What panic attacks are
Panic attacks are intense episodes of fear or discomfort that come on suddenly and reach a peak of intensity within a few minutes. They can be accompanied by physical symptoms such as palpitations, sweating, trembling, a feeling of suffocation or dizziness.
In the history of diagnosis, the concept of the panic attack was initially described under various names and interpretations, and the current term was introduced in DSM-III in 1980. In DSM-5, the diagnostic criteria for panic disorder, a distinct condition, include the presence of a number of unexpected panic attacks and persistent worry or behavioral change in connection with those attacks.
The difference between panic attacks and anxiety lies in their intensity and their nature. While anxiety is a persistent state of unease or worry, panic attacks are sudden, intense episodes of fear.
Causes and risk factors for panic attacks
Although these attacks may seem to happen for no reason or to be brought on by unclear circumstances, there are a number of causes and risk factors that contribute to their occurrence. In what follows we set out to explore and analyze these aspects, offering a detailed view of the biological, genetic, psychological and environmental factors that can influence the onset and the intensity of panic attacks. Understanding these causes and risk factors is essential for identifying and managing the disorder effectively, which in turn leads to better treatment and a better quality of life for the people affected.
- Genetics: There is a genetic component to the predisposition toward panic attacks; people with family members who have experienced panic attacks are more likely to develop them as well.
- Stress: Major stressful situations, such as losing a job, the death of a loved one or other traumatic events, can act as triggers in people who are predisposed.
- Previous trauma: Traumatic experiences in the past, such as physical, sexual or emotional abuse, can increase the risk of developing panic attacks.
- Mental health disorders: People who suffer from other mental health disorders, such as generalized anxiety disorder or obsessive-compulsive disorder, may be more prone to experiencing panic attacks.
- Biological factors: Chemical imbalances in the brain, especially in the neurotransmitters serotonin and norepinephrine, can play a significant role in the onset of panic attacks.
- Substance use: Excessive intake of caffeine, nicotine or other stimulants can increase the risk of their occurrence.
- Medical conditions: Certain medical conditions, such as hyperthyroidism, heart disease or respiratory disorders, can be associated with the onset of panic attacks.
- Sensitivity to bodily sensations: People who are hypersensitive or who pay heightened attention to bodily sensations may be more likely to misread those sensations and to take them as signs of an imminent panic attack.
- Family history: A family history of anxiety disorders or of panic attacks can increase the risk of developing them.
- Personality type: Certain personality traits, such as a tendency toward perfectionism or an excessive need for control, can contribute to the onset of panic attacks.
The symptoms of panic attacks
Panic attacks are characterized by a series of intense symptoms that appear suddenly and reach a peak within a few minutes. These symptoms can vary from person to person and may include the following:
- Palpitations or a racing heartbeat: The person may feel that their heart is pounding or beating irregularly.
- Excessive sweating: Heavy sweating may be noticed, even in the absence of intense physical effort.
- Trembling or a sensation of shaking: The person may feel that they are shaking or may show visible tremors in the hands or the legs.
- A feeling of suffocation or shortness of breath: The person may feel that they cannot breathe properly or that there is not enough air.
- Chest discomfort or pain: At times the symptoms may be experienced as pain or pressure in the chest area.
- Numbness or tingling: Sensations of numbness or tingling may appear in various parts of the body, such as the hands or the face.
- A choking sensation: The person may feel that they are choking, even though there is no physical obstruction.
- Dizziness or a feeling of faintness: Sensations of dizziness or vertigo may appear, and at times the person may feel that they are about to faint.
- Feelings of losing control: The person may feel that they are losing control or that they are about to “go mad”.
- Intense fear of imminent death: An overwhelming feeling of fear or anxiety may accompany the panic attack, and the person may feel that they are going to die or lose control completely.
It is worth noting that not all of these symptoms have to be present for an episode to count as a panic attack, and their intensity and combination can vary from one person to another.
Diagnosis
The diagnosis of panic attacks is based on the patient's medical history, on the assessment of the symptoms and on the diagnostic criteria set out by medical organizations, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11). In general, the following aspects are taken into account when diagnosing a panic attack:
- Symptom assessment: The doctor or mental health specialist will look into the symptoms reported by the patient and the way they affect daily life. It is important that the symptoms were present in at least two previous panic attacks.
- Ruling out other medical conditions: At times the symptoms experienced can be similar to those of other medical conditions, such as heart conditions or thyroid disorders, so the doctor may request additional tests in order to rule them out.
