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Panic Attack

A panic attack is a sudden occurrence of anxiety consisting of bodily symptoms and negative thoughts. The bodily symptoms can include breathlessness, sweating, heart pounding or racing, feeling faint, feeling hot, blurred vision, feeling unreal, tingling in parts of the body, nausea, an urge to empty one’s bladder or bowels, dizziness, and a dry mouth. In a panic attack at least four symptoms suddenly increase in intensity or occur within a 10 minute period. This time-frame differentiates a panic attack from other forms of anxiety that usually have a slower onset or rise time.

Panic attacks are associated with negative thoughts that usually represent very negative interpretations of symptoms or feelings. For example, during a panic attack the person might think that they are about to faint, collapse, have a seizure, stop breathing or have a heart attack or stroke. These thoughts are misinterpretations of bodily symptoms. Often the symptoms that are misinterpreted are caused by other emotions such as stress or normal bodily reactions such as feeling dizzy because of moving to suddenly.

Panic attacks are quite common and around 1 in 10 people will have one at some time in their life. However, some people go on to develop repeated attacks and fear of having them. When this happens and it interferes significantly with the person’s ability to function a condition called Panic Disorder may have developed.

Panic attacks can be caused by some medical conditions and it is therefore important to visit your doctor to rule-out the possibility that there is a medical cause for them. They can also be caused by taking drugs and by drinking too much caffeine and alcohol. It is sensible to avoid none-prescription drugs, reduce caffeine intake and alcohol use if you are suffering from panic attacks.

There are different types of panic attacks defined by the number of symptoms experienced and the situation in which they occur. An attack of less than 4 symptoms is called a limited-symptom attack: it just differs from a full-blown panic by having fewer symptoms. There may only be one or two prominent ones. There are also nocturnal panic attacks that tend to occur during sleep and the individual awakes in a state of anxiety. These attacks can be caused by changes in breathing patterns whilst asleep and some people with this suffer from a problem called sleep-apnoea. Your doctor will be able to explore this with you. When panic attacks occur in the context of exposure to feared situations or objects these are called cued panic attacks. Such attacks can occur in connection with phobias. For example a person with a phobia of mice can have a panic attack if they see a mouse. Some panic attacks are spontaneous and occur unexpectedly and out of the blue.

Panic Disorder

Panic disorder is a condition in which a person has one or more panic attacks that occur spontaneously and then they go on to have further panic attacks or intense fear of having future attacks. These attacks or the fear of having them becomes disruptive for the person’s normal life. In some cases avoidance of situations in which attacks might occur develops and this condition is called agoraphobia. Agoraphobic avoidance may be mild and involve one or two situations or more severe in which case people can become virtually house-bound.

In panic disorder misinterpretations of symptoms have taken hold and the person believes that they are fainting, collapsing, losing control, suffocating, losing their mind or having a heart attack during a panic. These misinterpretations give rise to the rapid rise in anxiety symptoms that are the nature of panic itself, so this is very much a vicious cycle of: anxiety • misinterpretation • greater anxiety.

Treatment

The best treatment for panic disorder is Cognitive Behaviour Therapy (CBT). In this treatment the therapist and patient work together to identify the vicious cycle of symptoms and misinterpretations and the behaviours that are keeping them going. Treatment focuses on challenging erroneous interpretations of symptoms and abandoning unhelpful behaviours such as avoidance. This is done gradually at an acceptable pace and treatment typically ranges from 10-14 sessions. Outcome studies have shown that following CBT approximately 80 per cent of patients become panic-free.

Drug treatments are also used to treat panic but these are not usually as effective as CBT. Some of the antidepressant drugs (e.g. tricyclic antidepressants) can be helpful and your doctor can advise you about the available treatment options.

Metacognitive Therapy for panic is not well developed at this time as this has not been a priority given the effectiveness of standard CBT. However, metacognitivetreatments might offer useful alternatives. In two pilot studies involving single cases a metacognitive technique called Attention Training significantly improved panic,and in a randomized controlled trial and a systematic case series Attention Training reduced health anxiety and worry about symptoms in patients prone to misinterpret their symptoms.

References

Cavanagh M & Franklin J (2000). Attention training and hypochondriasis:Preliminary results of a controlled treatment trial. Paper presented at the World Congress of Cognitive and Behavioral Therapy, Vancouver, Canada.

Clark DM, Salkovskis PM, Hackmann A, Middleton, H, Anastasiades P, & Gelder M(1994). A comparison of cognitive therapy, applied relaxation, and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759-769.

Clark, DM, Salkovskis PM, Hackmann A, Wells A, Ludgate J & Gelder M. (1999).Brief cognitive therapy for panic disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 67, 583-589.

Papageorgiou C & Wells A (2000). Effects of attention training on hypochondriasis: abrief case series. Psychological Medicine, 28, 193-200.

Taylor S (2000). Understanding and treating panic disorder: Cognitive-behavioural approaches. Chichester, UK: Wiley.

Wells A (1997). Cognitive Therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley. (Contains CBT treatment manual for panic for use by therapists).

Wells, A (1990). Panic disorder in association with relaxation induced anxiety: Anattention training approach to treatment. Behavior Therapy, 21, 273-280.

Wells, A. (1997). Attention Training: Effects on anxiety and beliefs in panic and social phobia. Clinical Psychology and Psychotherapy, 4, 226-232.