feeling like you might have a heart attack or die.
Making Sense of Panic Attacks
When a person is incredibly worried about things and feeling quite anxious, it may come as no surprise to them when they experience a panic attack. It may be easy for them to logically see how their worries and stress culminated in a panic attack. However, sometimes a person who experiences a panic attack may ask themselves later, “Where the hell did that come from?” To them it seems like this panic attack came out of nowhere or ‘out of the blue’ as many people describe. Because the panic attack seemingly came out of nowhere, the person struggles to make sense of it. “I wasn’t even feeling anxious”, or “I was feeling good”, they may tell themselves. Because there was no obvious trigger, they may not draw the connection between their anxiety and stress, and the panic attack.
This may leave the person feeling confused, and fearful of when the next panic attack may strike. It is essential to understand and make sense of panic attacks, and why they occur. If a person can not make sense out of them, they are likely to believe that they are random or that they are arising because there is something wrong with them. This will only add further anxiety and stress to the situation. This can often result in a person going back and forth to doctors for tests and assessments, only to be told time and time again that there is nothing physically wrong with them.
When a person understands the mechanics of anxiety then it helps to take the mystery out of the equation. Without this kind of understanding, it is likely the person will continue to live in fear of a recurring attack, and this fear is exactly what will fuel subsequent attacks. Anxiety thrives on fear, so therefore the last thing we want to do is to fuel the fear.
Physiology of Fear
When we are in a dangerous situation we will experience a stress response, often referred to as the fight or flight response. It may also be referred to as the fight, flight, freeze, and faint response or similar. These responses are ultimately there to prime us for survival. This may include:
- Transference of blood from vital organs and into the big muscle groups to help us fight or flee the situation.
- Increased heart rate allows blood to be circulated around the body more efficiently.
- Increase in the depth and rate of breathing helps to take in more oxygen whilst fleeing a situation, whilst maintaining the right oxygen/carbon dioxide balance.
- Increase in the production of stress hormones to help 'pump' us up and provide us with more strength and agility.
- An increase in sweating might make us more slippery for a predator to latch onto.
- Freezing in place may prevent us from being seen by a predator, or
- Perhaps the predator might assume we are dead, and lose interest.
- Losing control of bladder or bowel function may be deter a predator from eating you.
Anxiety is Your Friend, Not Your Enemy
Can you see that these sensations are there for a good reason? Imagine if we did not experience the fight or flight response. We wouldn’t survive very long, right? If you are experiencing anxiety and panic like symptoms then know that there is nothing wrong with you, your body is doing exactly what it is supposed to do.
The trap that many people fall into is interpreting these sensations and symptoms as signs of danger. People will often assume the worst and believe that there is something wrong with them. They tell themselves that they are losing control, going crazy, or that they might even die. This kind of catastrophising will only make matters worse. These behaviours will only fuel your anxiety further, making a subsequent panic attack more likely. The key is to see these sensations and symptoms for what they are and have an under reactive attitude towards them. Staying neutral and unafraid of anxiety and panic attacks is the best way to prevent them happening in the future.
Whilst these survival responses are there to keep us alive and arise when in real danger they can also arise when we simply perceive we are in danger. For example, we might imagine that a speech we are going to deliver will go badly or that we might get stuck under a gas truck on the way to work. Our brain perceives these imagined worst case scenarios as danger and subsequently sets off the fight or flight response. But it was a false alarm, we weren’t in any real danger, right? This is a big part of the reason why these apprehensive behaviours need to be addressed in therapy, as they may be causing you a significant amount of stress without realising it. In my experience most people are largely unaware of many of their behaviours that are contributing towards their anxiety and panic. This is why psychotherapy is so important. A trained therapist can identify these behaviours and help the client to change them. Without this kind of work, it is unlikely that the person will ever truly succeed in overcoming panic attacks.
Out of the Blue Panic Attacks
What is important to remember is that panic attacks can seemingly come out of nowhere and with no obvious trigger. However, there are reasons for these panic attacks occurring, it just might not be obvious to you why they did occur. This may lead you to becoming confused and believing there is something wrong with you. But rest assured that there is not.
