Panic Attack: Signs & Treatment
Panic attacks are a fear response we may have when we perceive ourselves to be in danger or stress.
During a panic attack, one may feel light-headed, breathe rapidly and have a pounding heart. The person may feel like they are dying – which is the exaggerated fear response of the body.
Sometimes, people’s teeth may chatter uncontrollably, and they may hyperventilate or cry with panic.
You might experience a single panic attack due to a social or emotional trigger. Or you might have several panic attacks throughout your life, which may eventually lead to a panic disorder.
Fortunately, panic attacks are treatable with the right kind of professional counselling and peer support.
Read the article to learn about the signs, causes, treatment, and self-care tools for coping with panic attacks.
What Is a Panic Attack?
A panic attack is an intense episode of fear that may occur unexpectedly. Your heart may pound, you may find it difficult to breathe, and you may feel like you are having a heart attack.
Most times, panic attacks do not have a clear trigger and may occur without warning. However, you may learn to identify and control your triggers with enough professional guidance.
Recurrent panic attacks are usually caused by something triggering – either emotional, social, environmental, or work-based triggers.
For example, activities like public speaking, presentations, conferences, crossing the road, or interacting with strangers could trigger a panic attack.
Usually, you may feel crippled or freeze during a panic attack and may find it hard to overcome the episode alone.
Sometimes, panic attacks could also lead to other conditions, such as social anxiety or depression symptoms.
What Is a Panic Disorder
A person may be diagnosed with a panic disorder if they experience unexpected and frequent panic attacks for more than 2 weeks.
Panic attacks are the main symptoms of panic disorder, which include fear of discomfort or a sense of losing control over one’s own thoughts and actions. It is important to understand that not everyone who has panic attacks may have panic disorder.
Panic disorder is more common in women or more easily identifiable in women. This is because men may tend to express their panic in frustration and anger.
However, the signs can manifest in completely different ways among all genders. Sometimes, men may also show signs such as heartburn, racing thoughts, and breathlessness.
Panic disorder often starts in late teens or early adulthood. Sometimes, it could start due to a specific stressor like academic stress or work pressure.
People with trauma (especially childhood trauma) are more likely to develop panic disorder.
An Atypical Presentation of Panic Disorder: Case Study
Cultural upbringings and religious practices may also influence the symptoms of panic attacks.
In this case study, a 62-year-old Chinese woman in Singapore experienced episodes of possession trance.
This woman, whom we’ll address as X in this article, had recurrent anxiety attacks with uncontrollable screaming and shaking.
X complained of auditory hallucinations (eg hearing voices) and visual hallucinations (eg seeing a rotten corpse). X attributed these signs to the influence of “evil spirits.”
In panic disorders, there is a sub-type to consider culture-specific symptoms. Hence, X was diagnosed with panic disorder with a cultural symptom and major depressive disorder.
In such cases, Singaporean counsellors may seek to understand their client’s belief systems and use an empathetic approach during counselling.
What Are the Symptoms of a Panic Attack?
A person may experience physical and mental symptoms of a panic attack. A panic attack typically lasts anywhere from 5 to 30 minutes.
However, some people may also experience prolonged anxiety attacks, which may last up to 1 hour or more.
The number of anxiety attacks someone may have depends on the severity of their condition.
For example, someone who is constantly exposed to stressful or traumatic conditions may have frequent anxiety attacks in comparison to someone who is in therapy and currently under treatment.
Panic attacks are not dangerous and can be controlled with the right kind of therapeutic plan. Usually, symptoms of panic attacks can also be signs of other mental health conditions.
Symptoms of an anxiety attack include:
- Pounding heart
- Sweating
- Feeling faint
- Nausea or chest pain
- Shortness of breath
- Trembling and shaking
- Hot flushes or chills
- A choking sensation
- Dizziness and headaches
- Numbness throughout the body
- Dry mouth or gastrointestinal issues
- A feeling of dread
- Fear of dying
- Churning stomach
- Dissociation from reality
Panic Attack vs. Anxiety Attack
We may use panic attacks and anxiety attacks interchangeably due to confusion. However, there are some subtle differences between the two.
In the DSM-5 (an official manual used by mental health professionals to diagnose disorders), anxiety attacks are not listed as a condition. Moreover, anxiety attacks do not have a clinical or formal definition or diagnostic criteria.
On the one hand, anxiety attacks may occur due to distress that is built up over time and may lead to uncontrollable and intense outbursts.
For example, imagine you are struggling to share your displeasure with your partner because they made a decision (for the relationship) without asking you.
As you avoid the confrontation and feelings, you may end up piling all your emotions on top of each other until they reach a boiling point.
During an anxiety attack, you may feel irritated, restless, angry, and distressed due to your bottled-up emotions.
On the other hand, panic attacks are sudden and may often occur for no reason. You may have feelings of derealisation (ie, detached from your reality) and doom.
Panic attacks are more intense but may pass within 30 minutes. Whereas anxiety attacks could last for hours but they are less intense
Causes of Panic Attacks
Like any other mental health condition, panic attacks may also have more than one cause.
For example, a mix of factors such as upbringing, social environments, parental availability, and academic experiences could trigger a panic attack.
