Panic Attacks and How to Treat Them
The fear and avoidance they inspire can be seriously impairing
“Panic attack” is a term that has come to be used very loosely for an anxious reaction. “You hear a lot of people say things like, ‘When I’m around dogs I have a panic attack,’” says Dr. Jerry Bubrick. “Most likely what they mean is they get panicky, but they’re not having a real panic attack.”
A real panic attack is when you experience sudden, intense physical symptoms — racing heart, sweating, shaking, dizziness, shortness of breath, nausea — and you interpret them to mean something is terribly wrong. People often believe they’re dying. Or “going crazy.”
“All of a sudden, you have this explosion of physical symptoms that are really uncomfortable,” explains Dr. Bubrick, a clinical psychologist at the Child Mind Institute. “A lot of times, people think that they’re having a heart attack and they go to the emergency room.”
Andrea Petersen describes having a panic attack at 20, on an “ordinary morning” when she was a sophomore in college registering for classes. “All of a sudden my heart rate kicked up, I was short of breath, and the words I was reading started to morph, to dip and buckle,” she recalls. “I was gripped with this overwhelming terror. I felt like I was going to die. Something in my body or brain had gone horribly wrong.”
Ambushed by panic
What you’re experiencing in a panic attack is your body’s alarm system — which is wired to prepare you physically to handle an emergency — going off without a real threat. Panic attacks usually peak at 10 minutes and abate by about a half hour. But some people report ongoing symptoms.
Petersen, whose memoir On Edge: A Journey Through Anxiety, chronicles her experience, as well as the latest research on anxiety, spent a month on her parents’ couch, immobilized by intense physical sensations as well as overwhelming terror and dread. “I think of it as a month-long panic attack,” she says. “Yes there were peaks and valleys. But it was a full-body and consuming experience, and incredibly disabling. And, it turns out, not actually that unusual.”
Often, as with Petersen’s experience, a panic attack happens out of the blue, and you have no clue what triggered it. Clinicians call those unexpected panic attacks.
But people who’ve had panic attacks often associate them with places or situations where they’ve occurred, and anticipate with mounting anxiety having another attack in that situation. That makes them prone to what clinicians call expected panic attacks.
A panic attack develops into something called panic disorder when a person worries so much about having another attack that she begins to avoid places or situations that she associates with them.
Not everyone who has a single panic attack goes on to develop a full-blown disorder. Some have the experience but dismiss it as an uncomfortable aberration that they hope won’t happen again. But in someone who is predisposed to anxiety disorders, Dr. Bubrick notes, the pathway in the brain that assesses for threats may be hyperactive. Avoiding another attack becomes an overriding priority.
For Petersen, whose panic disorder wasn’t diagnosed for a year, “My world just got smaller and smaller. If I was in the line at the coffee shop, and I felt panicky, I wouldn’t go to the coffee shop again. I stopped going to movies. I stopped going to parties. I stopped doing pretty much anything besides going to the couple of classes I was able to take — I had to drop half my courses — and my room in the sorority house.”
Panic plus agoraphobia
Because part of the experience of a panic attack is an intense need to flee, people who’ve had them often avoid situations where it would be difficult to get away if an attack occurred, such as cars, trains, planes, crowds. This avoidance of places deemed difficult to escape is agoraphobia.
“Agoraphobia just means the fear of not being able to escape a situation in case you have a panic attack,” says Dr. Bubrick. That often includes enclosed spaces. “People will say, ‘You know what, it’s fine. I just won’t cross a bridge, ever. I won’t go on a plane. I don’t need to fly anywhere,’” he adds. But it could also be at a baseball game with friends who wouldn’t take kindly to having to leave in the fifth inning. Or at the theater, or a movie.
Petersen, a Wall Street Journal contributing writer who is an ambitious traveler despite her anxiety, notes that even now she doesn’t drive on the highway, after a “terrible” panic attack driving between San Diego and Los Angeles.
People with panic disorder also can develop intense fear of the physical sensations associated with panic — like an elevated heart rate, sweating, shortness of breath — even when they’re not in the context of a panic attack. That might lead them to avoid exercise because they interpret those physical sensations as dangerous, even though they’re actually signs of a healthy, strenuous workout.
“You can imagine a lot of people then don’t go to the gym,” Dr. Bubrick notes. “People don’t want to be in situations where it’s hot, because that might trigger them, or in situations where they think they’re going to have that physical distress like on a rollercoaster or an airplane. “
While young children can have fearful or panicy episodes, true panic disorder doesn’t appear until the teen years. Panic attacks can also develop as a feature of another kind of anxiety, like social anxiety with panic attacks, or specific phobia with panic attacks.
