Panic attacks are sudden experiences of intense worry, fear and anxiety, often accompanied by other physical symptoms. Estimates of prevalence rates vary but according to the Mental Health Foundation, 13% of people will experience a panic attack over the course of their lifetime and No Panic state that 6.6% of the population in England suffer from general anxiety.
Women are more likely to experience them than men and although children can also experience them it is rare. In most cases they begin during puberty or early adulthood.
The NHS state that panic attacks usually last between 5 and 30 minutes and although they are obviously extremely distressing, they are not physically harmful. For these reasons experiencing a panic attack is not necessarily indicative of any larger problem, for instance a mental health disturbance or a physical illness.
However, according to the Mental Health Foundation, you should see your GP if you are experiencing recurrent panic attacks or excessively worrying about them as this may be a symptom of a type of anxiety disorder, such as panic disorder or post traumatic stress disorder. The NHS support this, stating it is important not to self-diagnose; instead see a Doctor because regular feelings of panic or anxiety could indicate a number of underlying conditions.
What are the symptoms of panic attacks?
Alongside the upsetting feelings of panic, panic attacks can be accompanied by other symptoms, including:
- Rapid breathing or breathlessness
- Feeling very hot or cold, sometimes accompanied by sweating
- Feeling sick
- Feeling lightheaded or dizzy
- Tingling fingers
- Shivering or shaking
- Racing heart or irregular heartbeat (palpitations)
- Feeling out of control
- Feeling trapped
What are the causes of panic attacks?
Panic attacks are triggered by our bodies’ response to feelings of anxiety and fear. During these moments we produce hormones like adrenaline and cortisol which are important for our fight or flight responses. Evolutionarily speaking this is very useful as it prepares us to run away from or fight in a life threatening situation, such as when chased by a potential predator. Once we have done this our bodies’ hormone levels can return to normal.
However, in the modern day this fight or flight response is much less useful because our sources of stress are less likely to be resolved by running away or fighting. After all, you can’t very well fight your boss or run away from work if you’re facing a tight deadline and running won’t help much if you have money worries.
Yet the physical response to stress remains the same and without being able to expend a lot of energy by running or fighting, it is much harder for the hormone levels in our bodies to return to a normal relaxed state. Aside from the long term health implications, this can also cause some people to have a panic attack.
This indicates that stressful life events are the cause of panic attacks, and they certainly can be. Aside from current stress, other causes of these feelings of anxiety and stress can be phobias, past trauma and side-effects of medications. However sometimes they also occur for no clear reason.
What should you do during a panic attack?
When you feel a panic attack is about to occur, the NHS advises you try the following:
- Don’t fight it
- If possible, stay where you are (despite a potential urge to flee, initiated by your flight or flight response)
- Breathe slowly and deeply
- Remind yourself that the attack will pass
- Focus on positive and relaxing images
- Remember it’s not physically damaging or life threatening
What should you do to try and prevent them from recurring?
Firstly, if you are having regular panic attacks remember to see your GP. The following are some different types of support recommended by the Mental Health Foundation and the NHS:
- Breathing exercises:
Practising breathing slowly and deeply when you are feeling calm can help you to manage the rapid breathing that is commonly experienced during a panic attack. This will also help to regain some feeling of control over the situation and in turn may reduce the feeling of panic.
- Progressive muscle relaxation:
This anxiety reducing technique has been around since the 1930s and is another technique which can be useful during a panic attack, but like the deep breathing it will be most beneficial if you practice when you are calm. It involves tensing (15 seconds) and then relaxing (30 seconds) your muscles, working from the top of your body to the bottom.
The NHS recommends regular exercise, such as swimming, yoga, gentle running or walking as a method of stress reduction. Highly intense exercise is not necessarily as helpful, however, because the increased heart rate and breathing can feel very similar to the symptoms of a panic attack, which may in turn induce one.
Eating a healthy diet with regular meals will help to keep your energy levels stable. In addition, reducing your intake of caffeine, alcohol or cigarettes (if applicable) can help to manage panic attacks because these things all contribute to feelings of stress and anxiety.
However, keep in mind that a sudden withdrawal can cause a temporary increase in anxiety if you consume a large amount. Therefore it is important to slowly cut down, it may even be sensible to seek medical advice for the best way of doing it for you.
