Problems that Usually Need Psychotherapy or Psychiatry Treatment

Panic Attacks

Panic attacks are episodes of very extreme anxiety that come on suddenly and can make a person feel as if they are having a nervous breakdown or a heart attack. In addition to severe anxiety, people may also experience symptoms such as stomach upset, dizziness, lightheadedness, numbness and tingling, ‘seeing stars’, and chest pains. A panic attack may cause a person to feel like they’re losing control of themselves, leading them to develop a fear of experiencing another panic attack in the future. An attack can last from a few minutes to several hours, although longer attacks are much rarer, during which time the person feels helpless and terrified. When they happen frequently the condition is called panic disorder.  If you suffer from panic disorder then professional help is usually warranted. A psychiatrist can help by prescribing medication, usually antidepressants, and psychotherapy can also help by addressing underlying anxieties and providing techniques to manage anxiety and panic attacks. Both of these in combination are often the best treatment.

Before you seek treatment, it can help to understand what happens during a panic attack. Most panic attacks are essentially anxiety attacks made more intense by hyperventilation (fast and deep breathing).  What happens is that anxiety causes your auto- nomic nervous system to go into ‘fight-or-flight mode’, which causes the release of the stress hormones cortisol and adrenalin. The adrenalin prepares your body for rapid and vigorous move- ment by pulling blood from your internal organs to your muscles, by making you sweat, and by increasing your heart rate and your rate of breathing.

The last one, increased rate of breathing, is the problem. People experiencing panic attacks are usually sitting still, so the extra oxygen you are getting is not being used, and not being converted to carbon dioxide. The resulting low level of carbon dioxide causes vasoconstriction (when the blood vessels constrict or squeeze together), and this reduces blood flow to the brain and causes dizziness, lightheadedness, and numbness and tingling. This process often makes people feel that they are not breathing properly, but they experience it as not getting enough oxygen and try to breathe even more, which makes it worse. The feeling of not being able to breathe causes the anxiety to escalate into terror, the frantic overbreathing can cause chest pains, and people may feel that they are having a heart attack or dying. They go to the hospital, tests are run, and they are told that they are physically fine.

When having a panic attack, it helps to remember a few things. First remind yourself that you are not in physical danger, and you are not having a heart attack. Second remind yourself that you are breathing too much, not too little, and slow your breathing down. If you can do this, then the physical symptoms such as dizziness will go away. People are often told to breathe into a paper bag, because this makes you rebreathe carbon dioxide instead of more oxygen, but the principle is the same: take in less oxygen temporarily so that your oxygen and carbon dioxide levels go back to normal.

You can actually test this out at home. Sit down and take several deep breaths, one right after another.  After a few, you will notice that you start to get a little bit dizzy. This is the very early stage of hyperventilation. Then slow your breathing down, or hold your breath, and you will notice that the dizziness goes away quickly. If you want, you can practice doing this at home, and you may be able to train yourself to slow your breathing down whenever you first feel dizziness. While this can help to control panic attacks, it does not address the underlying anxiety, and professional help is still recommended.  When Panic Attacks become so frequent that they lead to Panic Disorder, occasionally the sufferer will become so afraid of experiencing a panic attack outside of the home that their fear will prevent them from leaving their house. This is called agoraphobia, and it important that professional treatment is obtained so the sufferer can find some relief and lead a normal life.

Thomas B. Hollenbach, Ph.D.

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