Treatment for panic disorder
Research shows that the most successful treatment for panic disorder is a combination of antidepressant medication and cognitive behavioral therapy (CBT). Many clinicians recommend CBT as the first-line treatment, with medication added if necessary to make the patient comfortable enough to participate in CBT.
In treating someone who has panic disorder with CBT, the clinician starts by working with the patient to think more flexibly about his anxiety. Rather than viewing the physical symptoms as dangerous, he practices tolerating them, knowing that they aren’t harmful.
To help the person disconnect the negative feelings associated with attacks, the therapist induces those physical sensations — the patient does jumping jacks or stair climbing to get the heart racing, spinning to get dizzy, breathing through a coffee straw to get shortness of breath. “We’re exposing you to the actual, physical feelings of a panic attack, one symptom at a time,” Dr. Bubrick explains.
Then, instead of simply tolerating the anxiety and waiting for it to subside, the person is taught how to do deep breathing techniques, to calm the physical symptoms down. Some clinicians don’t do the deep breathing, on the grounds that the symptoms will pass on their own. But Dr. Bubrick likes to give kids tools to give them a sense of empowerment, “to have them feel that they can control the symptoms.”
As the fear of attacks diminishes, attacks themselves grow less severe and less frequent. The person is also ready to start venturing into real-world situations associated with his panic attacks. “Now we can go onto buses or subways or movie theaters, wherever it is they were avoiding, knowing that if they have a panic attack they have a way of dealing with it.”
Patients who’ve been treated with CBT sometimes return for “maintenance sessions,” to refresh their skills. “When I start to feel anxiety kick in, and I feel a relapse is possible,” Petersen says, “I go for CBT again.”
If you think of panic attacks as a malfunctioning alarm system, antidepressants called selective serotonin reuptake inhibitors (SSRIs) make the system less reactive.
Petersen describes the effect of SSRIs as reducing the intensity of worry. “Over several weeks I notice that if worry was taking up 70 percent of my brain before, space is opening up, and worry is taking only 40 percent,” she says. “I find myself more present in the moment, able to have conversations, actually hearing what the other person is saying. The worry monologue can be so loud and so distracting.” And she says, over time there are fewer panic attacks.
It’s not uncommon for people who experience panic attacks to be prescribed a sedative such as Klonapin, Xanax or Ativan to be taken if they have an attack. But since panic attacks are short-lived, clinicians note that it’s easy to misinterpret the diminishing symptoms as the effect of the medication, and develop a psychological dependency. And these medications, called benzodiazepines, have to be taken very carefully, as they can become addictive, and have dangerous interactions with other medications.
Being open about panic attacks
While panic attacks are much more widely understood than they were when Petersen was first experiencing them, she notes that research shows that people who have panic disorder often wait years before they discuss symptoms with a medical professional — or even other people. It’s easy to feel ashamed by the symptoms — if you’re not dying, does that mean there’s something terribly wrong with your brain?
When she was struggling in college and didn’t know what was wrong with her, she notes, “I told friends that I had mono.”
But later, after some bad experiences with romantic partners who weren’t supportive, she says, “I made a vow to tell every person I dated about my anxiety up front, as if it was a communicable disease. Being around people who can accept that part of you and support you is super important.”
What to Do (and Not Do) When Children Are Anxious by Clark Goldstein, PhD
What Is Separation Anxiety? by Rachel Ehmke
Tips for Calming Anxious Kids by Michaela Searfoorce
How to Foster Resilience in Kids by Alan Ravitz, MD, MS
Nonverbal communication: body language and tone of voice by Raising Children Network (Australia) Limited.
