Wellness Wednesday: How to Handle a Panic Attack

August 24, 2016

Most people are prone to some type of panic. After all, the unexpected bill or a threat to your safety or that of a loved one is a perfectly reasonable time to panic. But for those of us who suffer from panic attacks and/or anxiety disorders, what starts as the occasional moment of stress can spiral into daily (sometimes hourly) moments where the brain and body go on life-threatening alert. It can disrupt your day, and if left unchecked it can severely impact your life.

We reached out to our good friend, Dr. Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program, to help us define exactly what a panic attack is, define panic disorder, and give some helpful advice to manage it all:


First of all, what is a panic attack?

“The DSM-5 defined a panic attack in this manner: ‘A panic attack is the sudden onset of intense, intense anxiety that manifests in a very physical way; an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which four or more of the following symptoms occur.’ This can be, most commonly:

  • the feelings of having heart palpitations
  • a pounding heart or rapid heartbeat
  • sweating
  • trembling or shaking
  • sensations of shortness of breath or feeling like you can’t breathe
  • feelings of choking
  • chest pain
  • nausea or upset stomach
  • dizziness
  • lightheadedness, or feeling faint
  • feeling hot or cold
  • numbness or tingling sensations, usually in the hands or feet

A panic attack can also have this feeling of de-realization or depersonalization, feeling sort of detached from reality, of being detached from yourself. A lot of times, people have a secondary fear that comes over them, where they’re actually afraid they’re going crazy in that moment; and in some cases, the physical sensations are so intense that people feel like they’re dying, where a mortal fear that they’re having a heart attack or some other life-threatening health situation.

Many different things can precipitate a panic attack, and someone who has a panic attack doesn’t necessarily have panic disorder, which is the frequent recurrence of panic attacks that come unprovoked. Someone can have a panic attack as a reaction to a certain medication, for example, or they can have a panic attack if they’re really having a physical problem like a heart attack or in reaction to a very real, fear-inducing situation that precipitates an intense anxiety reaction complete with a flood of cortisol and all the stress hormones; the fight-or-flight reaction of the body. Essentially, a panic attack is an over-activation of the fight-or-flight response that really backfires, because it’s so intense that it actually ends up making people feel paralyzed.


Do you have to have panic disorder to have a panic attack?

“No. Commonly, people do but it is important to get a physical check-up if you’ve never had one before, just to make sure there isn’t something wrong with your heart. But once you’ve been checked out and you know it’s a panic attack, then you can sort of focus on how to control the emotional response. If the panic attacks continue to progress and happen more and more frequently without cause, then it’s time to talk to someone about panic disorder.

Let’s look at the evolution of this. An example might be where a traumatic experience happens, like a car accident or perhaps someone is attacked.  The next time they’re in a car or in a similar situation to where they experienced trauma, even if nothing is going on, they might have a panic attack. They might start avoiding taking the train, but then the panic attacks start happening at other times, and then the brain in its own logic tries to create causal relationships to the perceived trauma, and it can end up that people start avoiding all sorts of things that may or may not actually be the cause of the panic attacks. It can end up being very debilitating, because some people end up having panic attacks combined with agoraphobia, which means a fear of going outside. They end up getting shut in because the panic attacks are so terrible and come with such an overwhelming level of fear, the idea that you could experience it anywhere at any time becomes so overwhelming that it feels safer not to do anything that might precipitate it. But that’s unfortunately kind of an emotional trap, because in fact it’s not walking outside that’s causing the panic attack, but something that needs addressing in terms of the way the individual processes their own reactions to stress. Even the fear of a panic attack can precipitate a panic attack in certain situations.”


What’s the best way to handle a panic attack?
The key to managing panic attacks is to deal with the thoughts and feelings that are precipitating them when they’re not a direct cause of a fear-inducing situation. In terms of psychotherapy treatments, the most common and most evidence-based treatment is cognitive behavioral therapy, which is a type of psychotherapy that looks at your thoughts and feelings and behaviors to help you understand that, in fact, it’s not being in a crowded subway platform that causes the panic attack but the thoughts you have about it, including the fear of having a panic attack. If you can alter and challenge those patterns of thought along with working on how to control your feelings, you can be quite successful in conquering panic disorder.

Also, breathing exercises or other relaxation techniques can prevent the panic attacks from happening. There are other forms of therapy that are also helpful for panic disorder, such as psychodynamic therapy. Certain medications can help panic disorder in many cases.

In terms of helping, if you are having panic attacks, reach out and get help; you don’t have to conquer this on your own. Also, while avoidance feels good in the short term, it’s the thing that really perpetuates the panic disorder, so finding ways to conquer that avoidance is key. It’s often helpful to have a professional help you do that in a way that’s safe. If you can conquer the causes of the panic attacks in a systematic way with help, panic disorder actually has a very good prognosis for most people.

Also, be aware that panic attacks can also often occur with other problems, such as major depression or substance abuse disorders. If you’re having panic attacks and you also have depression, another anxiety disorder, or substance abuse disorder, it’s even more important to get help.”


How can you help manage your panic attacks? Can you do anything to prevent them?
People are more likely to have a panic attack when they’re sleep-deprived, when their internal resources are depleted. Also, if you’re overly hungry and haven’t nourished your body, you’re much more likely to be in a high-stress physical state, which could put you at more risk for panic attacks. So, sleep and nutrition absolutely are important. Exercise also really helps many people. It helps actually tone the emotional and physiological responses to stressful situations, and can be very helpful both in managing psychological anxiety as well as physiologic response to anxiety. So sleep, nutrition, exercise, reaching out for help, talking about it, helping your loved one understand what’s going on and what they should do if you’re having a panic attack – all of that can be incredibly helpful before they begin and to help you during and afterwards.”