- Medical and family history: The doctor may ask about the patient's medical and family history in order to identify any risk factors or genetic predispositions to panic attacks.
- Duration and frequency of the symptoms: The symptoms must have persisted for at least one month and must have had a significant impact on the patient's life.
- Assessment of the impact on daily life: It will be considered whether the symptoms affect the patient's daily activities, such as work, interpersonal relationships or leisure.
- Ruling out other disorders: The doctor will assess whether the symptoms may be better explained by other anxiety disorders or by other psychiatric conditions.
- QEEG (Quantitative Electroencephalography) Brain Mapping is an advanced neurophysiological diagnostic technique that uses electroencephalography (EEG) to measure and analyze the electrical activity of the brain. In the context of panic attacks, QEEG Brain Mapping can be useful in identifying abnormalities in the brain activity associated with this disorder.
Through QEEG Brain Mapping, the electrical signals produced by the brain are recorded and analyzed at rest and, at times, during provocation with specific stimuli that can trigger panic attacks. This process makes it possible to identify patterns or anomalies in brain activity that could be associated with anxiety disorders, including panic attacks.
Using QEEG Brain Mapping in the diagnosis of panic attacks has several advantages:
- Objectivity: QEEG provides objective data about brain activity, largely removing subjectivity from the diagnostic process.
- Identifying specific patterns: QEEG analysis can reveal abnormal patterns or distinctive features in the brain activity associated with panic attacks, which can support an accurate diagnosis and appropriate treatment.
- Personalizing the treatment: Identifying specific patterns in brain activity makes it possible to tailor the treatment to each individual, taking into account each person's neurophysiological particularities.
Diagnosing a panic attack can be complex and requires a detailed, comprehensive assessment of the symptoms and of the patient's medical and personal context. That is why it is important to seek the help of a mental health specialist for a correct assessment and diagnosis.
Treatment options for panic attacks
Treating panic attacks is an important concern in the field of mental health, because these intense episodes of fear can have a significant impact on a person's quality of life. In addressing these disorders there is a wide range of treatment options available, from psychological and complementary therapies to medication and innovative technologies. In what follows we will explore a number of treatment options for panic attacks, highlighting the benefits and the applicability of each one and placing special emphasis on noninvasive therapies, which can complement and improve the effectiveness of conventional treatment while offering long-term benefits.
- Cognitive behavioral therapy (CBT): CBT is an effective form of therapy that focuses on identifying and changing the negative thoughts and behaviors associated with panic attacks. This therapy helps patients learn anxiety management techniques and acquire skills for coping with these attacks and reducing how often they occur.
- Breathing and relaxation exercises: Breathing and relaxation techniques, such as diaphragmatic breathing and mindfulness meditation, can be learned and applied on your own or within therapy.
- Neurofeedback therapy: Neurofeedback is a noninvasive technique that involves monitoring brain activity and delivering real-time feedback to help patients regulate that activity effectively. In the case of panic attacks, neurofeedback therapy can help regulate the abnormal patterns of brain activity associated with the disorder, offering an approach that complements conventional therapy and medication.
- Medication: Certain medicines, such as serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or benzodiazepines, may be prescribed to help manage severe anxiety symptoms and to reduce the frequency and intensity of panic attacks. Even so, it is important to discuss with your doctor the benefits and the risks associated with the use of medication and to monitor side effects closely.
- A healthy lifestyle: Adopting a healthy lifestyle, which includes a balanced diet, regular exercise, adequate sleep and stress management, can have a positive impact on mental health and can help reduce the frequency and the severity of panic attacks.
- Social support and group therapy: Taking part in group therapy or joining social support networks can give patients the chance to share their experiences, to receive support and to learn anxiety management strategies from other patients or from professionals in the field.
- Acupuncture and other complementary therapies: Certain alternative or complementary therapies, such as acupuncture, yoga, massage and herbal therapy, have been associated with reduced anxiety and stress and can be built into the treatment plan of people with panic attacks, with the doctor's agreement.
- Education and self-knowledge: A deeper understanding of panic attacks and of the factors that can trigger them can be helpful in managing them and in reducing how often they occur. Education and self-knowledge can be gained through reading and through taking part in seminars, support groups or online resources dedicated to anxiety and panic disorders.