The Other Senses: Interoception by Pat Porter
Dyslexia – in tune but out of time by Usha Goswami
Side Effects of ADHD Medication by Roy Boorady, MD
Autism spectrum disorder (ASD) by Mayo Clinic Staff
Mental illness in children: Know the signs by Mayo Clinic Staff
6 Types of Anxiety that Can Affect Children by Kathleen Smith, PhD, LPC
What Is a Language Processing Disorder? by Devon Frye
Matatizo ya hofu na jinsi ya kuyatibu Hofu na kuepuka wanayowavutia inaweza kuwa mbaya sana <unk> Matatizo ya hofu<unk> ni neno ambalo limetumika kwa urahisi sana kwa athari ya wasiwasi. "Unasikia watu wengi wakisema mambo kama vile, 'Ninapokuwa karibu na mbwa mimi hupata mshtuko wa hofu,'" asema Dakt. Jerry Bubrick. "Hata hivyo, ""mwisho wa siku"" ni wakati wa kukabiliwa na mshtuko wa ghafla, na dalili za mwili za ghafla, kama vile moyo wa kasi, kutetemeka, kutetemeka, kichefuchefu, kupumua, na kichefuchefu, zinamaanisha kwamba kuna kitu kibaya sana." Mara nyingi watu huamini kwamba wanakufa. "Hata hivyo, ""mtu anapoteza akili yake, ana dalili nyingi za mwili ambazo hazifurahishi,"" anaeleza Dakt. Bubrick, mwanasaikolojia wa kliniki katika Taasisi ya Akili ya Mtoto." "Wakati mwingine, watu hufikiri kwamba wanapata mshtuko wa moyo na kwenda kwenye chumba cha dharura. "" Andrea Petersen anaelezea kuwa na mshtuko wa hofu akiwa na umri wa miaka 20, asubuhi ya kawaida, wakati alikuwa mwanafunzi wa mwaka wa pili katika chuo kikuu akiandikisha kwa madarasa." "Ghafula moyo wangu ukaanza kupiga, nikashindwa kupumua, na maneno niliyokuwa nikisoma yakaanza kubadilika-badilika, na kuzama", akumbuka. Nilikuwa na hofu kubwa sana. Nilihisi kana kwamba ningekufa. Kitu fulani katika mwili wangu au ubongo ulikuwa umepita vibaya sana. <unk> Ambushed na hofu <unk> Nini wewe ni uzoefu katika shambulio la hofu ni mfumo wa kengele ya mwili wako <unk> ambayo ni wired kuandaa wewe kimwili kushughulikia dharura <unk> kwenda mbali bila tishio halisi. Matatizo ya hofu hufikia kilele chao baada ya dakika kumi na hupungua baada ya nusu saa. Lakini watu fulani huripoti dalili zinazoendelea. Petersen, ambaye kitabu chake cha kumbukumbu On Edge: A Journey Through Anxiety, kinarekodi uzoefu wake, pamoja na utafiti wa hivi karibuni juu ya wasiwasi, alitumia mwezi mmoja kwenye kitanda cha wazazi wake, akiwa amezuiwa na hisia kali za mwili na hofu kubwa. "Ninaiona kama mshtuko wa hofu wa mwezi mmoja", asema. Ndiyo kulikuwa na vilele na mabonde. Lakini ilikuwa uzoefu wa mwili mzima na wa kuteketeza, na wenye kulemaza sana. Na, inageuka, si kweli kwamba ya kawaida. <unk> Mara nyingi, kama na uzoefu Petersen ya, mshtuko wa hofu hutokea nje ya bluu, na huna wazo nini triggered yake. Madaktari huita hayo mashambulizi ya hofu yasiyotazamiwa. Lakini watu ambao wamekuwa na mashambulizi ya hofu mara nyingi kuunganisha yao na maeneo au hali ambapo wamekuwa kilichotokea, na kutarajia na kuongezeka wasiwasi kuwa na shambulio jingine katika hali hiyo. Hilo huwafanya wawe na mwelekeo wa kupatwa na kile ambacho madaktari huita mshtuko wa hofu unaotarajiwa. Mshtuko wa hofu huendelea kuwa kitu kinachoitwa ugonjwa wa hofu wakati mtu anahangaika sana juu ya kuwa na shambulio jingine kwamba anaanza kuepuka maeneo au hali ambazo anaunganisha nao. Si kila mtu anayepatwa na mshtuko wa hofu mara moja anayesababisha ugonjwa kamili. Wengine wana uzoefu huo lakini wanauona kuwa kosa lisilo la kawaida ambalo wanatumaini halitatokea tena. Lakini kwa mtu aliye na mwelekeo wa kuwa na matatizo ya wasiwasi, Dr. Bubrick anasema, njia ya ubongo inayohesabu vitisho inaweza kuwa hai sana. Kuepuka shambulio jingine huwa jambo la kwanza. Kwa Petersen, ambaye