Updated: Apr 14
According to the Swiss Health Observatory, in the 2016 study "Psychic Health in Switzerland", 14% of Europe's population over the age of 14 suffers from an anxiety disorder. Panic attacks are one of these disorders and 2% of the population suffers from them. It is a problem that affects almost eight million people in Europe.
A panic attack is a frightening experience. It usually peaks within ten minutes and from there the attack begins to subside. The physical symptoms are so strong that people who suffer them believe they are going to die because they are suffering a heart attack or stroke. These symptoms include, according to the American Anxiety and Depression Association:
Palpitations, rapid pulse
Tremors or convulsions
Shortness of breath or choking sensation
Chest pain or discomfort
Feeling dizzy, unstable, lightheaded, or fainting
Chills or hot flashes
Paresthesia (tingling in the extremities)
Derealization (Feelings of unreality)
Depersonalization (Feeling separate from oneself)
Believing you're losing control or going crazy
Fear of dying
Not all panic attacks have all of the symptoms. Not everyone experiences all of the symptoms equally. Generally, someone is considered to have had a panic attack when four or more of these symptoms occur.
What are the causes of panic attacks?
Researchers point out that there may be a genetic predisposition, but what is clear is that there are some environmental factors that help trigger a panic attack:
Having high levels of stress over long periods of time.
Having anxiety, depression or phobias.
Having suffered traumatic events at the psychic level (affective, social, family, financial).
Having suffered physically traumatic events (accident or serious illness)
Excessive consumption of alcohol and/or caffeine.
Treatment. First steps.
Most people who experience a panic attack for the first time go to an hospital emergency room believing they have a stroke or heart attack. Don't be embarrassed when you are finally diagnosed with nothing. HAVING A COMPLETE MEDICAL CHECK IS THE FIRST STEP TO DISCARD OTHER ILLNESSES or heart problems. Before starting psychological treatment, I always refer my patients to the doctor for a check-up if they have not had one. This includes various tests including a blood test and an electrocardiogram. In Switzerland it costs about 500 francs (depends on what your insurance covers). In Spain it is covered by the Social Security. Do not consider it an expense, but an investment in your health and the first step in your recovery. Moreover, at a psychological level, the check-up is extremely important. The opinion of a doctor who confirms that you do not have any illness helps to lower your level of anxiety and decreases the probability and intensity of attacks.
After the medical opinion the psychological treatment begins. The therapy in my practice is cognitive-behavioral. Several studies and authors describe cognitive-behavioral therapy as the most effective for anxiety problems. The bedrock is as follows: Your thoughts provoke emotions, and these provoke physical behaviors and reactions. If you control your thoughts, you control your emotions and your physical reaction.
In the case of anxiety disorders, negative thoughts provoke negative emotions such as fear, anguish, anger or feelings of threat, which in turn provoke physical reactions such as increased pulse, blood pressure and the secretion of stress hormones (cortisol). This hormone focuses our mind on the threat, depresses our immune system and puts the body on alert.
Before we go on, let's be clear about one thing: Stress is not bad. It is a natural reaction with a biological function, saves lives and safeguards our integrity. The problem is chronic stress. Stress is a resource-consuming response and the body is not prepared to endure it for long.
Our life and integrity are not constantly threatened in developed societies, so chronic stress does not arise from real threats. It appears when we INTERPRETE a situation as a threat even if it is not. For example, our boss criticizes a job we have done. Some people will take it as an opportunity to grow and improve, while others will see it as an attack. The latter will suffer stress. If this criticism affects our self-esteem, you may fall into a vicious circle and begin to think that you are not worth it, that people are against you and will enter into a spiral of negative thoughts that will be reinforced. Over time, this chronic stress can lead to panic attacks.
These negative thoughts eventually create brain circuits that distort our vision of the world, and make us see dangers where there are none.
These are some distorted negative thoughts that cause anxiety disorders:
"Everything goes wrong for me."
"Everything's gonna go wrong."
"People think badly of me."
"I'm not worth anything."
