• What’s a Panic Attack?


    Tanya squeezed into the crowded elevator. She was running five minutes late for a meeting and now wished she hadn’t taken the time for a second cup of coffee that morning. Suddenly she became keenly aware of the number of people packed into the small space. Then she noticed that her breathing felt a little weird — it became harder to catch a breath. And her heart was racing. A thought flashed through her mind: “Am I having a heart attack?” Tanya felt a desperate impulse to escape. Tears ran down her face as she began to feel numb and disconnected from her body.


    What Tanya experienced wasn’t a heart attack. Rather, it was a panic attack. According to the Cleveland Clinic, up to 11% of Americans experience panic attacks every year, and 2% to 3% develop panic disorder.


    Treatment for panic attacks and panic disorder will be discussed in a future post. For now, let’s clarify what panic attacks are — and what they’re not.


    What panic attacks are not. Firstly, it’s important to know that panic attacks are not a persistent state. They’re temporary, and they pass if you can wait them out. And even if panic attacks keep coming back (panic disorder), they’re very treatable. However, do not assume that periodic attacks are “just panic” — always see a physician to make sure there isn’t an underlying physical condition, as medical issues can sometimes cause similar symptoms.


    What can trigger them? What we know about Tanya gives some hints as to possible triggers for her panic attack. That extra cup of coffee may have contributed, as caffeine tends to increase physiological anxiety responses. Also, she was rushing to a meeting. That means she was probably walking faster than usual — even running — prior to boarding the elevator, so her respiration and heart rate were likely elevated.


    What perpetuates them? Tanya had ridden in crowded elevators before without problems, but this time was different. Her attention was drawn to her rapid and shallow breathing. And then she focused on her fast heartbeat. Her immediate interpretation of what she was feeling was “a heart attack.” In that moment, her fight/flight/freeze system (also known as the autonomic nervous system) kicked in. That system often overrides the “thinking” brain and releases adrenaline as an adaptive response to a perceived threat, giving the body energy to run or fight. However, in this case, the body’s reaction actually makes the situation worse.


    But this threat is not one Tanya could physically fight or run from, nor did she need to. Nonetheless, the adrenaline increased her heartbeat and pushed her toward hyperventilation, reinforcing the fear that she was having a heart attack. Trapped in the moving elevator, the “fight or flight” response brought her anxiety to a level that was more than she felt she could tolerate. Her nervous system then defaulted to the “freeze” response, which she experienced as disconnect and numbing.


    What you can do. The Anxiety and Depression Association of America estimates that nearly a third of Americans will experience some form of anxiety disorder — including panic disorder — at some point in their lives.


    Therapy can be helpful by helping to identify panic attack triggers so you can change your thinking, behaviors and reactions. If you think you’re experiencing recurring panic, get evaluated by a physician to make sure there isn’t an underlying physical condition, and see a qualified therapist for assistance. You can contact me at , call me at 407-579-2070 or reach me through my website, CouplesTherapyOrlando.com.





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