Treatment for Panic Attacks

Fear is a normal reaction that warns people of danger. Without fear, humans would not have survived because a person without fear does not recognise any dangers.

The fear response triggers processes in the body that rapidly provide energy for a reaction to the danger—either to fight or flee. Stress hormones like adrenaline are released for this purpose. They cause the heart to beat faster to supply the muscles with oxygen-rich blood and induce sweating to disperse heat. Organs not needed for escape or attack, such as the digestive system, receive less blood flow.

In our highly technological society, everyday life is filled with a high density of stimuli. Under normal circumstances, such everyday stressors do not lead to an exaggerated fear response.

Panic Attacks are a type of anxiety disorders describing a state of intense fear combined with a variety of symptoms like chest pain, flashing vision, nausea, numbness, and, very frequently, a subjective feeling of an immediate death. They feel like an inexplicable and unthinkable traumatic event.

“The panic episode is like a repetitive micro-delusion exposing the patient to a concrete experience of dying, suddenly facing him with a ‘nameless’ dread and provoking in him that fear of annihilation, biological as well as psychological, that has the power of destructing the mind and damaging any sense of existential continuity and integrity.” Francesco De Massi

Panic Disorder vs. Panic Attack: What’s the Difference?

A panic attack is a brief period of severe anxiety occurring seemingly “out of nowhere.” During a panic attack, an individual experiences intense discomfort and fears, accompanied by various physical, psychological, and general symptoms.

Experiencing isolated panic attacks throughout one’s life does not constitute a diagnosis of panic disorder. In the majority of the cases, panic attacks tend to continue and increase in frequency. Such an ongoing anxiety condition marked by recurring panic attacks is called panic disorder.

The fear of a sudden panic attack, triggered by certain places or situations, such as large crowds, being in an airplane, or elevator, leads individuals to avoid such places or situations. In severe cases, they may become housebound.

The panic attacks caused by particular triggers are described in the psychiatry as phobias. However, phobic anxiety is identical with a panic attack.

Symptoms of a Panic Attack

A panic attack describes a state of intense fear emerging suddenly, often without warning and for no apparent reason. The leading symptom of a panic attack is severe anxiety with the feeling of losing control. During a panic attack, the person develops irrational thoughts, such as “I’m dying”,” I‘m about to faint or lose control,” and “I must escape from here.” Especially with the first appearance of a panic attack, the person is not able to recognise the condition. The anxiety in panic attacks has its own specific characteristics, such as the fact of occurring suddenly, a tendency to repetition, and a lack of recognition of events leading to it.

Panic attacks are associated with physical symptoms such as chest pain and heart palpitation that perfectly mimic myocardial infarction. Therefore, first-time sufferers may call for emergency services followed by a series of diagnostic measures, especially those excluding a heart attack. Despite the severity and the similarity of symptoms to myocardial infarction, panic attacks are purely psychological conditions with no underlying physical problems.  Thus, the proper diagnosis of panic attacks reduces patient’s unnecessary suffering and useless diagnostic measures. The initiation of psychiatric and psychological treatment relieves the suffering and protects the patient from symptoms aggravation.

Neurophysiological Effects of Panic Attacks

Physical symptoms of panic attacks occur because of an inappropriate “overdrive” of the autonomous nervous system. During the attack, the person tends to over breathe (hyperventilate), which causes excessive exhalation of carbon dioxide. In consequence, this lowers the blood acidity (low blood pH), known as respiratory alkalosis. The next sequence in the chain reaction is the removal of the calcium ions from the blood stream. This again leads to a temporary low blood calcium level, called hypocalcaemia. The effect of hypocalcaemia is elevated muscle tone up to cramps and dizziness.

The Fear of the Fear

The fear of the next panic attack triggers a “vicious cycle of anxiety,” leading to an expectation of fear, known as “fear of fear.” Many individuals with panic disorder consequently avoid places and situations that might trigger a panic attack. In consequence, people with panic attacks isolate socially, which causes increasingly more problems in their private and professional lives and can lead to full invalidism. Therefore, an early diagnosis and treatment of panic attacks are crucial for stopping the destructive spiral.

Diagnosing Panic Attacks

Panic attacks are different from other forms of anxiety. They appear “out of the blue” without any identifiably triggering factors. The phases between panic attacks are usually symptom-free; however, sometimes the condition can be co-morbid with generalized anxiety. In such cases, the affected person also feels anxious between the attacks.

The current diagnostic manuals, DSM V, and ICD 10, describe and quantify the symptoms. The phenomenological (descriptive) approach makes sense as the root causes of most psychiatric disorders are unknown.

At first glance, the cause of panic disorder is not explicable, yet it could be identified in the course of psychodynamic psychotherapy. Therefore, diagnostic manuals based on symptoms descriptions are useful as a quick method for creating a communication platform for psychiatrists.

