What is a Panic Attack?
Panic attacks are both very common & very distressing. They are a fear response that becomes locked in to a self reinforcing cycle resulting in a spiral of fear that can be terrifying for sufferers. In this article we will explain what causes panic attacks & what you can do it about it.
Fear
Fear is a normal human response. We have evolved it because it helps us identify and respond to threats effectively, keeping us safe as individuals, and helping us survive as a species. When we perceive a threat (whether it is an objectively dangerous situation or not) our threat response kicks in and we experience fear.
But fear is more than just an emotion. Threat prompts our bodies to respond so that we can physically respond to the threat. If we think back to when our emotions evolved, threats were primarily physical. When in danger we usually needed to fight, or take flight, or that didn't work, freeze (play dead in hope that a predator got bored and left us alone).
If you're going to fight or run, then you need your muscles to respond with as much power as they can muster. That means breathing hard to take on oxygen and your heart pumping quickly to get blood to your muscles as fast as possible. You might recognise that as the experience of your heart pounding and hyperventilating during a panic attack. The physical sensations we experience during a panic attack are all related to our body's attempt to ready us to deal with the threat. It's normal to notice some or all of the following...
Pounding or racing heartbeat. As your body works to move blood to your larger muscles.
Struggling to breathe. Your body wants as much oxygen in your system as possible and so your breathing becomes shallow and rapid. This can make it feel like you are struggling to control your breath.
Pain in your chest. As your muscles work hard to breath hard while at the same time contracting to protect you from harm this can lead to pain in your chest.
Feeling faint, dizzy or light-headed. As your breathing becomes shallower and more rapid your body takes on more oxygen. This can paradoxically lead you to feel faint although you are unlikely to pass out from TOO MUCH oxygen.
Feeling very hot or very cold. As blood moves to power your muscles the temperature in different parts of your body will change.
Trembling or shaking. As your body is primed for fast movements, to manage the threat, they can twitch or shake. Fine muscle control is reduced in favour of larger muscle movement, because that's what you need in a fight.
Nausea (feeling sick). As blood moves to the larger muscles ready to fight or run, it moves away from digestion which can leave us feeling nauseous. Also, muscle tension in your abdomen and the presence of stress hormones may contribute to nausea while anxious.
Fear of fear
As we can see, both the feeling of fear/anxiety & many of the bodily experiences we have during a panic attack are normal responses to threat (real or imagined). So, if we feel under threat, it's normal for our body to respond this way. This wouldn't be such a problem were it not that, for many people, we learn to fear these experiences themselves.
For e.g., a classic example of a panic attack is for someone to believe they are having a heart attack. When this happens, they understandably feel afraid. Their body responds to this fear by increasing their heart rate and breathing which they interpret as 'proof' they are indeed having a heart attack. As you can imagine, as they go around that cycle a few times their bodily sensations & fear will increase, and they become locked into a cycle of spiralling panic.
In this example we can see that our bodily sensations themselves can become sources of fear. Even just the idea that something might happen can be enough to begin the cycle, as I become anxious about the possibility, and create a self-fulfilling prophecy. If I believe that my heart rate increasing means I'm having a heart attack, I might begin monitoring my physical sensations for any sign that these experiences are occurring. That hyperfocus can lead me to become anxious and quickly start the whole cycle off as my threat response increases my heart rate. Once begun, I might continue to hyper focus on my bodily sensations, generating more fear, and feeding the cycle that becomes a panic attack.
Of course, fear of having a heart attack is just one type of feared outcome. For some, simply the possibility of having a panic attack is enough. For others, the possibility that they may die, collapse, or faint, or even simply be publicly embarrassed is enough to drive the fear. In essence, it only matters that experience of bodily sensations, is connected to a sufficiently feared consequence. So that for e.g., a rapidly increasing heart rate (or other bodily experience connected to the threat response) comes to mean that the person will collapse, die, be embarrassed or otherwise reach an unacceptable outcome. The cycle is maintained by attempts to escape or avoid our own naturally occurring responses to threat leading, paradoxically, to them being activated.
In short...if you fear your body's threat response being activated, your body's threat response will be activated, creating a cycle.
How to break the cycle...