ugonjwa wake wa hofu haukugunduliwa kwa mwaka mmoja, ulimwengu wangu ulizidi kuwa mdogo. Kama ningekuwa katika mstari katika duka la kahawa, na nilihisi hofu, nisingekuja kwenye duka la kahawa tena. Niliacha kwenda sinema. Niliacha kwenda kwenye karamu. "Nilikuwa na kuacha kufanya karibu chochote isipokuwa kwenda kwa madarasa machache niliyoweza kuchukua, na kuacha nusu ya kozi zangu na chumba changu katika nyumba ya ushirika wa wasichana. ""Panic plus agoraphobia"" Kwa sababu sehemu ya uzoefu wa shambulio la hofu ni haja kubwa ya kukimbia, watu ambao wamekuwa nao mara nyingi huepuka hali ambapo itakuwa vigumu kutoroka ikiwa shambulio lilitokea, kama vile magari, treni, ndege, umati." Kuepuka mahali ambapo ni vigumu kutoroka ni aina ya hofu ya mahali pa mbali. "Agoraphobia humaanisha tu hofu ya kutoweza kutoroka hali fulani ikiwa utapata mshtuko wa hofu", asema Dakt. Bubrick. Mara nyingi hilo latia ndani maeneo yaliyofungwa. <unk>Watu watasema, <unk>Unajua nini, ni sawa. Mimi tu si kuvuka daraja, kamwe. Sitapanda ndege. "Hakuna haja ya kusafiri kwa ndege", anaongeza. Lakini inaweza pia kuwa katika mchezo wa besiboli na marafiki ambao hawangepokea kwa fadhili kuwa na kuondoka katika inning ya tano. Au kwenye jumba la maonyesho, au kwenye sinema. Petersen, mwandishi wa Wall Street Journal ambaye ni msafiri mwenye tamaa licha ya wasiwasi wake, anasema kwamba hata sasa haendeshi barabarani, baada ya shambulio la hofu "la kutisha" kuendesha gari kati ya San Diego na Los Angeles. Watu wenye ugonjwa wa hofu pia wanaweza kuendeleza hofu kali ya hisia za kimwili zinazohusiana na hofu - kama vile kiwango cha juu cha moyo, jasho, upungufu wa pumzi - hata wakati hawapo katika muktadha wa shambulio la hofu. Hiyo inaweza kuwaongoza kuepuka mazoezi kwa sababu wao kutafsiri hisia hizo za kimwili kama hatari, ingawa wao ni kweli ishara ya afya, mazoezi ya nguvu. "Unaweza kuwazia watu wengi kisha si kwenda kwenye mazoezi ya mwili", Dr. Bubrick anasema. "Watu hawataki kuwa katika hali ambapo ni moto, kwa sababu hiyo inaweza kuwasababisha, au katika hali ambapo wanafikiri wao ni kwenda kuwa na kwamba shida ya kimwili kama juu ya rollercoaster au ndege. " <unk> Ingawa watoto wadogo wanaweza kuwa na hofu au hofu, ugonjwa wa hofu halisi haionekani hadi miaka ya ujana. Matatizo ya hofu pia yanaweza kutokea kama sehemu ya aina nyingine ya wasiwasi, kama vile wasiwasi wa kijamii na matatizo ya hofu, au hofu maalum na matatizo ya hofu. Matibabu ya ugonjwa wa hofu: Utafiti unaonyesha kwamba matibabu yenye mafanikio zaidi ya ugonjwa wa hofu ni mchanganyiko wa dawa za kukandamiza na tiba ya tabia ya utambuzi (CBT). Wataalamu wengi wa matibabu wanapendekeza CBT kama matibabu ya kwanza, na dawa huongezwa ikiwa ni lazima ili kumfanya mgonjwa awe na raha ya kutosha kushiriki katika CBT. Katika matibabu ya mtu aliye na ugonjwa wa hofu na CBT, daktari huanza kwa kufanya kazi na mgonjwa kufikiri kwa kubadilika zaidi juu ya wasiwasi wake. Badala ya kuona dalili za kimwili kuwa zenye hatari, yeye huzoea kuzivumilia, akijua kwamba hazina madhara. Ili kumsaidia mtu huyo kuondoa hisia mbaya zinazohusiana na mashambulizi, mtaalamu wa matibabu huchochea hisia hizo za kimwili - mgonjwa hufanya kuruka jacks au kupanda ngazi ili kupata moyo wa mbio, kuzunguka ili kupata kizunguzungu, kupumua kupitia kijiti cha kahawa ili kupata pumzi. "Tunakufunua hisia halisi, za kimwili za mshtuko wa hofu, dalili moja kwa wakati", anaeleza Dakt. Bubrick. Badala ya kuvumilia wasiwasi na kusubiri upite, mtu huyo hufundishwa jinsi ya kufanya mazoezi ya kupumua kwa kina ili kupunguza dalili za mwili. Madaktari fulani