- Manage your sleep:
If you are struggling to sleep it will be beneficial to create a bedtime routine, wind down and relax before bed (for instance with a warm bath or relaxing music) and reducing the number of electronic gadgets in the bedroom.
- Isolate the causes of stress in your life:
It may be that there is a clear source of stress, such as a significant life event. Such events, like having a baby, moving house or bereavement can cause a great deal of stress. You could also be dealing with long term sources of stress, for instance work, unemployment or caring responsibilities to name a few. If you pinpoint these causes of stress you will be more able to build strategies to manage them more effectively.
- Speak to loved ones:
Speaking to someone can have multiple benefits. Firstly, if you have isolated some causes of stress in your life, as explained above, speaking to people about it could help you to find some solutions.
You may discover you’re your colleagues also find the work situation stressful and there is a way to tackle it. Or your family will recognise that you have taken on the majority of caring responsibilities and will give you some respite. Secondly, discussing it with your loved ones will better prepare them to help you if they witness you experience another panic attack.
- Speak to strangers:
Talking to people you do not know can also help. Samaritans are always available if you need someone to talk to. The charity, Mind, also run a peer to peer support service which enables people who are all going through the same thing to talk and help each other in an online environment. This means you can receive help, or just chat with someone who understands, in the hours that suit you, even if you live in a remote area.
- Psychological Therapies:
A psychologist or other mental health professional can help you to work through your feelings and behaviours. Techniques like Cognitive Behavioural Therapy (CBT) can help to form new patterns of thinking which will help you better manage you own panic attack triggers. Your GP can refer you to a CBT specialist.
In cases of regular panic attacks, medication may be helpful. This is obviously a decision that should be made with your doctor, who can prescribe you some medication if they think it would be beneficial. The type of medication usually prescribed is selective serotonin reuptake inhibitors (SSRIs), also commonly taken by people suffering from depression. One medical review concluded that these are most effective when used in combination with CBT.
- Use online resources and apps:
The sources already mentioned in this article (the NHS, the Mental Health Foundation, Mind, No Panic) as well as others (Anxiety UK) have a wealth of online resources and apps to help with all of the above advice.
What should you not do?
- Do not completely avoid situations that make you anxious. This will not prevent the panic attacks and your world will become gradually more restricted. Instead, set small realistic targets to slowly build up time spent in worrying situations. Regaining control over a previously anxiety inducing situation should gradually reduce anxiety.
- Do not try to do everything at once. While you shouldn’t be completely avoiding triggering situations, do not rush into them either. Instead, set small realistic targets.
- Do not focus on the things you cannot change. Instead focus on helping yourself feel better using the above advice.
- Try not to feel isolated and alone. Most people experience anxiety at some point in their life and with modern technology it is easier than ever to connect with them.
- Do not self-medicate with alcohol, cigarettes or drugs because while it may feel like it helps in the short term, in the long term these can all contribute to poor mental health.
What is the prognosis?
Some people will only have one panic attack and never experience another. Other people experience them fairly regularly. If left untreated they can increase the risks of depression, various anxiety disorders and suicidal thoughts. Therefore it is important to seek help as soon as possible.
According to a recent systematic review (Freire et al., 2016) one-third of sufferers will continue to have panic attacks after treatment. However this does mean that the majority can be free from symptoms or at least see a reduction in their frequency and intensity.
Panic Away was formed by Barry McDonagh who personally suffered from chronic anxiety, beginning suddenly when he was a young adult. Any move away from his comfort zone, meaning any time he left his house, he was anxious and prone to experiencing panic attacks. He tried looking for advice online but did not find it helpful. This led to him developing his own coping strategy that involved completely changing his thought patterns (what he terms “mental manoeuvres”) when it comes to panic attacks.
Now Barry McDonagh says his panic has gone and the general anxiety he was living with has lifted. He works as a personal coach for other anxiety sufferers worldwide and has written a book outlining his “21-7 technique”, as well as compiling the Panic Away program. This program offers a 100% money back guarantee, so confident is he in its effectiveness.
It claims to be different from the usual advice of breathing techniques and talking therapies, which traditionally aim to help suffers to live with their anxiety, rather than teaching them how to eliminate it. So if you have tried all the usual advice and found it to be ineffective, or in fact you do not want to manage and live with your anxiety but eliminate it completely, then you may want to explore Panic Away.
Sources of help:
- Your GP
- The NHS
- The Mental Health Foundation
- No Panic
- Anxiety UK
- Panic Away