The treatment options for panic attacks are varied and can be tailored to the individual needs and preferences of each patient. From psychological therapies and innovative technologies, such as neurofeedback therapy, to the use of medication and complementary therapies, there are multiple ways to manage and reduce the symptoms associated with this disorder. Certain medicines prescribed for the treatment of panic attacks, such as serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or benzodiazepines, can cause unpleasant side effects such as drowsiness, nausea, dizziness, insomnia, changes in appetite or weight gain. It is important to communicate openly with mental health professionals and to monitor closely any adverse reactions or changes in health during treatment for panic attacks. Adjustments can often be made in order to minimize side effects and to make sure that the treatment is as effective and as well tolerated as possible.
By adopting an integrated approach and by encouraging noninvasive treatments, it is possible to obtain better long-term results, which in turn helps improve the quality of life and the general well-being of patients affected by panic attacks, without the trouble caused by adverse effects.
First aid during a panic attack
When someone is going through a panic attack, offering first aid can be especially useful in helping them cope with and get through that difficult moment. Here are a few techniques and strategies you can use in such situations:
- Keep a calm attitude: It is important to stay calm and to convey relaxing, reassuring energy to the person having the panic attack. Avoid showing your worry or becoming agitated, because that can amplify the anxiety of the person affected.
- Provide a safe environment: Help the person move to a quiet, safe place, away from stimuli that could trigger or worsen the panic attack. If possible, take them to a quiet, comfortable space, away from crowds or loud noise.
- Encourage deep, controlled breathing: Help the person practice deep, controlled breathing, focusing on slow, regular inhalations and exhalations. You can try telling them to breathe in slowly through the nose, count to four and then breathe out slowly through the mouth.
- Be empathetic: Show your support and empathy toward the person affected. You can use encouraging, empathetic statements such as: “I am sorry you are going through this, I am here for you and I will help you get through it” or “Breathe slowly and deeply, you are safe and this attack will pass”.
- Help them focus their attention: You can try to steer their attention toward something that draws them away from the anxiety and fear they feel during the panic attack. You can ask them to count backward from 100 in threes or to focus on describing an object in the room in detail.
- Be patient and encourage them to express their feelings: Listen carefully and without judgment to what the person affected has to say about their experience and encourage them to express their feelings and fears in a safe, supportive environment.
- Reassure them that the attack will pass and that it is temporary: Offer reassurance that the panic attack is temporary and that it will pass soon. It can help to remind them that they have been through such moments before and that they managed to get past them.
- Help set up an action plan for future situations: Once the panic attack is over, talk with the person affected about the ways in which they can prepare for and cope better with similar situations in the future. It can help to identify together stress management techniques and relaxation strategies that give them a sense of control and safety.
If you are the one going through a panic attack, it is important to have at hand a few techniques you can use to regulate your anxiety and calm yourself down. Here are some useful techniques you can try:
- Deep, controlled breathing: Focus on your breathing and try to breathe slowly and deeply. Breathe in through the nose for four seconds, hold the air for four seconds and then breathe out slowly through the mouth for four seconds. Repeat this cycle a few times until you feel the anxiety starting to subside.
- Use the 5-4-3-2-1 senses technique: This technique involves focusing your attention on your senses and on your surroundings in order to reconnect with the present and lower your anxiety. Start by identifying five things you can see around you, then four things you can touch, three sounds you can hear, two things you can smell and one thing you can taste. This technique helps you move away from anxious thoughts and focus your attention on the sensations of the present moment.
- Use positive affirmations: Think of a few positive affirmations or mantras that make you feel safe and at peace. Repeat them in your mind or even out loud in order to encourage a state of well-being and calm.
- Practice mindfulness: Focus on the present and on your sensations in this very moment. Notice the sensations in your body, your breathing and your surroundings, without judging or trying to change anything. Practicing mindfulness can help you lower your anxiety and regain your emotional balance.
- Ground yourself with a soothing object or activity: If you have an object or an activity that relaxes and calms you, such as a stress ball, a smooth stone or coloring, use it to help you get through the panic attack.
These techniques can be useful in managing a panic attack and in quickly regaining emotional balance. It is important to experiment and see which of them work best for you and to build them into a personalized anxiety management plan. If panic attacks persist or become frequent, do not hesitate to ask for professional help from a therapist or a doctor specialized in mental health.
Complications associated with panic disorders
The complications associated with panic disorders can be divided into two categories: physiological complications and psychological complications.
