Panic Attacks, Part 2

If you missed Part 1, you can see it here: Panic Attacks, Part 1

If you have been told by your physician that your panic attacks are not the result of a biological condition, then you can concentrate on learning the skills needed to minimize your panic attacks. When psychologists first began working with panic attacks, our goal was to help you totally eliminate panic attacks. We eventually found this goal unworkable and unnecessary. The problem was that too much pressure existed to "never ever again have another panic attack." This level of perfect expectations would often backfire.

If you believed that you could never have another panic attack, the elephant in the room (your mind) was the thought that you just might have one. This germ of an idea would eventually grow into a fatal prediction that you, indeed, would have one. As you now know, this prediction would then bring on the panic attack. Psychologists have a different goal today: we teach people how to get to the place where they don’t care if they have a panic attack or not. This new attitude is more reasonable. It is possible because once you have the tools, then any panic attack will be short lived and under your control. In other words, it will merely be an inconvenience, not a terrifying experience.

So what do you need to do to bring your panic attacks under control? The first is to learn to activate your brain’s parasympathetic nervous system. You can do this by learning, practicing and mastering three simple skills: Natural Breathing, Muscle Relaxation, Mind Calming.

First, learn how to breathe properly (see Monday, October 6, 2008 post). When you are panicking, your breathing is shallow, fast and continuous. Learn to belly breathe by pushing out your stomach as you inhale; pull your stomach back in when you exhale. Then slow your breathing down by continuing to inhale and exhale as you spell the word "relax" at the rate of one letter per second. Finally, pause (stop breathing) momentarily after you exhale and before you take the next breathe. I call this type of breathing, Natural Breathing. This name is appropriate because this is the way that babies breath when they are born.

You also want to get rid of all the muscle tension that accompanies panic attacks. Learn to relax about 15 different muscles in your body by tensing a muscle for about ten seconds and then quickly releasing the tension and observing it for another ten seconds before tensing another muscle. This entire exercise should take between fifteen and twenty minutes. Do this slowly and observe the difference in feeling between a tense muscle and a relaxed muscle. Sometimes, relaxing a group of muscles results in a warm or tingling sensation. This indicates you are relaxing the muscle properly. Traditionally, people start with relaxing their feet, legs, stomach, back, shoulders, neck, and facial areas.

When you are finished relaxing your entire body, you want to practice calming your mind. Think of a pleasant scene (most people pick a peaceful water scene) and try to experience this as much as you can. The trick is to deal effectively with a wondering mind. You can do this by merely coming back to your chosen scene every time your mind wanders. This is often discouraging to beginners because our mind is supposed to "wander." You want to train your mind to focus on one topic for an extended period of time. This may take several weeks or months to become effective. Don’t be disheartened if the learning is slow because you will eventually be proficient. You only need to stay with this scene for a few minutes each time you practice Mind Calming.

The major mistake most people make in learning these three skills is to expect these skills to work with only minimal practice. When I teach these skills to my clients, they must practice Natural Breathing five times every hour while awake until it becomes automatic and easy. This usually takes place within a few days. They are expected to practice Muscle Relaxation four times a day. Mind Calming needs to be practiced about eight times a day.

The other skill you need to develop for your Panic Attack toolbox is to learn how to switch from worry to concern. The skills above are designed to activate your relaxation response in your body. Eliminating worry eliminates the panic attack trigger. You can learn this skill by reading our blogs on worry (there will be more to come) for checking out our book, The Worry Free Life.

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Panic Attacks, Part 1

Have you ever had a panic attack? If you have to ask, "What is a panic attack?" then the answer is "No." Panic attacks are terrifying and many people end up going to the local emergency room because they think they are having a heart attack.

The list of panic attack symptoms is long. Heart palpitations and sweating are very common. Sometimes people tell me their heart is pounding so loud they can't think. Others have described visual distortions like the floor or the sidewalk they are on is moving or waving. Some people find that the inability to swallow makes it seem like they are choking. Physicians are often told about dizziness, nausea or chest pains. Embarrassment can also occur because trembling or shaking may be visible to others. Other symptoms include feelings of heat or cold or tingling sensations. These are just a few of the more common symptoms.

Anyone who begins to experience panic attacks must immediately get a complete physical because certain diseases or physical conditions can also cause the above symptoms. A physical exam will try to rule out heart problems, asthma, hormonal problems, neurological disorders, anemia, withdrawal from alcohol or drugs, medication side effects, excessive caffeine intake or even some type of head injury. There are an entire host of other physical issues that can also contribute to panic attack symptoms.

If the physical exam eliminates all potential physical problems, the likelihood of a "pure" panic attack is highly probably. It is important to understand why your body has panic attacks. To experience a panic attack, one must have two preconditions: one is genetic and one is learned.

Panic attacks tend to run in families. This may sometimes be difficult to determine because the diagnosis is fairly recent – within the last several decades. Panic attacks cannot occur without a genetic predisposition for them. This is why it is often seen in relatives. Emily told me that she had a parent, an uncle and a sibling who had panic attacks. As she thought more about her more distant relatives, she realized that perhaps her grandmother and a great aunt may also have had panic attacks. The family thought them a bit odd, because they often refused to attend family functions or take vacations too far from home.

However, a predisposition to have panic attacks can only be set off by a learned condition called "worry." Worry is something we have to learn to do. Babies don't worry because their brains are not developed enough to do so. Many people have been taught how to worry by others when they were children. I know of no one who has read a book on how to worry and be miserable. By adolescence, worry can become a habit (although I have worked with some younger children who have already developed the habit). There are many types of worry, but only a specific one is associated with worry.

Panic attacks are triggered by making predictions about the future. The prediction takes the form of, "Something bad is going to happen to me and it will be a catastrophe." As this prediction repeats itself in a person's head, that person is getting set up for a panic attack (if they have the required biology).

Once the panic hits, the associated behavior is to escape and leave whatever situation the person is in. When a person leaves the environment of the panic attack, the symptoms will often subside. This is why many people think that situations, places or people "cause" the panic attack. Here, in California, many of my clients are afraid to drive on freeways because that is where they had their first panic attack (no wonder, with all the time we spend in our cars). Like Pavlov's dog, the freeway becomes the trigger that sets off the panic attack.

The environmental trigger is not what really causes the panic attack. Rather, the trigger sets the mental prediction in motion which then sets off the adrenaline overload which is the mechanism for having a panic attack.

In our next blog we will cover the strategies that need to be learned in order to conquer panic attacks. Have you ever had a panic attack? Did it match this description? What have you tried to help manage the panic attacks?

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