Psychological Conditions

Panic Disorder (PD)

Panic attacks are actually quite common. Panic Disorder (PD) occurs when attacks have become frequent, when they interfere with functioning, and when fear of having another panic has become a problem in and of itself for more than one month. Typical panic symptoms include palpitations, flushing, tingling in the extremities, dry mouth, light-headedness, and fear of loosing control or going “crazy.” Panic symptoms may seem to “come out of the blue” or be more expected. Often, the frequency and severity of attacks waxes and wanes in a confusing manner. People with Panic Disorder develop anticipatory anxiety and often get into a habit of avoiding situations and places that they believe puts them at risk for having another attack. This is called fear of fear. A severe kind of social withdrawal called agoraphobia may emerge. Depression is also common as a co-occurring feature. There may also be a tendency to self-medicate that only makes matters worse. Those with PD also seek out “safety signals” like sitting on the aisle of a row of seats at a movie theater or become hyper-aware and anxiously scan their environments for problems. Unfortunately, the relief that avoidance behaviors bring feeds into the problem by a process of negative reinforcement.

A number of medical conditions exist that can mimic Panic Disorder. Therefore, it is important that these conditions be ruled out as part of the diagnostic process. There has been a lot of speculation about what causes panic attacks. Both biological and psychological theories have been well researched. Overall, perhaps the most helpful way to conceptualize PD is to use the concept of a “false alarm.” There is a part of our nervous system that is designed to deal with perceived threats. This, essentially, involves the “fight or flight” response. This physiological mechanism has been wired into human beings since caveman days and is designed to protect us. In our modern world many individuals have “fight or flight” responses that mistakenly get triggered. However, the body reacts as if it was faced with real danger. All of the symptoms and behaviors involved in a panic attack would be useful and make sense if the danger was real. The person having a sudden Panic Attack understandably cannot make sense of what is happening to them and usually will do just about anything to escape the awful thoughts and feelings they are experiencing. Panic Attacks are very frightening until a person really has developed the necessary knowledge and skills to cope effectively. People strive to avoid re-experiencing Panic Attacks, sometimes regardless of the costs to their education, career, or relationships.

When a person develops PD, they often become hypersensitive to their regular and involuntary bodily functions. Changes in body temperature, breathing, heartbeat or other sensations are usually misinterpreted as a sign of an imminent panic attack. Therefore people will carefully “monitor” these functions, becoming overly sensitive. This hyper-awareness combined with cognitive errors (e.g. “I am sweating therefore I am having a heart attack.”) generates a physiological reaction triggering a Panic Attack.

Luckily, Panic Disorder is very treatable. The key is early and effective intervention. For many, a combination of Cognitive-Behavior Therapy (CBT) and medications will provide the best results. CBT for this condition involves becoming as educated as possible about the false alarm model. The next step is to eliminate backfiring avoidance behaviors and safety signals and gradually learn to remain in uncomfortable situations. Developing the skills to tolerate uncomfortable but benign physiological changes and interpret them more rationally (e.g. “I’m not going crazy, I’m just dizzy.”) is essential for success.

The next step includes practice in bringing on the very symptoms that have been so distressing. The idea is that a person can learn to think about these symptoms in a less upsetting way and learn how not to react to, or become “desensitized,” to erroneous “fight or flight” activations. Some treatment protocols involve teaching relaxation exercises as well.

The evidence is that Panic Disorder, although very discomforting, can greatly improve with timely and systematic treatment.

Tip: Re-label the Panic attack as a “false alarm.” See how long you can stay in the uncomfortable state. Practice this regularly and there is a good chance that you will begin to make progress.