Physiological complications:
- Cardiovascular conditions: Panic attacks can lead to a rise in heart rate and blood pressure, which can increase the risk of cardiovascular conditions such as high blood pressure, ischemic heart disease and arrhythmias.
- Gastrointestinal problems: People with panic disorders may show gastrointestinal symptoms such as abdominal pain, nausea, diarrhea or constipation, which can be worsened or triggered by the stress associated with panic attacks.
- Respiratory problems: Panic attacks can lead to a feeling of suffocation or shortness of breath, which can cause further panic and can worsen respiratory symptoms in people with pre-existing conditions such as asthma.
- Sleep disturbances: People with panic disorders may have difficulty falling asleep or staying asleep because of anxiety and restless thoughts, which can lead to poor sleep quality and to a general state of fatigue and irritability.
Psychological complications:
- Depression: Panic disorders can be associated with an increased risk of developing depression, because chronic stress and the inability to cope with anxiety can have a negative effect on a person's mood and emotional functioning.
- Co-occurring anxiety disorders: People with panic disorders often also present other anxiety disorders, such as generalized anxiety disorder (GAD), social anxiety disorder or obsessive-compulsive disorder (OCD), which can make their management and treatment even more complicated.
- Social isolation: Because of intense anxiety and the avoidance of situations that can trigger panic attacks, the people affected may end up isolating themselves socially and avoiding social interaction, which can lead to the loss of social ties and to feelings of loneliness and isolation.
- Reduced quality of life: Panic disorders can have a negative effect on a person's quality of life, limiting their ability to take part in social, professional or recreational activities and to enjoy life in general.
It is important that people affected by panic disorders receive appropriate help and support in order to manage the symptoms and prevent the complications associated with this disorder. An integrated treatment plan, which may include psychological therapy, medication and other stress management techniques, can be beneficial in managing and controlling the symptoms and in preventing long-term complications.
Preventing panic attacks
Preventing panic attacks can be a complex process and involves addressing the risk factors and managing stress and anxiety effectively. Here are a few strategies that can help prevent panic attacks:
- Learn about panic attacks: Understanding the signs and symptoms associated with panic attacks can help prevent them. Knowing the triggers and the way the body and the mind react during a panic attack can give you a sense of control and confidence.
- Manage stress: Lowering the level of stress in your life can help prevent panic attacks. Identify your sources of stress and find ways to cope with them, for example by practicing relaxation techniques such as meditation, yoga or deep breathing.
- Keep a healthy lifestyle: Adopting a healthy lifestyle, which includes a balanced diet, regular exercise and adequate sleep, can help maintain emotional balance and lower the risk of panic attacks.
- Avoid excessive use of stimulants: Certain substances, such as caffeine, alcohol and illegal drugs, can worsen anxiety and increase the risk of panic attacks. Try to cut down on or avoid the use of these substances in order to protect your mental health.
- Deal with negative thoughts: Negative and catastrophic thoughts can amplify anxiety and can trigger panic attacks. Learn to spot and challenge irrational or exaggerated thoughts and to replace them with realistic, balanced ones.
- Be prepared for stressful situations: Develop stress management strategies and techniques that you can use during stressful or challenging situations. These may include deep breathing, meditation, positive visualization or progressive muscle relaxation techniques.
- Seek professional help: If you are dealing with frequent or severe panic attacks, do not hesitate to ask for professional help from a therapist or a doctor specialized in mental health. Cognitive behavioral therapy (CBT) and other forms of therapy can be effective in teaching anxiety management techniques and in preventing panic attacks.
By putting these strategies into practice and actively addressing the risk factors, you can reduce the chances of experiencing panic attacks and improve your quality of life in general.
Are you dealing with panic attacks? Get in touch!
At the Brain Map Neuroscience Institute we use a revolutionary Neurofeedback technology based on brain science, which helps you fight anxiety and get rid of panic attacks, so that you can improve your quality of life. The whole procedure is painless and causes no side effects. It involves no electrical stimuli and no other dangerous, ineffective procedures. If you or someone dear to you suffers from anxiety, there are solutions for treating it for good with brain training therapy. If you have further questions about the procedure or you want to find out whether it is right for you, book now a free 15-minute consultation with one of our specialists 👇
References:
- Kim, H.-G. et al. (2021) Management of panic disorder with neurofeedback in patients with muscular dystrophy: A case report, Alpha psychiatry. Available online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9590642/ .
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