The diagnostic manual (DSM V) of the American Psychiatric Association (APA) defines the panic disorder and its diagnostic criteria.

Diagnostic Criteria of Panic Attacks

To sum up, a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Paraesthesia (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
• Fear of losing control or “going crazy”
• Fear of dying

Course of Panic Disorder

Panic disorder is a condition where the patient experiences recurring panic attacks. In panic disorder, the person will experience ongoing worries of getting further attacks (anticipatory anxiety).

Anticipatory anxiety is the effect of conditioning. After the first occurrence, the panic attack will inevitably tend to manifest itself again. The result is a vicious circle where the attacks tend to reoccur and increase in intensity.

In panic disorder, patients feel dominated by an escalating sequence of events that follow an unstoppable progressive course. The anxiety in the panic attack feels real. Fully established panic disorder progressively affects more areas of a person’s life and may end in full invalidism.

On the diagnostic level, panic attacks should be differentiated from phobias, in which the anxiety is triggered by certain situations. For example, such conditions as agoraphobia or claustrophobia (anxiety appearing by exposure to wide or small spaces) and phobias related to other circumstances, for example, flying phobia, unleash the same symptoms and dynamics of anxiety as those in a panic attack.

Treatment for Panic Attacks with Medication

The medication used for treatment of panic attacks:

• Antidepressants: These medications fall into categories like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

• Beta-blockers: These drugs can be effective in controlling certain physical symptoms, such as a rapid heart rate.

• Anti-anxiety medications: This category includes benzodiazepines, which are sedative medications that can provide quick relief from symptoms.

Benzodiazepines are very useful as emergency treatment to suppress panic attacks. The state of the art threatment of panic attacks is the use of antidepressants such as SSRIs and SNRIs. Antidepressants are typically used for long-term treatment, and it takes some time to notice their effects. The treatment with antidepressants should be continued for at least six to twelve months after improvement has been achieved.

Despite the effectiveness of the medication, pharmacotherapy alone will not resolve the problem. The state-of-the-art treatment of panic disorder is the combination of medication (highly effective in a short time) and psychotherapy that addresses the underlying causes of the disorder.

According to the author’s own 30 years of clinical experience, medication can fully suppress the symptoms of panic attacks. However, suppressing the symptoms with medication does not “cure” the patient. The medication will facilitate a stable mental condition, protecting the patient from the terror of panic attacks and opening the door for psychotherapy.

Treatment for Panic Attacks with Psychotherapy

A body of research compared behavioural, cognitive, and Cognitive Behavioral Therapy (CBT) in the treatment of panic attacks and concluded that CBT had the best long-term effect, which makes it an evidence-based treatment approach.

Recent studies proved that psychodynamic psychotherapy is equally effective in relieving panic attacks as behavioural approaches but has fewer relapses.

Behavioural Therapy in Treatment of Panic Attacks

In exposure therapy for panic disorder treatment, the patient will be exposed to the physical sensations of panic in a safe and controlled environment, giving him the opportunity to learn healthier ways of coping. The psychotherapist may evoke sensations like the symptoms of panic. With each exposure, the patient can become less afraid of these internal bodily sensations, feeling a greater sense of control. Through this experience, the patient learns that the situation isn’t harmful. Behavioural therapy aims to identify and change harmful patterns of behaviour.

Cognitive Therapy

Cognitive therapy is based on the idea that certain ways of thinking triggers and maintain panic attacks. This type of panic attack treatment is focused on the understanding of the patient’s thought patterns to identify any harmful, unhelpful, and mistaken ideas or thoughts. The aim of cognitive therapy is to change how people think to avoid the pathogenic ideas and create more realistic and helpful thought patterns.

Cognitive Behavioral Therapy (CBT)

CBT is a mixture of the above-described therapies where the patient benefits from changing both thoughts and behaviours. Cognitive behavioural therapy is the most researched and the most effective form of treatment for panic disorder. CBT focuses on the thinking patterns and behaviours that are sustaining or triggering the panic attacks. It helps the patient create insight, showing his fears in a more realistic light. Once the patient learns that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.

Psychodynamic Psychotherapy in Treatment for Panic Attacks

Psychoanalytic/psychodynamic treatment for panic disorder attempts to uncover unconscious conflicts. From the psychoanalytical point of view, the panic attacks are the effect of a fragile self-defence. The clinical experience teaches us that the symptoms of panic are always accompanied by an identity defect and betrays a failure of the self.

The psychodynamic treatment of panic attacks focuses on two goals. At the beginning, the therapist aims to help the patient comprehend the root cause of his anxiety, his internal conflict, which he is not aware of. Then the therapist assists the patient in developing an insight into the problem. The awareness of the conflict opens the way for the integration of repressed emotions.