Now we know that it our fear of own body's response to fear that is driving our panic attack there are things we can do to break the cycle. The first is reminding ourselves that our experiences are normal & cannot harm us*.
*learning to recognise what is normal for us is important. If you are experiencing a new sensation, such as pain in the chest, for the first time, it is important to be checked by a medical professional.
Grounding.
When we notice our anxiety beginning to rise or when we are in the middle of a full-blown panic attack grounding can be a very helpful way to regain control of ourselves. Grounding is about bringing our attention back to what is happening in the present moment. That may seem strange, as you are well aware you are having a panic attack in the present moment, but actually a panic attack is about what we fear is going to happen in the future, not what is happening now. For e.g., we fear that we are going to collapse, die, be humiliated, etc, possibly in the near future, but that hasn't happened yet, which is why we are monitoring our physical sensations so closely, for fear that it might.
So, grounding is about coming back to the present moment. To acknowledge what is happening and separate that from what we fear might happen if our sensations continue.
1: Notice and label what you are experiencing. For e.g., I might notice that my heart rate is increasing and label it as a normal part of my threat response while reminding myself that I am safe in this moment.
It can be useful to note your sensations and do the same for each of them, reminding yourself that these are normal responses and are not dangerous to you.
Remember it is our fear that these physical sensations are dangerous that leads us into the panic cycle. Reminding ourselves that we can have this sensation, however unwanted it is, and that we will be safe in this moment is important in helping us step back and out of the cycle.
2: Widen my attention to include other aspects of my experience. Our minds will naturally hyper focus on those elements of our experience which we perceive as threatening but at any moment we can bring our attention to other aspects of our experience.
We can do this on purpose by naming and describing...
5 things we can see,
4 things we can feel,
3 things we can hear,
2 things we can smell
1 thing we can taste.
If you regularly experience panic attacks, it can be useful to have things to hand which help you do this, such as a favourite or comforting perfume on a handkerchief and a strong flavoured mint or sweat that you can focus on.
3: Slowing your breathing.
Bring your attention to your breath and breathe in for a count of 4. Hold for a moment and breathe out for a count of 4.
If a visual prompt helps, then you can try 'square breathing'. Trace your eyes around the sides of a window or door, breathing in for a count of 4 as you move across one side, then breathe out for a count of 4 as you move along the next side, and so on.
4: Let your thoughts come and go.
This is a mindfulness technique. It involves naming and labelling your thoughts as thoughts, not facts, as they come into your awareness. As we know, the mind is telling us our own bodily sensations are signs of danger. It is useful to notice and label these thoughts, and any other thoughts that come up in the moment, for what they are - thoughts.
Remember, we're just noticing the thoughts and recognising them for what they are. We're not criticising ourselves for having them (see point 5.).
5: Self compassion. Often, we are our harshest critics and will add to our own suffering by criticising ourselves for having the panic attack. Perhaps we worry that others are judging us in the same way. Reminding ourselves that this is normal, and common, and absolutely not our fault is important. We are suffering because we have a threat response system, that we did not choose, and which can overreact in the moment through no fault of our own.
Think about how you would respond to a friend or loved one experiencing the same thing. Would you criticise them, or call them weak? If you did, would you expect that to help, or make things worse? Most likely you would want to help them and try and support them by acknowledging their pain without blaming them and instead offering support. Responding to ourselves in the same way is important. You'll gain nothing from attacking yourself, but will benefit from speaking to yourself from a position of kindness and compassion.
I have included a video which puts together some of these techniques which you can watch below...
It will be useful to practice these techniques so that they are accessible to you when you need them but also because getting used to acknowledging what we are experiencing, in our minds, bodies and emotions, will help us reduce the fear we have of our own experience in the long-term helping us to reduce the likelihood of becoming caught up in the panic cycle at all.
Of course, it can be useful to get help to resolve your panic attacks. Approaches like CBT and ACT lead to excellent results for many people, often in a relatively short space of time. You can access support through your GP or, if you choose to access private help, ensure your therapist is appropriately accredited with an organisation such as the BABCP, to ensure appropriate training and competence.
Christian Hughes is a Psychotherapist, and former uniformed military mental health clinician, specialising in Acceptance and Commitment Therapy, Compassion Focused Therapy & CBT, with expertise in trauma & PTSD and a special interest in Moral Injury.
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