Here are some reasons that your panic attack seemed to come ‘out of the blue’:
Your body has become overstimulated over the years because of the cumulative effects of chronic stress. You may feel like your stress level is about the same as usual, but your stress level may be higher than what you realise. In this state of overstimulation fight or flight responses can fire off involuntarily, resulting in panic attacks that seem to come out of nowhere.
It would be a good idea to take some time to list all the current stressors in your life (Environmental, Cognitive, Behavioural, Chemical, and Physical). Then actively try to reduce these stressors as much as possible. You may also want to introduce activities that have a calming effect on your nervous system such as walking, meditation, diaphragm breathing, or mindfulness, for example.
The autonomic nervous system (ANS), specifically the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS) works together in order to achieve an internal homeostatic environment. The sympathetic nervous system’s main role is to trigger the fight or flight/stress response. The parasympathetic nervous system’s main role is to promote rest and relaxation. When a stress response has ended the parasympathetic nervous system will help you to calm down from the stress response, bringing about a balanced internal state (homeostatic equilibrium). When one system (PNS/SNS) is activated, the other become suppressed. The problem is that many anxiety sufferers have learnt too many behaviours that engage the SNS and not enough behaviours that engage the PNS. The PNS does not have enough time to adequately promote the rest and relaxation response because of the fight or flight response constantly firing off. By making choices on that quell rather than stoke the anxiety fire, we gradually learn to change what is going on. Subsequently, we stop triggering off the fight or flight response so often, this then allows the PNS to promote rest and relaxation.
However, when the body is overstressed, the body must work even harder to bring about this rest response in order to bring the body back to its set point. If you experience a reasonable amount of stress from time to time, then the body does not have to work particularly hard to bring about this rest and relaxation. After a period of resting your body finds it’s homeostatic set point and you are then equipped to deal with further stress. But imagine for a moment that you keep piling on stress without giving the body ample time to recover. Things are going to go haywire, right? In this state the body can begin to fire off stress responses involuntarily. Therefore a panic attack could strike at any time, even though you may not feel particularly stressed or anxious at that time.
Fearing anxiety sensations and symptoms is the ultimate recipe for having further panic attacks. Anxiety and panic thrive on fear, so if we take the fear out of the equation then having panic attacks in the future becomes decreasingly likely.
Catastrophising is making a problem bigger than it needs to be. People will say "You're blowing things out of proportion", or "You're making a mountain out a molehill". The bigger we make the problem, the more stress and anxiety we create for ourselves. Therefore, we need to do the opposite, we need to under react and put it in perspective.
Because having a panic attack can be quite a visceral and scary experience by itself, people will often interpret it as catastrophic. They might tell themselves, “This is the worst thing ever!” Or they might ask themselves, “What if I am having a heart attack?” Catastrophising will trigger off more fight or flight responses and therefore you will experience more stress and more symptoms. Instead of throwing fuel onto the fire we want to let the fire fizzle out. We do this by using more self-reassuring language. “OK, I am aware that I am having a panic attack, but it’s alright. I will just continue doing what I am doing and ride it out until it ends. It’s no big deal I have done this before.” Can you see how with this response, you are less likely to make the situation worse compared with the first response?
Responding to Panic Attacks
Regardless, how the panic attack came about, we need to learn to underreact to these experiences. We do not want to start making a big deal out of them or fearing them because this will fuel our anxiety further and create more stress, more of what we don’t want. We also need not fear having panic attacks in the future because fear and stress is exactly what fuels panic attacks. Having an under reactive attitude towards anxiety symptoms and not caring about whether we have a panic attack or not takes the fear out of the equation. Consequently, we are less likely to experience them in the future, and if they do occur, we can use some of the above tips to put an end to them.
As you can see, when panic attacks happen, they always happen for a reason. They may appear to come out of nowhere or ‘out of the blue’, but there is always a reason for them even if they are unexpected. It is essential that we learn to understand the mechanics of anxiety and fear, and how panic attacks work. If we take the time to educate ourselves, we learn to manage our fear, stress, and responses to panic. Over time, panic attacks become a thing of the past.
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