Niamh Delmar is a Chartered Registered Counselling Psychologist and provides Psychological Support Workshops to work environments. Here she writes about coping with panic attacks or helping someone else with theirs.
What are they?
The physical sensations of panic attacks are so intense that people sometimes end up in A&E. It feels life-threatening and the person is overwhelmed with feelings of terror. The mind races, conjuring up worst-case scenarios such as: "I’m going to die, have a heart attack or go crazy."
Having a panic attack generates the fear of having another one. This 'fear of the fear’ places the person on high alert. The stress response gets activates emergency reactions. However, there is no emergency as it is a false alarm. There is a glitch in the link between the amygdala and the prefrontal cortex of the brain.
The amygdala, (the emotional centre) sends a distress signal to the hypothalamus (the command centre) which sends messages to the adrenal glands, releasing adrenaline and cortisol. Research has linked panic attacks to increased cardiovascular morbidity and mortality so assessment and treatment are vital.
Symptoms
Imagine yourself asleep in bed at night. You awake to an intruder barging into your room and see a figure with a balaclava on. You will go into fight, flight or freeze within seconds. That’s what it feels like in the middle of a panic attack, except there is no actual threat.
Some people experience panic attacks in relation to specific triggers. The Diagnostic and Statistical Manual (DSM-V) categorises panic attacks as "expected", which are associated with a specific fear and "unexpected", which have no specific trigger. Panic disorder is when recurrent panic attacks feature.
On average, a panic attack lasts 10-15 minutes but can last for longer. Symptoms include increased heart rate, hyperventilation, heightened senses and feeling a loss of control. As the body accelerates to high alert, a person may experience nausea, cramps, dizziness, chills, shaking and tingling or numb sensations.
People sometimes describe it as having an out-of-body experience. Derealisation (feelings of unreality) and depersonalisation (being detached from oneself) often feature. Post-panic attack, people experience an ‘adrenaline hangover’ and are left feeling fatigued, sore, shaky, dizzy or nauseous.
Contributing factors
Biological, psychological and environmental facets have been identified as risk factors. Biological influences include having a family history or hormonal shifts. An anxious temperament and anxiety-related personality types may predispose someone.
Substance abuse has been found to be associated with the maintenance of panic attacks and escalating symptoms. Hangovers after a night of drinking alcohol often lead to ‘hangxiety.’ This a mini withdrawal from alcohol which can leave the person vulnerable. Heavy drinking can deplete GABA, a chemical in the brain, which increases panicky sensations.
Psychological characteristics also interplay, such as high anxiety sensitivity (checking the body to make sure it is ok) and a fear of physical and mental health issues. Interoception and scanning aggravate symptoms.
Overdoing it contributes to stress and burn-out resulting in elevated anxiety levels, leaving a person more susceptible. Thought processes and emotions, such as overthinking, anxiety-provoking thoughts and emotional dysregulation, disrupt psychological equilibrium.
The context within which a person has lived, or is living, is also significant. Extreme life events and ongoing stress have been found to be associated with the onset of panic attacks. Family dynamics, adverse childhood experiences, trauma, and major changes are also often reported. Sometimes, it is after a crisis has eased that a person is then faced with panic attacks.
What to do when you're having a panic attack
Assessment is central to understanding the nature and course of panic attacks, and in identifying any underlying disorders, such as PTSD. Psychoeducation is an important aspect of treating panic attacks. This information helps the person to understand what is happening and dispel any misinterpretations. You can infuse or diffuse the panic with your reaction. How you respond to the attack influences the outcome.
Having a practised action plan to help with the intensity can reduce ‘the fear of the fear’.
Firstly, have a script ready so the self-talk is logical and brave. For example: "This is adrenaline, there is no emergency, it will pass, I can handle this."
Secondly, work with your breath to ease hyperventilation. The 7/11 technique involves breathing out for 11 seconds and in for 7 seconds and repeat for 50 breaths and again if needed. Some people benefit from box breathing. Try to relax the muscles in the body by dropping the shoulders, loosening the jaw and other areas of tension.
Thirdly, refocus your attention to something else. Have a list of healthy distractions to turn to. Grounding techniques are effective and help you feel in control. They can be sensory, physical, cognitive or emotional. The 3 3 3 rule involves looking around you to identify 3 objects and three sounds, then moving 3 different parts of your body. If panic attacks intrude with your functioning and are extreme and intolerable, you need to talk with your GP and engage in evidence-based treatment with a mental health professional. Therapy needs to be grounding, not anxiety-inducing.
Long-term changes
According to Psychologist David Clarke what maintains panic attacks is a misinterpretation of body sensations, scanning for body sensations and avoidance and safety-seeking behaviours. For long-term gains and relapse prevention, lifestyle factors need to be adjusted.
Identify stressors and explore all options. Activities, interests, daily exercise and healthy interactions will help. Caffeine, sugar, alcohol, cigarettes and drugs are best avoided. Good quality sleep is essential.
Many people find that mindful practices are beneficial to wellness maintenance. Psychoeducation gives valuable information to support someone having panic attacks. Gradually, try to do some things you have been avoiding.
How to help someone having a panic attack
To help someone experiencing a panic attack, be a calming presence, encourage them to breathe as mentioned earlier. Remind them it will pass and that there is no danger. Use encouraging words such as: "You’ll get through this".
Move them to somewhere quiet and comfortable. Give the person space but be nearby. Your presence can be a comfort. Try not to talk too much and remain neutral. Afterwards, encourage the person to get some intervention.
It can get better, become less frightening and be managed with a systematic approach.
If you have been affected by issues raised in this story, please visit: www.rte.ie/helplines.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ.
