As many as three percent of people in the United States suffer
from panic disorder. Most people experience their first attack
in their twenties, but attacks can start at any age, including
the very young and very old. Most people describe their first
panic attack as the most traumatic experience they have ever
had. In general, we don't know what causes the first attack,
but extremely stressful situation seem to be one contributing
factor. Fortunately, panic attacks are not life-threatening,
and full-blown attacks tend to last for only a few minutes.
A panic attack is a frightening experience. Suddenly, out
of nowhere, you may feel like you are having a heart attack,
suffocating, or going crazy. You may have the feeling that
something has gone wrong inside your body, and you are filled
with dread and terror.
Chances
are that you will begin to sweat profusely, and your heart
will begin to pound. When this happens, many people end up
in a hospital emergency room, which may seem a sensible place
to go given how you feel. After being examined there, you
will probably feel better because will most likely be told
that you are perfectly fine, and not to worry because you
"just had a panic attack and now it's over." You
will likely feel calm and reassured.
Unfortunately, since an attack can seem to disappear as quickly
as it happened, most people return to their lives afterwards
as if nothing happened However, once you have a panic attack,
your body is now on alert (or "sensitized"), and
the chances of having another attack in the next few days
or weeks is increased. If you do have a second or a third
attack, you risk developing a condition called panic disorder.
Later attacks are generally less severe than the first, but
are still extremely frightening. In some unfortunate people,
panic attacks can occur daily. Sometimes the attacks are very
unpredictable, but in most cases they tend to occur in situations
similar to the first one.
Panic Attack Defined
According to the Diagnostic and Statistical Manual of the
American Psychiatric Association (often referred to simply
as "the DSM"), which lists and defines psychological
disorders for health care professionals, a panic attack involves
the sudden onset of intense apprehension, fear, or terror,
often associated with feelings of impending doom. Common fears
include dying, going crazy, or doing something uncontrollable
during the attack. Other common symptoms include:
trouble breathing
heart palpitations
chest pain or discomfort
choking or smothering sensations
dizziness or unsteadiness
feelings of unreality
odd body sensations
hot and cold flashes
sweating
fainting
trembling or shaking.
In order to be diagnosed as having panic disorder, you must
have had at least four panic attacks, within the last month
or be in extreme fear of having another panic attack.
How
a Second Attack Happens
An
important contributor to the occurrence of further panic attacks
is related to where the first one occurred. For most people
it happens in a situation from which it would not be easy
to escape if they wanted to: for example in a plane, on a
subway, in a classroom, in a tunnel, in a wide open space,
on an elevator, or in a tall building. For example, if you
had your first panic attack while riding on a subway train,
chances are you will be quite nervous the next time you have
to take the subway. The more nervous you are, the greater
the chance that a new panic attack will happen. If you have
already experienced a panic attack, you will almost certain
to try to escape (in this case, from the subway) if you feel
an attack coming on.
Once
out of the subway, you will probably feel less panicky. A
few experiences like this, and you will be avoiding the subway
altogether. This is very typical in the development of panic
disorder; people are afraid of putting themselves in situations
where they might panic, and where escape is difficult. This
development is diagnosed as "panic disorder with agoraphobia."
Treatment
Medication
There are quite a number of medications that are effective
in reducing the frequency of panic attacks. In the past, the
most frequently prescribed medications were tricyclic antidepressants,
like imipramine (Tofranil). In recent years, however, newer
antidepressant medications called serotenorgic reuptake inhibitors,
or " SSRIs" have also been shown to be effective
against panic attacks. The medications, which include such
fluoxetine (Prozac), are swallowed as pills.
In most cases, medication will take effect in several weeks,
and people can begin to slowly get back to a normal lifestyle.
Unfortunately, some people cannot tolerate the side effects
of the medication, and the risk of relapse is very high for
those who stop taking their medication.
Cognitive-Behavior
Therapy
Cognitive-behavior therapy is another approach to the problem.
Although this treatment may take more effort on your part
than taking a pill, the final result can be more lasting control
over your panic attacks. Cognitive-behavior therapy involves
a combination of learning breath control (breathing retraining),
relaxation techniques, and exposure and response prevention.
These techniques should be taught to you by a qualified cognitive-behavior
therapist.
Breathing Retraining: When you start to panic, you automatically
start to breathe rapidly (hyperventilate). This response more
than any other produces sensations that can feel strange and
frightening. . Breathing in a conscious and gentle way, using
your diaphragm, helps you get control over many of these sensations.
Learning breath control is the first step in controlling panic.
Relaxation
Exercises:
If you are beginning to feel panicky, your body automatically
becomes tense, preparing for danger. This defensive behavior
increases the unwanted internal sensations. Learning systematic
relaxation techniques and then applying them in threatening
situations is another technique that can help you control
your panic attacks.
Graded
Exposure and Response Prevention: A third important
method for controlling panic is to face your fear in a gradual
way. For instance, if your panic attacks occur while riding
on crowded subways at rush hour, the chances are that you
will feel only mild panic when riding a fairly empty train
at midday. With this technique, you practice your breathing
and relaxation skills in easier-to-handle situations before
you progress to more frightening situations. This gradual
exposure to the sensations you experience during panic attacks,
along with the prevention of hyperventilation and tension
during the exposure, are the essential ingredients for learning
to control panic attacks.
Typically,
After several weeks of training using these methods, many
sufferers learn to control their panic, so that they can continue
living normal productive lives. The risk of relapse is low
following treatment, in contrast to people who discontinue
medication treatment.
Combined
Treatment
The combination of medication and cognitive-behavior therapy
is probably the most rapid way of getting control over panic
attacks. It is certainly the best choice if both medication
and cognitive-behavior therapy have failed on their own. However,
it usually means having to go to two doctors, both a psychiatrist
and a behavior therapist. With combined treatment, you can
be gradually weaned off the medication after several months,
as long as you maintain your behavioral skills.
In
Summary
Panic disorder and its related fears are usually the result
of an automatic fear reaction that goes off by mistake. Unless
you know how to control this reaction, it is likely to occur
again, especially in similar situations. There are two effective
way of handling it: medication or cognitive-behavior therapy.
Both methods are effective in most people within a few weeks.
Both work quite well, but although the medication method is
easier, the behavioral method has more long lasting results.
© 2004
Healthology, Inc.
