ANXIETY DISORDERS

Panic Disorder

According to the Institute of Mental Health, 1 in 5 people have gone through or will go through a panic attack in their lifetime. If you’ve ever been through one, you’d be familiar with the extremely uncomfortable feeling of a sudden surge of helplessness, tightness in your chest, and laboured breathing. Fortunately, most of us only experience this once, but an individual with panic disorder might experience it a few times a month, or even a few times a day!

What is a Panic Attack?

Panic attacks are surges in intense fear or discomfort, speedily reaching peak intensity within a couple of minutes. Some of the following symptoms are present in a panic attack.

Ψ Palpitations, pounding heart, accelerated heart rate 
Ψ Sweating
Ψ Trembling or shaking
Ψ Sensations of shortness of breath or smothering 
Ψ Feelings of choking
Ψ Chest pain or discomfort
Ψ Nausea or abdominal distress
Ψ Feeling dizzy, unsteady, light-headed, or faint
Ψ Chills or heat sensations
Ψ Paresthesia (numbness or tingling sensations) 
Ψ Fear of losing control or “going crazy”
Ψ Fear of dying
Ψ Derealization (feelings of unreality) or depersonalization (being detached from one-self)

Panic attacks often induce worry because it reflects presence of a life-threatening illness. The strong symptoms are eerily similar to that of heart attacks, and many individuals end up in the emergency room as they fear they are having one and are about to die. Panic attacks also cause much social concern for the individual as they fear judgment from others because of the paralyzing effects some of the symptoms have. Maladaptive behaviour occurs in response to avoid these symptoms and consequences as an attempt to control the situation.

What is Panic Disorder?

Individuals with Panic Disorder experience more than 1 unexpected full-blown panic attack that are not better explained by medical conditions or substances. This is accompanied by at least a month of persistent worry about subsequent panic attacks and their consequences. They also demonstrate significant maladaptive changes in their behaviour to avoid such panic attacks from occurring, such as avoiding large crowds or avoiding exercise. The frequency of these attacks vary, from short bursts (daily) with long breaks without any attacks, to moderately frequent (once a week), or even low frequency attacks (once a month) over many years.

What causes Panic Disorder?

Like many other disorders, there is no single contributing cause for panic disorders. Genetics is associated with one’s vulnerability to developing panic disorder, although it is still unknown whether there is a specific gene that is implicated. There is also an increased risk for panic disorder among children of parents with anxiety, depressive and bipolar disorders.

Apart from biological factors, individuals with high neuroticism and sensitivity to anxiety are at risk for onset of panic attacks, as they are prone to experiencing these negative emotions and predisposed to believe these symptoms of anxiety are harmful. Environmental factors such as childhood sexual or physical abuse are also seen amongst cases of panic disorder. Interpersonal stressors, physical well-being stressors, negative experiences with illicit drugs, and grief also increases the risk of panic attacks and panic disorder.  

Can Panic Disorder be Addressed?

Fortunately, panic disorder responds well to various forms of management, especially if there is early intervention. Management plans can come in the form of psychotherapy or medication, and combination of both often leads to improved management outcomes!

Many therapy modalities, such as Cognitive Behavioral Therapy, Interoceptive Exposure, and Acceptance and Commitment Therapy have been shown to be effective in addressing panic disorder.  

Panic Control Treatment

Ψ This is a type of Cognitive Behavioral Therapy that involves a management plan that greatly improves panic disorder. Individuals go through psychoeducation about anxiety and panic, and are taught to practice controlled breathing and restructure some of the maladaptive automatic thoughts that they have regarding panic. Exposure to feared situations are also done to build up tolerance in the individual to the discomfort of panic.  

 Interoceptive Exposure

Ψ Unlike Graded Exposure (gradually introducing feared stimuli to an individual with a phobia), interoceptive exposure deliberately exposes individuals with panic disorder to feared internal sensations. This is done by having these individuals engage in various exercises that bring on the internal sensations of a panic attack and sticking with the sensations until they subside in order to habituate to them. Evidence shows that it has been effective in the management of panic disorder.  

Acceptance and Commitment Therapy

Ψ ACT creates an open, nonjudgmental stance towards the feelings and sensations in the body at the moment and recognizing them for what they are. The key ideas in ACT for anxiety and panic uses the concept of psychological flexibility to teach acceptance of anxiety, distinguishing the self from symptoms of anxiety and panic and acting in the individual’s valued directions.

How do I support someone who is having a panic attack?  

Ψ STAY CALM. Prevent the situation from getting worse for the person going through the panic attack by reducing the amount of stress experienced. 
Ψ Ask if they are taking any medication for the panic attack. If they are, offer it to them and ask them what they need.
Ψ Do not make any assumptions and speak to them in short, simple sentences.
Ψ Slow down their breathing by counting slowly from 1 to 10.
Ψ Offer encouragement! Say encouraging things like “you can get through this”, “I am proud of you”.

Remember, the most important point is not to panic as your panic will only make things feel worse to them, so stay calm!