Panic attacks can be dealt with if one accepts them as a natural process, writes Dr Harry Barry.
THEY CAN strike without warning, cause chaos in the lives of sufferers, lead to the dreaded "fear of fears", where the latter live in constant dread as to when they will reappear - we call them "panic attacks" and they do indeed cause just that!
Some will get them as part of a more general anxiety disorder; others as a harbinger of depression; others as an unwelcome accompaniment to addictions. But in most cases they seem to have no particular trigger and a life of their own.
Take Mary, for example, who at work suddenly feels her heart beating faster, stomach going into knots, mouth dry, dizziness, shaking all over, difficulty breathing and an overwhelming certainty that a heart attack/stroke/imminent death is about to happen.
She alerts her work colleagues; the ambulance is called and she arrives in the jungle of her local AE; has numerous tests done; eventually to be told she is quite healthy and leaves feeling foolish and terrified that it will happen again and her workplace friends will think she is nuts. Welcome to the world of panic attacks.
In practice, they are simply adrenaline rushes, where the stress box in our emotional brain triggers the adrenal gland to release bursts of this hormone as if we were defending ourselves against a mugger (to fight or flee). It is adrenaline that causes the symptoms.
The good news for Mary and all with this condition is that help is at hand in the form of CBT. It provides a simple explanation/treatment that is drug-free and highly effective. Through its eyes let's examine her above attack.
Mary starts by getting simple physical symptoms as described above, then assigns a danger to them - she is going to get heart attack/stroke/die/make a fool of herself. She then demands that the symptoms go away, making her more anxious and triggering full-blown panic. Finally, she looks for reassurance/safety by going to AE.
CBT would teach her that she must firstly realise a panic attack, purely an adrenaline rush, will last only 10-15 minutes if she does nothing, lasting much longer if she tries to stop it.
She would learn that this adrenaline rush is a normal function of the body, useful if we are being attacked and commonly released when we are anxious.
So the actual physical symptoms of a panic attack represent little more than an acute anxiety-related adrenaline rush - unpleasant but not dangerous.
Secondly, it would counsel that safety behaviour like taking tranquillisers, doing breathing exercises or chasing off to AE only convinces the emotional brain that something terrible must be happening, prolonging the attack.
Lastly, it would help her examine the initial trigger - the original physical symptoms.
They are of course symptoms of ordinary anxiety that only become a problem when we assign a danger to them. She would be taught that symptoms of anxiety are uncomfortable but not dangerous. To consolidate this thought, she will be asked about her last episode - did she die?
By learning to accept that these symptoms are uncomfortable rather than dangerous, she will no longer demand they go away and stop triggering the actual panic attack itself.
She would finally come to the realisation that a panic attack is little more than becoming anxious about being anxious. In practice we all suffer (some more than others) from anxiety but are unaware that physical symptoms accompany it.
In my own practice I encourage the patient to go through on paper the above sequence (as this encourages the logical brain to get involved). I start by discouraging them from ever trying to stop a panic attack, instead accepting them as an uncomfortable but brief episode that will pass quickly if they don't. I tell them never to involve themselves in safety behaviour like tranquillisers/complex breathing exercises, rather to go with the flow. I even recommend the person tries to bring them on so they can learn to deal with them.
I then target their initial anxiety symptoms and the danger assigned to them, helping them to understand the key to it all. Symptoms of anxiety are uncomfortable but not dangerous - crack that and you are set to banish panic attacks for good.
Underlying depression or significant anxiety/addiction may need further work; otherwise the person has a life-long tool through CBT to rid anxiety about anxiety from their lives.
Dr Harry Barry is a GP in Drogheda