The second condition is to help the patient build a stable and permanent sense of self. Building a stable “self” is a process of developing individuality with the capacity to formulate autonomous opinions and thoughts to attain emotional experiences. The patient can be freed from inhibitions, self-indulgences, and unconditional conformity and make his own ethical decisions.

Psychodynamic psychotherapy focuses on the root causes of the disorder and less on the symptoms. This approach is causal in its nature. The psychoanalytical process lasts for several months and sometimes even up to two years. Throughout the analytical treatment, the frequency and intensity of panic attacks decrease, ultimately resulting in complete recovery.

Root Causes of Panic Attacks

A panic attack is a frightening feeling of fear that appears “out of the blue” in a normally non-threatening situation. By definition, panic attacks occur without an identifiable triggering factor. Anxiety attacks triggered by a particular situation or place are called ‘phobias’. The intense fear and associated physical symptoms in phobias, such as sweating, heart racing, chest pain, and breathing difficulties, are the same as those seen in panic attacks. Although panic attacks seem to occur randomly, there are deeper-rooted “emotional complexes” causing them. But they are not recognisable at first glance. It may take hours of psychotherapy with an experienced psychologist to find the “Ariadne’s Thread” that descends into the depths of the psyche to find the hidden problem, the cause of the panic attack. This article describes different approaches towards the origin of the panic disorder.

Genetic Factors

Genetics and neurophysiological changes in the brain pathways play a significant role in predisposing individuals to panic disorder. According to neuroscientific hypotheses, somatic (bodily) anxiety causing a multitude of physical and psychological symptoms derives from an improper activation, through the limbic system, of primitive neurobiological or neurochemical mechanisms that start from the amygdala and cause a short circuit of psychosomatic responses.

Various twin studies where one identical twin has an anxiety disorder have reported around 50% incidence of the other twin also having an anxiety disorder diagnosis.

Environmental Factors

“Critical life events” are considered potential influences on the development of mental illnesses. Life events are considered “critical” when they involve significant, life-altering, and extraordinarily stressful experiences. Such events often include sudden or prolonged changes or restrictions in one’s life circumstances, perceived as significant stressors. Not only the absolute number of experienced life events but also the nature of these events and their emotional processing play a crucial role in the genesis of the illness. Environmental factors such as major stress, an overly cautious view of the world expressed by parents, and cumulative stress over time have been found to be correlated with panic attacks. Other factors are significant personal loss, life transitions, and major life changes.

Although the evidence for neurophysiological factors in panic disorder is impressive, these observations are more persuasive regarding the vulnerability for panic attacks than their onset.

Childhood Trauma

Childhood trauma with a tumultuous, unpredictable environment increases the susceptibility to mood and anxiety disorders later in life. For instance, a child raised by an abusive or volatile parent might develop hyper-vigilance, constantly monitoring their parent’s moods to stay safe. This habit can carry into adulthood, leading them to overanalyse others’ reactions, increasing their vulnerability for panic disorder.

Major Life Events

Life changes also can trigger the onset of panic disorder. They often lead to feelings of being out of control, especially in unexpected situations. Unhealthy coping mechanisms and negative mindsets can make it seem impossible to adapt to changes. Pepale’s perspective on life also plays a crucial role in how they handle new situations. Negative outlooks can exacerbate feelings of stress, making major changes even more challenging to navigate. Additionally, even positive changes can be unsettling because they disrupt familiar routines and comfort zones. Therefore, it’s important to find healthy ways to cope and maintain a positive outlook during times of transition.

Panic Attacks in Light of Evolutionary Adaptation Theory

Anxiety is a natural and universal experience, which human beings share with all mammals. Since it is ubiquitous, it serves a biological function. The biological function of anxiety is crucial for survival in a world full of dangerous situations, preparing the individual to meet whatever emergencies may arise.

The actual experience of anxiety is directly associated with physiological changes that prepare the body for violent action: the heart rate increases, the blood pressure rises, adrenaline is secreted, the energy stores are mobilised in the liver and released into the bloodstream, and blood is redistributed from the internal organs to carry oxygen and energy the muscles and the brain will use to master the danger. Those changes are caused by activation of the sympathetic nervous system, preparing the organism for the fight or flight response.

Frustration of Evolutionary Development

The anxiety disorders are caused by the modern lifestyle. Only a small percentage of the population develops anxiety, which requires treatment. In the environment of evolutionary adaptation, anxiety is essential for survival. In the modern world, however, the physiological function of anxiety is often “misguided” or exaggerated. A crucial question is why a natural response (anxiety) reaches the level of a psychiatric disorder. The answer could be the following: The species Homo sapiens was “designed” to live in stable social groups.

