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Wait... Should I panic now?! (A General Guide to Understanding Panic Attacks)

The image is of the panic attack cycle with some tips for different things that a person can do both when not having an attack and during an attack.
The Panic Attack Cycle starts with something triggering a racing heart which causes an automatic sensory reflex along with unhelpful thoughts and fearful emotions. This leads into a panic attack which inevitably ends and leaves a sense of relief. The relief may or may not last, and at some stage it is likely that some anticipation of another attack will occur, which kicks off the cycle again.

What is a Panic Attack?

Most people who have experienced panic attacks will simply tell you, "It's the worst feeling in the world." It is often described as feeling like you are going to die, that you can't breath, and that you need to get away. Although sometimes able to link to a clear trigger, many times it is hard to trace what started a panic attack as they often seem to come out of nowhere, or can even happen during sleep. In general, however, almost always there was a physiological experience of the heart racing for some reason - whether due to too much caffeine, smelling or hearing something that was reminiscent of a trauma, thinking about stressors, engaging

A picture depicting the list of symptoms of panic attacks.
Panic Attack Symptoms: Note that all panic attack symptoms in blue are physical; there are only two which would be considered emotional/ mental which are underlined in yellow.

in high intensity exercise (though it's not the exercise alone that's linked to a panic attack, it's the increased heartrate combined with unhelpful thoughts magnifying the intensity of the heartrate and focused on the potential that something must be wrong, or that it must be going to lead to a panic attack, for example), having a dream, or any number of other situations or reasons.

Once the heart starts racing, a false alarm is triggered resulting in reflexive sensations, thoughts, emotions, and actions. People spend on average 1-10 minutes in a state of noticing the different reflexive sensations being activated, as well as will generally move to an interpretive response fueled by unhelpful thoughts distorted by magnification (thinking something is bigger than it is) and fortune telling (predicting a negative outcome, like a panic attack or death) along with emotions of dread, terror, and/ or intense fear. These symptoms eventually become so piqued that a full panic attack emerges. The attack itself will typically last 10 - 20 minutes. There will then be a period of relief, which can be of any duration. Sometimes, a person will rapidly move back to anticipating a panic attack, the heart will start racing again, and another full cycle will transpire immediately, sometimes several times in succession. Usually, however, the period of relief will be longer - even up to years, and if some anticipation starts to be noticed, working on noticing these thoughts and retraining them or letting them go can often successfully prevent further attacks.

About 2/10 people will have at least one panic attack in their lifetime. The first panic attack a person has is often associated with a traumatic experience, and future panic attacks are often brought on by situations that evoke similar fearful feelings. This anticipatory fear of having further attacks, or about potential consequences of the attack can cause avoidant behaviour - which is modifying one's behaviour to avoid the attacks. This can not only increase stress/anxiety (which increases the likelihood of another attack, but can also lead to Agoraphobia if it becomes severe. Panic Disorder develops in around 4/100 people. Having panic attacks does not automatically align with meeting the diagnostic criteria for a panic disorder.

Why are panic attacks considered a "false alarm"?

With a panic attack, although it can feel like you are going to die, this is not what happens. In fact, the one thing that is absolutely true of all panic attacks is that they all end, no matter what one does or does not do during the attack. People often also feel like they will faint during an attack; this almost never happens. In other words, although the level of fear is intense, there is no real danger (or certainly so little danger that there's no logical reason to sound the alarm). So panic attacks are like a faulty smoke alarm - the alarm is going off, but there's no fire. So ideally, if we can learn to disarm the alarm (ie. take the batteries out), or at least learn to ignore it, there's hope that we can move through a panic attack just like how we would move through a smoke alarm going off while dinner is being cooked - maybe take a breath, perhaps mutter in a bit of frustration, but ultimately keep doing what needs to be done without going into a full panic response.

What helps when having a panic attack?

As mentioned above, the one thing that is true of all panic attacks is that they will end no matter what you do or do not do. That being said, it can be beneficial to have some ways to ride out the wave, and this can be done by either leaning in to the panic, or by finding ways to tolerate the distress of the panic a bit more comfortably. In the image at the start of the article, some of these ideas are captured in the "Red Zone Options."

Leaning Into Panic

One option to lean into a panic attack (which is beneficial because it can help decrease sensitivity to future panic attacks) is to fill out a Panic Diary. This technique helps by giving something to focus on during the attack, can build insight, and helps stay with the experience instead of what most people want to do during (ie. make it stop/ avoid it). Here is a sample template that can be used.

The picture is of a sample panic diary template with prompts for what to write about during or immediately after a panic attack.
Sample Panic Diary Template

Tolerating the Distress of the Panic

Another option during a panic attack is to practice distress tolerance skills or find ways to stabilize and ground. A useful acronym to keep in mind for this is ACCEPTS as seen in this image. The idea here would be to create a list of options one can turn to during a panic attack to be a bit more comfortable in as healthy a way as possible while having a panic attack.

The image is of ACCEPTS: Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts, Sensations
ACCEPTS is an acronym that can be used to create a list of distress tolerance skills.

What helps prevent panic attacks?

In good news, we can practice ACCEPTS when not panicked to help not only decrease the frequency and prevalence of panic attacks, but also to train up for times where one may experience a panic attack. Additionally, building self awareness, doing things to decrease stress and anxiety, catching unhelpful thoughts and retraining them or letting them go, and practicing good self care can be prioritized and built in. Some further suggestions can be seen in the "Green Zone Options" in the image at the start of this article.

Further, therapy such as EMDR, CBT, DBT, ACT, and Mindfulness can all help reduce or eliminate panic attacks. Medication may also be an option and should be explored with a doctor, nurse practitioner, or psychiatrist. (And please note; this article is not meant to be a substitute for therapy - if you are struggling with panic attacks, please consult with your medical team and consider working wit a qualified therapist.) We have several clinicians on our team who have a specialized focus on anxiety and panic who can help.

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