Panic Attack

A panic attack is not just a mental or emotional occurrence, it is a physiological and biological symptom. Panic attacks can be described as the body's "fight or flight" response. This system protects us from danger, propelling us into action when faced with a threat. However, this response can be triggered during a panic attack without an external, life-threatening cause.

When an individual experiences a panic attack, their body undergoes several abrupt changes. Adrenaline, a hormone responsible for the fight-or-flight response, floods the system. This results in an increased heart rate, rapid breathing (hyperventilation), and a surge of energy. While useful in an actual threat scenario, these reactions can feel overwhelming and frightening when they occur out of context. The rapid intake of oxygen can cause dizziness or lightheadedness. The muscles may tense up, readying the body to flee or defend itself.

The amygdala, a small structure within the brain, plays a significant role in this process. This part of the brain is primarily responsible for processing emotions. When the amygdala perceives a threat, it sends out an alarm for the body to prepare for danger. Over time, with recurrent panic attacks, the brain might become more sensitive to triggers and may react to minor stressors or stimuli.

Panic attacks may cause the amygdala to misfire, sending the wrong signals when there isn’t an immediate danger. While they might feel like they're coming from nowhere, they result from a complex interaction between hormones, brain structures, and neural pathways, all responding to what they perceive as an imminent threat.

Panic attacks often share a common cluster of physical symptoms. Identifying these symptoms can be helpful, as understanding them can help you seek treatment.

The onset of a panic attack can be abrupt, and the intense fear or discomfort can peak within minutes. One of the most distinguishing features of a panic attack may be the feeling of impending doom or a sense that a person is losing control. These feelings can be accompanied by palpitations or chest pain, sometimes making individuals feel like they’re experiencing a heart attack. Fear of a heart attack or another medical emergency even leads some people to go to the hospital. Shortness of breath or a suffocating sensation can be a common symptom and may include trembling or shaking.

Physical symptoms often mirror the body's exaggerated fight-or-flight response. Individuals might experience sweating, chills, hot flashes, nausea, or stomach cramps. The sensation of being detached from oneself (depersonalization) or feeling that things are unreal (derealization) may also occur. 

Some describe feeling confined or trapped, leading to an intense desire to escape their situation. Dizziness and lightheadedness, including faintness, are also common. The culmination of these symptoms might result in fear or panic that something bad is about to happen.

Panic attacks last for a brief period, but they do vary in duration. While most might last up to 20 minutes, panic attack symptoms usually peak within 10 minutes. However, some episodes can be longer, and the emotional and physical aftereffects can leave an individual feeling drained or on edge for hours or days.

Recognizing these symptoms and understanding that they’re signs of a panic attack, not a more life-threatening condition, can be a positive step toward seeking help and managing future events. However, people may experience different symptoms, and looking for patterns or triggers specific to the individual is helpful. 

Like many other mental health conditions, panic attacks don’t always have a singular cause. Rather, they may arise from a complex interplay of biological, psychological, and environmental factors.

• Biological and genetic factors: Growing evidence suggests that some people may have a genetic predisposition to anxiety and panic attacks. This data doesn't mean there's a definitive "panic gene," but certain genetic profiles may increase susceptibility. Neurologically, alterations in certain parts of the brain, especially those responsible for the fight or flight responses, can predispose individuals to panic attacks. Imbalances in neurotransmitters, the chemical messengers in the brain, can play a role. For instance, alterations in serotonin levels have been linked to anxiety disorders.
• Psychological triggers: Individuals with a history of trauma or significant life stressors can be more vulnerable to experiencing panic attacks. Childhood adversities, such as physical or emotional abuse, can also increase the risk. Personal temperament and how one internalizes stress or handles pressure are also factors to consider. For some, a significant life change, like the death of a loved one or the loss of a job, can be the initial trigger for the onset of recurring panic attacks.
• Environmental factors: Certain environments or experiences can act as triggers for those predisposed to panic attacks. For example, individuals who've experienced a traumatic event in specific settings may later feel panic symptoms in similar scenarios if there's no immediate threat. Substance use, such as stimulants like caffeine or certain drugs, may also provoke panic attacks. Some medical conditions and medications are also known to trigger anxiety symptoms resembling panic attacks.

While these factors provide insights into potential causes, panic attacks can sometimes occur without an obvious trigger. However, understanding some of these underlying causes can be instrumental in developing targeted strategies for prevention and treatment.

A multifaceted approach often proves most effective when managing panic attacks. Acknowledging and understanding the condition can help, but adopting certain practices and therapeutic interventions can improve one's quality of life.

• Therapeutic interventions: Research indicates cognitive-behavioral therapy (CBT)² may be an effective method for treating panic attacks and panic disorder,³ which is an anxiety disorder that causes fear of future panic attacks. CBT can help individuals recognize and challenge the irrational fears and beliefs that trigger or contribute to panic attacks. Through this evidence-based approach, one learns how to react to the physical sensations of panic, gradually confronting and tolerating the feared situations to reduce their sensitivity over time. Apart from CBT, exposure therapy may also be beneficial when specific situations or places are triggers. In this approach, individuals are gradually exposed to the feared situation in a safe space until it becomes less intimidating.
• Breathing techniques: One common symptom during a panic attack is hyperventilation, which can exacerbate other symptoms like dizziness or a racing heart. Deep or controlled breathing can counteract these effects. Focusing on slow, deep breaths can help distract the mind from panic and deliver adequate oxygen to the brain, thus regulating the body's response.
• Grounding techniques: Grounding exercises can also help divert the mind away from the panic attack and connect the individual to the present. The "5-4-3-2-1" method can be a helpful technique. Here, the individual identifies five things they can see, four they can touch, three they can hear, two they can smell, and one they can taste. This method can bring attention to one's immediate surroundings and can distract from the overwhelming sensations you may experience.
• Self-care and lifestyle choices: Regular physical activity can reduce anxiety and prevent panic attacks. Activities like yoga and meditation are also known for their calming effects. Reducing or eliminating the intake of caffeine and certain medications can help decrease the occurrence in predisposed individuals. Eating nourishing meals, getting adequate sleep, and avoiding alcohol, nicotine, and sugar can also contribute to overall mental well-being.
• Medication: Medications can help reduce symptoms associated with panic attacks. The most commonly prescribed medications are SSRIs and SNRIs. Benzodiazepines may also be prescribed but are typically used on a short-term basis because they may become habit-forming and can cause dependence. Other anxiolytics and antidepressants may be used as well. Do not start, stop, or change medications without first consulting with your physician or other qualified healthcare professional.

While these coping techniques can be beneficial, it can help to remember that everyone has their own response to treatments. What works for one person might not work for another. It's often a process of trial and error. Guided by professional advice, you can determine the most effective coping strategies for your panic attacks.