The group and its members struggled to survive dealing with hunger and dangerous situations. However, they lived in balance with nature. Their lives were matching the basic human needs. The group protected the individual and integrated him into a clearly defined social structure. We will not find any anxiety disorders in hunters and gatherers of the Kalahari Desert living a very similar life to those of our remote ancestors. In this context, panic attacks can be seen as an archetypal neurosis.

Living in Human Zoo

In his book, “The Human Zoo,” Desmond Morris writes:

“Under normal conditions, in their natural habitats, wild animals do not mutilate themselves, attack their offspring, develop stomach ulcers, become fetishists, suffer from obesity, or commit murder. Among human city dwellers, needless to say, all of these things occur… Other animals do behave in these ways under certain circumstances, namely when they are confined in the unnatural conditions of captivity. The zoo animal in a cage exhibits all these abnormalities that we know so well from our human companions. Clearly, then, the city is not a concrete jungle; it is a human zoo.”

Panic Attacks from Psychodynamic Viewpoint

The psychodynamic approach is based on the idea that panic attacks are the expression of an intrapsychic conflict and that the patients could benefit from a psychotherapeutic process exploring the unconscious. An in-depth analysis of people suffering from panic attacks shows that the anxiety is caused by unconscious worries related to developmental changes and milestones that the individual feels unprepared for. For example, panic attacks can appear in an 18-year-old woman while living at home during her studies. She might develop a panic attack before getting married, especially if the marriage of her parents ended in a divorce. She could also have panic attacks after discovering her pregnancy, feeling unprepared for her mother role. At the mature age, the panic can appear after her children leave home, and she is facing the big “unknown.”

Panic Attacks and the Narcissistic Collapse

In less complex cases, panic attacks signal the collapse of a person’s narcissistic organization. For this reason, panic attacks are particularly common during the mid-life transition or mid-life crisis. The anxieties appear along the realisation of the limitations of one’s existence. A person can face it by crossing the age when the myth of one’s own efficiency, beauty, or success can no longer be maintained.

Cognitive Approach Towards Panic Attacks

For cognitivism, panic derives from a perceptive distortion of the fear signals. The recommended therapy approach is based on a combination of cognitive reconstruction and gradual exposure of the patient to the terror-inducing stimuli. 

History of Panic Attacks

Anxiety is a universal human experience and, as such, has been dealt with in many different ways in literature, philosophy, religion, and, of course, psychology and medicine.

The first written records describing anxiety are mentioned in the Epic of Gilgamesh in about 2000 B.C. Even the origin of the word “panic” has ancient roots. The Greeks called groundless fear “panikos.”

In essence, the evolution of the term “panic” and its psychiatric connotations reflects the continuous refinement of our understanding of anxiety and its manifestations. From its mythological origins to its contemporary clinical usage, “panic” serves as a linguistic bridge connecting ancient fears to modern psychiatric insights, elucidating the intricate interplay between language, culture, and mental health.

Research on Panic Attacks in the 19th and 20th Century

The terms “panic attack” or “panic disorder” are relatively young and only entered psychiatry as a diagnostic entity in the late seventies. Meanwhile, Panic Disorder emerges as a distinct diagnostic category, marked by the recurrent occurrence of panic attacks with defined frequency. Often, this disorder intertwines with agoraphobia, further complicating the clinical picture.

Historically, the technical usage of “panic” diverges from its colloquial counterpart, denoting both abnormal group behaviour and acute individual states of high anxiety. This conceptual framework, formalised for the first time in the diagnostic manual, the DSM-III, underscores the evolving understanding of anxiety disorders, panic attacks, and generalised anxiety and their classification.

In psychology, the study of anxiety has its origins in the late 19th century. It was Sigmund Freud’s who investigated anxiety and, in particular, the panic attacks. Considering today’s criteria, he presented the most detailed description of panic symptoms.

Freud also created the theoretical foundation of this disorder. He recognised the importance of environmental factors without neglecting the hereditary predisposition. Despite his pioneering research, he was quite mistaken on the aetiology of panic attacks by overestimating the impact of sexuality.

Emil Kraepelin’s Research on Anxiety

Kraepelin, a prominent figure in clinical psychiatry, documented cases of panic attacks and severe agoraphobia. He categorised various anxiety disorders, delineating generalised anxiety characterised by pervasive worry, obsessive thoughts, and compulsions. He also identified phobias, including insect phobias, agoraphobia, specific social phobia, and generalised social phobia, contributing significantly to the classification of contemporary anxiety disorders.

Walter Canon. Fight-or-Flight Response

Walter Cannon, a physiologist and the intellectual descendant of Darwin, emphasised in 1919 the crucial roles of anger and fear as a survival strategy. His work on the secretion of epinephrine from the adrenal medulla led to the development of the concept of the fight-or-flight response. Despite some misconceptions about chemical transmission, Cannon’s research legacy remains influential in contemporary research on stress.