"I never do what I set out to do."
"I'm a loser."
"People must always think I'm fantastic."
"I have to please others, otherwise they won't want me."
"I always have to be right"
"I'm never right"
"It's all the other people's fault."
"If I don't solve all the problems, no one will."
"The world is against me"
"It's all my fault."
"I've made a mistake and it's unforgivable."
"I must always be the best."
"Something's wrong with me."
"I can't do anything to make things right."
"They're all useless."
These are absolute thoughts, where there is no middle ground. The very formulation closes the door to seeking a solution. If I truly believe that everyone goes wrong because everyone is useless, there is nothing I can do.
The problem is that they are thoughts that we say to ourselves unconsciously and many times we don't even realize that they are the ultimate cause of our anxiety.
The first part of my job is to detect those distorted negative thoughts and make the patient realize that they are not real threats. Then I have to teach him to replace those negative thoughts with positive ones. In this way, new brain circuits are created to interpret reality in an undistorted, more positive way. This therapy works very well in the medium and long term. Creating these new neuronal circuits takes time, between six and nine months. This work that solves the root of the problem. Suffering new panic attacks during the process is normal, but they will be more and more spaced and less intense until the patient returns to normal.
The second part of my job is to give my patients the tools to react to an anxiety attack. These techniques do not solve the root of the problem (negative thoughts) but they are very effective in the short term because they reassure you and in the long term because they are automated. When suffering a panic attack you have to change the focus of attention, not letting fear take over your mind. To do this, I teach my patients to relax by breathing. First I guide them so they learn the process, but quickly they do it alone and use this technique every time they feel anxious. At the same time they have to change their thoughts. Faced with a panic attack you have to think: "This is not real. I am completely healthy. Nothing happens to me.” A technique that works very well is to weaken the attack with humor: "All right, panic attack: whenever you want, please stop bothering me so I can get on with my stuff.”
The third part is getting people to face their fears. If a person has suffered a panic attack while driving, they tend to avoid driving. This reaction is normal but counterproductive, because it can lead to a phobia. It is necessary to drive again as soon as possible. First through the neighborhood, slow, then through the city, and finally getting out onto the motorway. If you have suffered an attack while doing sports, or in a work meeting, or in an airplane, you have to do the same: Confront your fears as soon as possible.
The fourth and final part is very simple: Avoid chemical triggers. Coffee, alcohol, and of course drugs should not be taken during the recovery period. And once recovered, caffeine and alcohol should be consumed in moderation and drugs, of course, avoided at all costs.
Panic attacks can be healed in some cases without outside help. There are very good books and websites that can help you along the road to recovery. At the end of the article you can find a couple of very interesting links (1)(2). If you want to try it alone, I wish you patience and success.
I recommend the help of a psychologist if you have not been successful on your own, if your panic attacks prevent you from living a normal life or if you do not feel strong enough to face the problem alone.
A professional has the disadvantage of the cost, but considerably increases the probability of success and decreases the recovery time. Your negative thoughts are automatically produced by your brain and many times you are not even aware that you are seeing reality in a distorted way. A psychologist and a psychiatrist are trained to make you aware of the distortion and thus change your thoughts. The second reason these professionals are more effective is personalization. Books and websites, like this article, talk in general terms about panic attacks, but not about YOUR PANIC ATTACKS. The psychologist will adapt the strategy, treatment and techniques to your specific case, so that the recovery will be faster and more complete. The third reason for the higher success rate with a professional is a sense of financial and personal obligation. No one likes to throw money away, and it has been shown that paying for treatment makes you more committed. As for personal commitment, no one wants to disappoint a person of authority (in this case the psychologist or psychiatrist) or betray the word given. Demand the title of psychologist or psychiatrist from the person who is going to treat you.
Panic attacks are hard stuff. Only the one who has had them knows how much one suffers. The good news is that the tools you are going to use to overcome panic attacks (the control of your own thoughts and relaxation techniques, for example) are going to serve you in other areas of your life.
(1) “When Panic Attacks" David D. Burns, MD.