Sometimes, panic attacks are linked to an underlying and pre-existent disorder, such as:
- Panic disorder
- Social anxiety
- Obsessive-compulsive disorder
- Post-trauma stress
- Generalised anxiety disorder
- Chronic stress
Research shows that if you have close relatives with anxiety, this may increase the likelihood of you experiencing anxiety attacks. This is also known as ‘anxiety sensitivity.’
Negative childhood experiences could also trigger an anxiety attack in adulthood. These could include experiences such as:
- Emotional neglect
- Feeling like your mom hates you
- Physical abuse
- Being bullied by other students or teachers
- Experiencing racism
- Parents who gaslight or manipulate
Some current life problems could also trigger an anxiety attack. These include:
- Work-related stress
- Homelessness or unemployment
- Hustle culture (eg working long hours)
- Financial issues
- Bereavement or death
- Feeling isolated from your community
- Bering abused or harassed
Treatments for Panic Attacks
Various types of treatment options are available to help with panic attacks and panic disorder.
The most common and beneficial options include talk therapies (eg CBT, relaxation techniques) and medication.
Talking Therapies
Talking therapy, or psychotherapy, involves a structured conversation with a professional about yourself.
Most talking therapies aim to:
- Create a safe and non-judgmental place to express yourself
- Help you make sense of the world and how you react to it
- Make you self-sufficient in handling your problems and managing your emotions
- Help you recognise your unhealthy coping patterns and find ways to change them to benefit you
The most common types of talking therapies to deal with panic attacks include CBT and relaxation techniques.
Cognitive Behavioural Therapy
CBT is a psychotherapy that helps clients make sense of their presenting problems by breaking them down into smaller parts.
CBT Therapists may focus on five areas, which include:
- Situations
- Thoughts
- Feelings
- Physical sensations
- Behaviours
Your anxiety counsellor may help you understand these 5 aspects and interconnect them to analyse how they influence and affect each other.
For example, your cognitive symptoms of a panic attack (ie your thoughts about a trigger) could affect how you feel physically and emotionally.
In other words, if you think, “I am in serious danger because I didn’t complete my assignment,” then you may feel dreadful (emotional) and may start shaking or have a pounding heart (physical).
Hence, through CBT techniques, you can gain control over your thoughts and eventually address your other panic attack symptoms.
Relaxation Techniques
Applied relaxation methods involve learning how to relax tensed muscles in situations where one might normally have panic attacks.
Your Singaporean Therapist may first work with you to identify situations where you may have a panic attack. During this exercise, you may also focus on identifying the panic cues and triggers.
Next, your Therapist might teach you progressive muscle relaxation through a series of gentle and guided instructions.
You will learn how to become more relaxed during this exercise as you continue to practise them consistently alone and during therapy sessions.
Finally, you might learn skills to relax in the presence of panic triggers and in real-world situations where you may experience a panic attack.
Medication
Medication is either used as a primary intervention or along with talk therapies to control or reduce panic attack symptoms.
Although medications can reduce physical and emotional signs, it does not identify the root cause of panic attacks. Hence, seeking a holistic and eclectic treatment approach
is usually advisable.
Data shows that medication is most effective when combined with psychotherapy and self-care strategies (eg lifestyle changes, forming a community).
Common medications prescribed for panic attacks include:
- Antidepressants (it takes a while to notice changes in symptoms)
- Benzodiazepines (acts quickly and control symptoms within 30 minutes)
Xanax is usually the most prescribed benzodiazepine for panic attacks. During panic attacks, your nervous system might be in a flight mode (ie hyperactivity).
Xanax may slow down your nervous system and help you reach a relaxed state. However, most medications for panic attacks are intended for short-term use.
In addition, without guidance from a doctor, benzodiazepines may trigger physical dependency and could lead to serious issues like confusion or coma.
Hence, it is important to talk to a doctor to understand the implications of your medication.
What if I Don’t Feel Better?
If you don’t feel better after taking meds or therapy, your healthcare professional may offer you additional resources and review sessions.
During your regular therapy sessions, your Therapist may check how you’re coping and may alter the therapeutic plan based on your progress.
Different approaches work for different people. Hence, if a certain medication or intervention does not work for you (eg cognitive behaviour therapy), please feel free to provide feedback to your counsellor. They may offer an alternative.
If you’ve tried several therapeutic approaches and none of them have worked, you might be referred to another professional or doctor.
Your Therapist may also provide referrals to psychiatrists. Your team of professionals may work together to assess your unique situation and provide a personalised therapeutic plan.
A psychiatrist referral is recommended if:
- Your symptoms do not reduce even after talk therapy
- Your symptoms cause distress and hinder your daily functioning
- You have a physical health problem along with panic attacks
- You are having thoughts of suicide or self-harm
It is important to remember that you are a unique individual, and your journey to recovery might not always be straightforward.
However, rest assured, TYHO counsellors will be with you every step of the way until you start observing significant improvements. You are not alone!
Subscribe to Our Newsletter
Interested in joining our newsletter and staying connected?
Drop your email address below to receive mental health news, latest TYHO articles, and tips delivered to your inbox monthly.