Sigmund Freud and the Concept of “Anxiety Neurosis”

The first description of anxiety disorders derives from Sigmund Freud. He created the first historical description of disorders that we call today “panic attacks” and “generalised anxiety disorder.” Freud described these disorders using the term “anxiety neurosis” (German: “Angstneurose”). As he wasn’t able to identify in both conditions any visible triggers, he called them “neurosis without conflict.”.

Freud on Panic Attacks

Freud interpreted anxiety attacks as exacerbations of an underlying basic anxiety.

The core symptom of “anxiety neurosis,” as Freud termed the condition, because “all its components can be grouped around the main symptom of anxiety,” is called “anxious expectation.” It is based on “usually latent but constantly lurking anxiety,” which can suddenly “break into consciousness” and “trigger an anxiety attack.”  This “consists either solely of the feeling of anxiety without any associated idea or with the immediate interpretation of impending death, ‘blow,’ or impending madness…”.

Based on chronic anxiety… two groups of typical phobias develop… The first group includes the fear of snakes, thunderstorms, darkness, vermin… The other group contains agoraphobia…”.

Freud created the connection between the panic attacks without any obvious reason and phobic panic attacks triggered by certain objects or situations.

In his clinical observation, Freud emphasised the relevance of unconscious conflicts and the role of psychoanalysis to uncover their source.

Freud’s Description of Panic Attacks

On the symptomatic level, Freud’s description of the anxiety neurosis correlates astonishingly well with the current description of panic attacks. In his paper on “anxiety neurosis,” he wrote:

“I append here a list that includes only those forms of anxiety attack that are known to me:

• Disturbances of the heart action, such as palpitation.
• Disturbances of respiration, several forms of nervous dyspnoea, attacks resembling asthma, and the like.
• Sweating, often at night.
• Tremor and shivering, which are easily confused with hysterical attacks.
• Ravenous hunger, often accompanied by vertigo.
• Diarrhoea coming on in attacks.
• Locomotor vertigo.
• Congestions, including everything that has been termed vasomotor neurasthenia.
• Paraesthesia (numbness). But these seldom occur without anxiety or a similar feeling of discomfort.”

When comparing the above-presented list of symptoms described by Freud with the criteria in the DSM classification, the level of agreement may be quite surprising. 

Freud on Aetiology of Panic Attacks

In 1895, Sigmund Freud published a paper entitled “On the Grounds for Detaching a Particular Syndrome from Neurasthenia Under the Description ‘Anxiety Neurosis’”. In this paper, he wrote:

“In some cases of anxiety neurosis, no aetiology (root cause) at all is to be discovered. It is worth noting that in such cases there is seldom any difficulty in establishing evidence of a grave hereditary taint. But where there are grounds for regarding the neurosis as an acquired one, careful inquiry directed to that end reveals that a set of noxae and influences from sexual life are the operative etiological factors.”

Freud paid attention to the fact that there is a higher occurrence of anxiety symptoms running in the members of the same family. For the cases without a family history, he related the origin of anxiety to sexual suppression.

Typical for his psychoanalytical theory, Freud overestimated the role of sexuality as an etiological factor.  From today’s perspective (and the author’s own clinical experience), we can conclude that the Freudian link to suppressed sexuality is valid only in a very low percentage of the anxiety disorders.

From Neurosis to Disorder

Looking back on the history of panic attacks and generalised anxiety, we will find old-fashioned psychoanalytical terms such as “neurosis”, “neurasthenia” or “hysteria”. Over time, these words “infiltrated” common language, gradually acquiring a negative overtone. In the current psychiatric nomenclature, psychiatrists have replaced the terms “neurosis” or “hysteria” with the more “politically correct” word “disorder.”

DSM III. Differentiating Panic Disorder from Generalized Anxiety Disorder

DSM-III introduced in 1980 split anxiety disorders in two categories, Panic Disorder and Generalized Anxiety Disorder (GAD). It was the official birth date of GAD as a diagnostic category. 

One major argument for the separation of spontaneous panic disorder from generalised anxiety was the assumption that they could be identified based of response to medication. The approach was termed “pharmacological dissection.” 

A double-blind placebo-controlled study conducted by Klein had shown that patients treated with imipramine got fewer panic attacks even though their levels of generalised anticipatory anxiety remained high. However, more recent studies conducted by Kahn and colleagues have disproved that panic disorder is a specific indication for antidepressant therapy, whereas GAD is not responsive. Contradicting Klein’s observations, Kahn proved that antidepressants are also effective in the treatment of GAD.

Practical Advice on Managing Panic Attacks

“What do I do during a panic attack? How can I endure it so that it ends faster?” These thoughts are familiar to many individuals dealing with panic disorder. After all, this extreme fear not only causes extreme terror (even to the point of fearing death) but also takes a toll on the body.

