What causes panic attacks, and how can you prevent them? - Cindy J. Aaronson
The body becomes its own corset.
Past, present, and future
exist as a single force.
A swing without gravity soars
to a terrifying height.
The outlines of people and things
dissolve.
Countless poets and writers
have tried to put words
to the experience of a panic attack—
a sensation so overwhelming, many people
mistake it for a heart attack, stroke,
or other life-threatening crisis.
Though panic attacks don’t cause
long-term physical harm,
afterwards, the fear of another attack
can limit someone’s daily life—
and cause more panic attacks.
Studies suggest that almost a third of us
will experience at least one
panic attack in our lives.
And whether it’s your first,
your hundredth,
or you’re witnessing someone else
go through one,
no one wants to repeat the experience.
Even learning about them can
be uncomfortable, but it’s necessary—
because the first step to preventing
panic attacks is understanding them.
At its core, a panic attack
is an overreaction to the body’s
normal physiological response
to the perception of danger.
This response starts with the amygdala,
the brain region involved
in processing fear.
When the amygdala perceives danger,
it stimulates
the sympathetic nervous system,
which triggers the release of adrenaline.
Adrenaline prompts an increase
in the heart and breathing rate
to get blood and oxygen
to the muscles of the arms and legs.
This also sends oxygen to the brain,
making it more alert and responsive.
During a panic attack,
this response is exaggerated
well past what would be useful
in a dangerous situation,
causing a racing heart, heavy breathing,
or hyperventilation.
The changes to blood flow
cause lightheadedness
and numbness in the hands and feet.
A panic attack usually peaks
within 10 minutes.
Then, the prefrontal cortex
takes over from the amygdala
and stimulates
the parasympathetic nervous system.
This triggers the release of a hormone
called acetylcholine
that decreases the heart rate
and gradually winds down the panic attack.
In a panic attack, the body’s
perception of danger
is enough to trigger the response we would
have to a real threat— and then some.
We don't know for sure
why this happens,
but sometimes cues in the environment
that remind us
of traumatic past experience
can trigger a panic attack.
Panic attacks can be part
of anxiety disorders
like PTSD, social anxiety disorder, OCD,
and generalized anxiety disorder.
Recurring panic attacks,
frequent worry about new attacks,
and behavioral changes
to avoid panic attacks
can lead to a diagnosis
of a panic disorder.
The two main treatments
for panic disorder
are antidepressant medication
and cognitive behavioral therapy, or CBT.
Both have about a 40% response rate—
though someone who responds to one
may not respond to the other.
However, antidepressant medications
carry some side effects,
and 50% of people relapse
when they stop taking them.
CBT, meanwhile, is more lasting,
with only a 20% relapse rate.
The goal of CBT treatment for panic
disorder is to help people learn
and practice concrete tools
to exert physical, and in turn mental,
control over the sensations and thoughts
associated with a panic attack.
CBT begins with an explanation of the
physiological causes of a panic attack,
followed by breath and muscle exercises
designed to help people
consciously control breathing patterns.
Next comes cognitive restructuring,
which involves identifying
and changing the thoughts
that are common during attacks—
such as believing you’ll stop breathing,
have a heart attack, or die—
and replacing them
with more accurate thoughts.
The next stage of treatment is exposure
to the bodily sensations and situations
that typically trigger a panic attack.
The goal is to change the belief,
through experience,
that these sensations and situations
are dangerous.
Even after CBT, taking these steps
isn’t easy in the grip of an attack.
But with practice, these tools
can both prevent and de-escalate attacks,
and ultimately reduce the hold of panic
on a person’s life.
Outside formal therapy,
many panickers find relief from the same
beliefs CBT aims to instill:
that fear can’t hurt you,
but holding on to it will escalate panic.
Even if you’ve never had a panic attack,
understanding them will help you identify
one in yourself or someone else—
and recognizing them is the first step
in preventing them.