hawafanyi upumuaji wa kina, kwa sababu dalili zitaisha zenyewe. "Bubrick anasema, ""Kutumia vifaa vya matibabu ili kuwapa nguvu, kuwafanya wahisi kwamba wanaweza kudhibiti dalili, na kuondoa hofu ya kushambuliwa, kushambuliwa wenyewe kunakuwa na uzito mdogo na mara chache.""" Mtu huyo pia yuko tayari kuanza kujiingiza katika hali za ulimwengu halisi zinazohusiana na mashambulizi yake ya hofu. "Sasa tunaweza kwenda kwenye mabasi au metro au sinema, popote walipokuwa wakiepuka, wakijua kwamba ikiwa wana shambulio la hofu wana njia ya kukabiliana nalo. " Wagonjwa ambao wametibiwa na CBT wakati mwingine hurudi kwa "vikao vya matengenezo", ili kusafisha ujuzi wao. "Paterson anasema, ""Ninapopata wasiwasi na kuogopa kurudi nyuma, mimi huanza tena kutumia CBT."" ""Kama unafikiria vitisho vya hofu kama mfumo wa kuonya unaofanya kazi vibaya, dawa za kukandamiza moyo zinazoitwa selective serotonin reuptake inhibitors (SSRI) hufanya mfumo huo usiwe na uwezo wa kujibu." Petersen anaeleza kwamba dawa za kuzuia matatizo ya akili hupunguza wasiwasi. "Kwa wiki kadhaa niliona kwamba ikiwa wasiwasi ulikuwa ukichukua asilimia 70 ya ubongo wangu hapo awali, nafasi inafunguliwa, na wasiwasi unachukua asilimia 40 tu,"" anasema." <unk>Ninajikuta niko karibu zaidi na wakati huo, na ninaweza kuwasiliana, kwa kweli kusikia kile ambacho mtu mwingine anasema. Monologue ya wasiwasi inaweza kuwa kubwa sana na kuvutia sana. <unk> Na anasema, kwa muda kuna mashambulizi machache ya hofu. Ni kawaida kwa watu ambao uzoefu mashambulizi ya hofu kuwa prescribed sedative kama vile Klonapin, Xanax au Ativan kuchukuliwa kama wana mashambulizi. Lakini kwa kuwa mashambulizi ya hofu ni ya muda mfupi, madaktari wanabainisha kwamba ni rahisi kutofautisha vibaya dalili zinazopungua kama athari ya dawa, na kuendeleza utegemezi wa kisaikolojia. Dawa hizi, zinazojulikana kama benzodiazepines, zinapaswa kuchukuliwa kwa uangalifu, kwa sababu zinaweza kuwa na kichocheo na kuwa na mwingiliano hatari na dawa nyingine. Ingawa mashambulizi ya hofu yanaeleweka sana kuliko wakati Petersen alipokuwa akiishi nao kwa mara ya kwanza, anaona kwamba utafiti unaonyesha kwamba watu walio na ugonjwa wa hofu mara nyingi husubiri miaka kabla ya kujadili dalili na mtaalamu wa matibabu au hata watu wengine. Ni rahisi kuhisi aibu na dalili <unk> kama wewe si kufa, je, hiyo ina maana kuna kitu mbaya sana na ubongo wako? "Wakati alipokuwa akipambana na chuo kikuu na hakujua ni nini kilichokuwa kibaya kwake, alisema, ""Niliwaambia marafiki kwamba nilikuwa na mononucleosis."" Lakini baadaye, baada ya uzoefu mbaya na washirika wa kimapenzi ambao hawakuunga mkono, alisema, ""Niliapa kuwaambia kila mtu niliyempenda juu ya wasiwasi wangu mbele, kana kwamba ilikuwa ugonjwa wa kuambukiza.""" Kuwa karibu na watu ambao wanaweza kukubali sehemu hiyo ya wewe na kukusaidia ni muhimu sana. <unk> Nini cha Kufanya (na Usifanye) Wakati Watoto Wana wasiwasi na Clark Goldstein, PhD Nini Ni Wasiwasi wa Kutenganisha? "Kama vile Rachel Ehmke, ""Masharti ya kutuliza watoto wenye wasiwasi"" na Michaela Seaforth, ""Jinsi ya kukuza uvumilivu katika watoto"" na Alan Ravitz, MD, MS, ""Uwasiliano usio wa maneno: lugha ya mwili na sauti ya sauti"" na Raising Children Network (Australia) Limited." "Kama ilivyoelezwa katika kitabu cha ""The Other Senses: Interoception by Pat Porter, Dyslexia in Tune but Out of Time"" na Dr. Usha Goswami, ""Ugonjwa wa autism spectrum disorder (ASD) kwa watoto"" na Dr. Roy Borady, ""Ugonjwa wa akili kwa watoto"" na Dr. Kathleen Smith, ""Ugonjwa wa wasiwasi wa aina sita ambao unaweza kuathiri watoto"" na Dr. Kathleen Smith." na Devon Frye