There are numerous ways to gain control over panic attacks. It may not always work immediately, but over time, people will notice that panic attacks occur less frequently and with less intensity. Armed with these strategies, you can learn to manage and gradually overcome the panic attacks.

Panic attacks aren’t medical emergencies, yet they feel like one. The below tips help you to recognise, manage, and prevent panic attacks.

1. Identifying Panic Attacks

No two panic attacks are alike. Since the symptoms are often non-specific, some individuals may not even realise they are having a panic attack. Typical symptoms of a panic attack can include:

• Shortness of breath
• Rapid heart rate
• Dizziness
• Sweating
• Trembling
• Tightness in the chest
• Visual disturbances (blured vision)
• Tingling or numbness in the arms or legs
• Dizziness
• Nausea

Not being able to explain the physical reaction associated with a panic attack, individuals often feel like losing control, being detached from themselves, or feeling like dying. Especially when a panic attack occurs seemingly out of nowhere and without an obvious trigger.

2. Acknowledging the Fear

Attempting to suppress a panic is futile; instead, the person affected should “let it happen” with the knowledge that every panic attack eventually subsides and it’s not a threatening condition. Resisting it only makes things worse.

If the panic attack strikes, people should stay where they are at that moment. While driving, the safest way is to pull over to the right side of the road and stop.

Confronting fears is the initial step to managing body control and emotions.

3. Narrowing the Focus

To halt panic attacks, focusing on something that doesn’t trigger anxiety, such as an object, helps. Directing attention to details of an object: colour, patterns, size, shape, decreases the anxiety.

4. Decreasing External Stimuli by Closing Eyes

Overwhelming stimuli can trigger panic. Closing eyes helps concentrate on breathing and regaining control.

5. Practice Diaphragmatic Breathing

When affexted by a panic attack, the most important rule is to try to stay calm and to shift focus to breathing. Concentrating on breathing and learning to make it deeper helps manage a panic attack. Slow, deep breaths ease anxiety. Diaphragmatic breathing—inhaling slowly and fully—can lessen the anxiety.

Developing awareness of breathing has the potential to put an end to a panic attack and reduce their frequency overall.

Practicing deep breathing exercises in safe and tranquil environments prepares you for handling a panic attack when it arises.

6. Talking to Someone

Talking to someone, like a friend or family member, helps to regain control. Informing a friend or loved one about panic disorder helps them provide support.

7. Progressive Muscle Relaxation (PMR)

PMR has gained acclaim to alleviate panic and anxiety attacks. Though not novel, healthcare professionals globally endorse it for panic disorders. PMR involves contracting muscle groups for 5 to 10 seconds while inhaling deeply, then relaxing them as you exhale.

How to Manage Long Lasting Panic Attacks?

First-aid measures can be helpful during acute panic attacks. However, adopting a healthy lifestyle is the best foundation for managing them in the long run. Here are some things sufferers should consider avoiding:

• Caffeine can be stimulating and may trigger anxiety in some individuals. Fortunately, there are many tasty decaf coffees available.

• Nicotine is a stimulant and not as relaxing as some might believe.

• Alcohol is not an effective way to calm anxiety; in fact, it can exacerbate anxiety symptoms. T

• Low blood sugar can lead to dizziness and lightheadedness. Eating regular meals helps to maintain stable blood sugar levels.

• Sleep deprivation can contribute to the development of anxiety disorders. Maintaining regular sleep patterns and improving sleep quality protects from panic attacks.

Managing panic attacks with meditation and mindfulness

Meditation and mindfulness exercises are also effective tools for managing panic attacks. They can help focus and calm down more quickly when needed. There are many free apps available to learn relaxation techniques step by step.

Seeking therapy can provide a confidential space to explore thoughts and feelings, learn coping strategies, and regain control over panic attacks. Here are some signs it might be time to seek professional help:

• Feeling constantly overwhelmed, with worries seeming out of proportion. 
• Experiencing physical health issues like nausea, headaches, or muscle pain, which can be linked to chronic stress and anxiety. 
• Struggling to build or maintain relationships due to anxiety affecting communication and conflict resolution. 
• Feeling like emotions are out of control, with anxiety making negative feelings more intense and harder to cope with.
• Experiencing a decline in academic or work performance due to difficulty focusing caused by anxiety. 
• Turning to unhealthy coping mechanisms such as alcohol abuse to manage anxiety. 
• Having a history of trauma or abuse can benefit from talk therapy with a trained professional. 
• Losing interest in activities people used to enjoy and feeling disconnected from life. 

How to Prevent Panic Attacks?

The following advice helps to prevent panic attacks:

• Avoiding alcohol, drugs, nicotine, and caffeine reduces the risk of panic attacks.

• Getting enough sleep, eating healthily, and exercising regularly. These habits strengthen the body and mind, helping to cope with anxiety.

