Panic attacks
A panic attack is an episode of sudden, intense fear, accompanied by sweating, trembling, shortness of breath, choking, tachycardia and a feeling of impending doom. The person experiencing it fears losing control, fainting, going mad or dying suddenly.
What is a panic attack
L'panic attack is an episode of sudden, intense fear, accompanied by sweating, trembling, shortness of breath, choking, tachycardia and a feeling of impending doom. The person experiencing it fears losing control, fainting, going mad or dying suddenly.
While panic is a natural response to stressful or dangerous situations, some people can fall into the vicious cycle of 'fear of fear', living in dread of future attacks. Anticipatory anxiety and the attempt to prevent them from recurring have the side effect of contributing to the development of panic disorder (PD).
DP is characterised by frequent panic attacks that can occur in a wide variety of situations. If, initially, the person tends to avoid only those circumstances in which he or she has been ill, later the avoidance may become so generalised that it contributes to the onset of agoraphobia.
The causes
Although the causes may vary from person to person, it is known that certain factors increase the risk of developing this condition. Here are some of them:
- Stressful situations such as bereavements, separations, health, work or economic problems, family conflicts
- Traumatic experiences such as accidents, psychological, physical and sexual violence
- Biological predisposition, familiarity
- Specific phobias
- Depression
Symptoms of panic attacks
Panic attacks cause both physical and emotional symptoms.
The first include tachycardia, nausea, confusion, sweating, uncontrollable shaking, muscle tension, dizziness, tingling, blurred vision and shortness of breath.
Emotionally, the person most often experiences an intense fear of going mad, losing control, dying or fainting.
An attack may last between 5 and 20 minutes and may be unexpected, like a bolt out of the blue with no apparent cause, or expected, i.e., accompanied by a series of anticipatory signals that the person is able to recognise.
How can we help you?
Cognitive Behavioural Therapy is considered the treatment of first choice for panic disorder and can achieve significant results in 70-90% of cases.
The intervention protocol, described below, is based on the model proposed by Dr David H. Barlow, one of the leading experts on the subject.
Respiratory trainingIt teaches how to recognise and control hyperventilation, one of the main symptoms of the problem, by learning specific deep abdominal breathing techniques.
Exposure to enterceptive stimuliThis technique involves gradual and controlled exposure to physical sensations similar to those of a panic attack, in order to learn strategies that facilitate recovery and reduction of unpleasant feelings. Exposure to enterceptive stimuli helps to understand that symptoms and beliefs do not necessarily have to evolve into a full-blown attack.
Cognitive restructuringIt helps to identify and become aware of automatic negative and catastrophic thoughts that occur during panic attacks. With the use of diaries and cards, one begins to guide the person to take an attitude of empirical and critical verification towards such thoughts and to identify more functional and realistic alternative explanations.
Exposure in imagination and in vivoExposure therapy aims to encourage individuals to face feared situations (both in reality and in imagination) without avoiding them, learning to tolerate the anxiety they arouse. The therapist accompanies the patient in confronting anxiety-provoking circumstances, in a gradual manner, starting with those that create less discomfort to those that are more difficult. In a first phase of treatment, as in agoraphobia, it is possible to deal with the situations avoided in imagination, through systematic desensitisation. Subsequently, when the anxiogenic charge is reduced, one moves on to gradual exposure in reality.
Homeworks
In the course of treatment, the therapist agrees with the patient on the performance of 'homework' in order to promote a generalisation of the skills learnt, greater autonomy and self-efficacy. Any difficulties, progress or setbacks become the subject of discussion during the sessions.
Psychotherapy for anxiety disorders: what to expect
Psychotherapy is a collaborative process in which therapist and patient work together to identify specific aspects of anxiety and develop concrete skills and coping techniques.
Patients will be able to practise the newly learnt skills in their daily life and learn to deal gradually with situations that can generate discomfort in them. The psychotherapist will not push the person to confront these situations until he/she has acquired the necessary skills to manage fear.
Anxiety disorders respond very well to cognitive behavioural treatment. The majority of patients report a reduction, if not complete resolution of symptoms after only a few months of therapy, and many notice improvements after only a few sessions.
Therapists receive highly professional training and are able to tailor each treatment to individual needs. (Panic attacks. How to get out of them. The power of Cognitive Behavioural Therapy. Enrico Rolla, 2017, IW editions)
Pharmacological treatment
Anxiety disorders can severely interfere with a person's ability to function at work, at school and in social situations. Anxiety can also interfere in relationships with family and friends. Fortunately, there are valid treatments.
In some cases, medication can help manage these disorders. However, research shows that behavioural therapy, alone or in combination with medication, is an extremely effective treatment for most people with anxiety disorders.
Should they be assessed as necessary, the most common pharmacological options include:
- Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side effects, they are recommended as drugs of first choice for the treatment of panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs). These drugs are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is approved by the FDA for the treatment of panic disorder.
- Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally only used in the short term because they can be addictive, causing mental or physical dependence. These drugs are not a good choice for those who have had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.
Antidepressants can take 2 to 4 weeks to take effect and up to 8 weeks to work completely.
Once pharmacological treatment has been started, it is important not to stop it abruptly and to monitor its effects in collaboration with the referring psychiatrist and psychotherapist to assess any changes in the treatment plan.