Panic Disorder Treatment

Panic disorder and panic attacks often overlap and can be confused with one another. Everyday expressions such as ‘having a nervous breakdown’ may also be incorrectly labelled as a panic attack or panic disorder. Here, we will clarify concepts such as panic attacks, panic disorder and agoraphobia.

What is a panic attack?

It is a state of intense fear, anxiety and distress that begins suddenly, rapidly intensifies, and has a beginning and an end. Symptoms often intensify and reach their peak within about 10 minutes, then usually subside gradually.

What symptoms occur during a panic attack?

• Palpitations, sweating, trembling,
• Shortness of breath or a feeling of not getting enough air, a feeling of choking,
• Chest pain or discomfort,
• Nausea, abdominal pain,
• Dizziness, lightheadedness, feeling faint,
• A feeling of detachment from your surroundings or yourself,
• Fear of losing control, going mad or dying,
• Numbness, tingling
• Feeling cold, chills, hot flushes, dry mouth

An episode in which 4 or more of these symptoms occur within minutes is called a panic attack.

Are panic attacks and panic disorder the same thing?

Having a panic attack does not mean you have a mental illness. Panic disorder, however, is a mental illness. If you have recurring panic attacks and worry between attacks that another one will happen, and the attacks significantly affect your life, functioning and lifestyle, this is referred to as panic disorder. Anyone can experience panic attacks in response to certain stressors or occasionally over the course of their life. This does not mean that the person has a mental illness. In other words, a panic attack can happen to anyone.

During panic attacks, people often have thoughts such as ‘I’m going to die’, ‘I’m going mad’, ‘I’m losing my mind’ or ‘I’m having a heart attack’. They interpret the physical and psychological symptoms they experience during the attack in catastrophic terms. During an attack, the body interprets a fleeting thought or a physical symptom as a catastrophe, a sign that danger is present.

Because they feel as though they are choking, the person begins to breathe faster and more deeply to relieve this feeling of air hunger. The belief at that moment that there is danger, and the fear and anxiety this creates, activate the body’s sympathetic nervous system (the system that rapidly kicks in to protect the body in situations that evolution has primed us to recognise as dangerous).

One of the flight, fight or freeze responses is activated. Blood flow to the skeletal muscles increases. Blood flow to the extremities decreases, the hands and feet become cold, the skin turns pale, and sweating and trembling occur. In response to this stimulating effect of the sympathetic system, the parasympathetic system activates within minutes, working to slow the body down and restore balance. The attack usually lasts no more than 20-30 minutes and ends on its own.

What to avoid during panic

In an attempt to escape this distressing state, the person often tries to breathe faster and more deeply, further fuelling this vicious cycle. Although actions such as going to the emergency department, leaving the situation, avoiding places where a panic attack might occur, drinking alcohol or taking sedative medication may provide immediate relief, they make panic disorder more persistent in the long term.

Remember that even if nothing is done, the body’s own mechanisms for restoring internal balance will activate, and the panic attack will naturally end on its own.

No panic attack lasts forever.

When should you see a psychiatrist?

If panic attacks recur, you experience fear and anxiety about having another attack between episodes (anticipatory anxiety), you avoid certain places or situations because of a fear of panic attacks, and your daily life and quality of life are affected, you should see a psychiatrist.

What can you do during an attack?

The most appropriate approach is to continue whatever you are doing at that moment. Many actions taken to try to stop or suppress an attack will perpetuate the attacks in the long term.

Panic disorder treatment

Panic disorder is a treatable illness. Cognitive behavioural therapy and medication can successfully treat around 80% of cases. Unfortunately, when medication is used alone, the risk of recurrence after it is stopped is high. For more lasting treatment, changes in thinking, thorough psychoeducation and a behavioural approach therefore substantially reduce the risk of recurrence.