• Meditation and mindfulness are effective tools for managing panic attacks. They help to focus and calm down faster when needed. Many free apps provide guides through relaxation techniques step by step.

Treatment of Panic Attacks. Summary

Panic attacks are episodes of intense fear that usually occur unexpectedly and without warning, lasting from a few seconds to several minutes. In some cases, the overwhelming fear can be so severe that those affected may think they are having a heart attack or another serious life-threatening condition. Recurrent panic attacks are called “panic disorder.”

Panic attacks are different from the “physiological” anxiety experienced in dangerous situations. Such anxiety doesn’t influence rational thinking; on the contrary, thinking speed and the level of concentration are increased, preparing the individual for the “fight or flight” reaction. In such cases, the people are simply afraid of an expected dangerous situation, allowing them to anticipate their “set of behaviours” to avoid danger.

However, during a panic attack, the activation happens “out of the blue” without any visible causes. Once a panic attack starts, it will progress automatically in an uncontrollable way, paralysing thinking and not allowing for interventions based on rational decisions.

Symptoms

A panic attack usually lasts 5–10 minutes. In rare cases, it can reach a duration of a few hours. Panic attacks come along with physical symptoms such as chest pain, heart racing, palpitation, and shortness of breath. Other physical signs of panic attacks are sweating, numbness, dizziness, blurred vision, and sometimes loss of bodily control ending in fainting. Some people also suffer from tunnel vision.

A psychological reaction frequently appearing in the course of a panic attack is depersonalization and derealization. Both are subjective experiences related to patients’ perceptions toward themselves (depersonalisation) and toward the surrounding world (derealisation). In depersonalisation, the patient feels detached from oneself. In derealisation, he feels that the world has become strange and unreal.

Therapy

Panic disorder is a treatable condition with a good prognosis. The state-of-the-art therapy is a combination of pharmacological treatment (medication) and psychotherapy. Most of the surveys show the high effectiveness of cognitive behavioural therapy (CBT) as well as psychodynamic psychotherapy.

CBT involves analysing the process of anxiety attacks, the triggers, the warning signs, and identifying ways of assessing and controlling the anxiety. Individuals are also supported in confronting their fears and reducing avoidance behaviours.

Untreated panic disorder tends to increase in frequency and severity, restricting more and more individual’s social and professional performance. In consequence, the circle of activities of people with panic disorder is more and more restricted, which can end in full invalidism.

Panic Attacks and their Treatment in Bullet Points

• Approximately four percent of people develop panic disorder at some point in their lives.
• The disorder typically emerges between the ages of 15 and 24 but can onset, particularly in women.
• Women are more commonly affected by panic disorder than men.
• The abrupt surge of a panic attack can occur from a calm state or an anxious state.
• Panic attacks cause various psychological and physical symptoms summarised in the DSM 5 criteria.
• Culture-specific symptoms (e.g., tinnitus, neck soreness, ache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
• Panic attacks can occur in the context of any anxiety disorder as well as other mental health disorders (e.g., depression, posttraumatic stress disorder (PTSD), dependencies) and some medical conditions (e.g., cardiac, respiratory, vestibular, gastrointestinal).
• The root causes of panic disorder are multifactorial.
• Panic attacks are often misdiagnosed as heart problems; therefore, the patients are often admitted to the emergency room with the suspicion of a myocardial infarction.
• The prerequisite of a successful treatment for panic attacks is a proper diagnosis by an experienced psychiatrist.
• Panic attacks are a well-treatable condition. The most effective treatment method for panic disorder is the combination of medication and psychotherapy.

FAQs about Panic Attacks and Panic Disorder

In the below FAQ (Frequently Asked Questions), we summarised answers to the common question asked by our patients about panic attacks. A series of frequently appearing panic attacks is called panic disorder.

CHMC, is a German Clinic for Psychiatry and Psychology in Dubai. We offer comprehensive diagnostics and treatment for panic attacks and panic disorder.

What are panic attacks?

A panic attack is a sudden occurrence of intense, devastating fear that induces severe physical reactions without any real danger.

Where to get help for panic attacks in Dubai?

Question

I just arrived in Dubai and don’t know how the psychiatric care functions. In my home country, I’ve been diagnosed with panic attacks. Currently I’m taking Zoloft. Can I continue my treatment in your clinic in Dubai?

Answer:

We treat in our clinic the entire spectrum of psychiatric disorders, including panic attacks. You can call us and book a consultation. Before starting the treatment, we have to verify your diagnosis.

I visited a hospital in Dubai with chest pain, but they told me it’s a panic attack…

Question:

I have been admitted to the emergency room in a hospital in Dubai. The reason was chest pain and difficulty breathing. It felt like a heart attack. After having excluded any physical reason for my condition, they told me that it was a panic attack. Should I visit a psychiatrist?

Answer:

Symptoms of panic attacks can mimic a heart attack or asthma. Affected individuals experience heart racing, sweating, difficulty breathing, dizziness, and sometimes numbness or tingling in the fingers or in the face. Some people feel disconnected from reality.

What causes panic attacks?

Causes of panic attacks have various reasons. They can be triggered by ongoing stress, traumatic events, certain medical conditions, substance abuse, or a family history of panic disorder.

How long do panic attacks last?

Panic attacks typically reach their peak within minutes and then gradually subside. However, some symptoms may linger for longer periods.

Can panic attacks be prevented?

While it may not be possible to prevent panic attacks entirely, managing stress, getting regular exercise, practicing relaxation techniques, and avoiding triggers can help reduce the frequency and severity of attacks.

What treatments are available in Dubai for panic attacks?

if you are diagnosed with panic disorder (repeating panic attacks), you definitely need treatment. If the panic attacks are very frequent and devastating, you need immediate help, which is possible by using medication. In the first days, you will need anxiety medication addressing the symptoms “on the spot.” In parallel, your psychiatrist will prescribe an antidepressant, which is the most effective medication in suppressing panic attacks. Once the symptoms are fully under control, we would advise you to start psychotherapy. If your panic attacks are infrequent, like once or twice per month, you can use only the psychotherapy. The most common method of psychotherapy used for treatment of panic disorder is Cognitive-Behavioral Therapy (CBT).

Can I die on panic attacks?

While panic attacks can be extremely distressing, often mimicking a heart attack, they are not physically dangerous in themselves. However, they can lead to complications such as avoidance behaviours, depression, or substance abuse if left untreated.

Can panic attacks be mistaken for other medical conditions?

Yes, panic attacks can sometimes be mistaken for heart attacks or other medical emergencies. It’s essential to seek medical attention to rule out any serious underlying conditions.

I’m getting a panic attack once in 2-3 months. Can panic attacks go away on their own?

You are getting panic attacks sporadically, and if they don’t affect your life quality and work, you can wait and see what happens. One or two panic attacks per year don’t require treatment. However, if you get panic attacks several times per week, we recommend taking them seriously and seeking professional help. Panic attacks are always a sign of unconscious worries the individual is not aware of.

Can everyone develop panic attacks?

Panic attacks are relatively common and can happen to anyone, regardless of age, gender, or background. So, while they can be distressing and disruptive, panic attacks are life threatening. However, if you’re experiencing panic attacks, it’s essential to seek support from a psychiatrist or psychologist.

Can panic attacks happen for no reason?

Yes, panic attacks can occur seemingly without specific triggers. These are often referred to as “unexpected” or “spontaneous” panic attacks. While some panic attacks are triggered by specific situations, thoughts, or physical sensations, others can seemingly arise out of the blue. This unpredictability can make them even more distressing for individuals experiencing them. However, even in cases where no obvious trigger is present, panic attacks are still believed to be a result of the body’s natural response to stress and anxiety.

Are panic attacks dangerous?

Panic attacks themselves are not directly life-threatening. However, they can lead to complications in rare cases, especially if they occur in situations where safety is compromised, such as when driving or operating machinery. It’s essential for individuals experiencing panic attacks to seek proper medical evaluation to rule out any underlying health issues and to receive appropriate support and treatment.

Can a panic attack cause a heart attack?

Panic attacks do not cause heart attacks, but the symptoms of a panic attack can sometimes mimic those of a heart attack, leading to confusion. However, panic attacks do not result in the physical damage to the heart that occurs during a heart attack. It’s crucial to seek medical evaluation if you experience symptoms of either condition to rule out any serious underlying health issues.

What do panic attacks do to my body?

Panic attacks trigger profound physical responses, such as a rapid heartbeat, sweating, trembling, shortness of breath, chest pain, nausea, and dizziness. These symptoms represent the body’s instinctive reaction to perceived danger or extreme stress.

Which medications are used for therapy of panic attacks?

Medications commonly used for panic attack treatment include selective serotonin reuptake inhibitors (SSRIs) such as sertraline and paroxetine, as well as benzodiazepines like alprazolam or clonazepam. While benzodiazepines are used as emergency medication, antidepressants are the main medication used for middle- and long-term treatment.

Are there specific places where panic attacks happen?

Panic attacks can happen anywhere, regardless of location. They are not tied to specific environments but can occur in various settings, including public places, at home, at work, or while driving.

Who treats panic attacks?

Panic attacks should be treated by psychiatrists and/or psychologists. Primary care physicians can also diagnose panic attacks and refer individuals to specialists for further treatment.

Will panic attacks ever go away?

Panic attacks can be effectively managed and healed with appropriate treatment. However, more frequent is a progressive course of the panic disorder, increasing in frequency and severity. With proper treatment, ideally, with medication and psychotherapy, panic attacks can be healed.