By Annabelle Parr, MA, AMFT
We’ve all felt anxious at one point or another. Anxiety involves worried thoughts about a possible future threat or unpleasant situation; it is a natural human emotion, evolutionarily wired to help us anticipate and prepare for or avoid danger. Anxiety can be adaptive, but it can also start to become like a smoke alarm that goes off in the absence of a fire…when this occurs, what we refer to as an “anxiety disorder” can develop.
What makes an anxiety disorder?
There are a variety of different anxiety disorders, or ways in which anxiety can take on a life of its own. At the core of each one is worry about an anticipated future scenario perceived to be threatening or uncomfortable, difficulty with uncertainty around whether the feared outcome will occur, and resulting functional impairments (i.e. the anxiety is getting in the way of your ability to function in your work, school, relationships, etc.).
What are panic attacks?
One feature that can occur within or outside the context of any anxiety disorder is panic. Sometimes referred to as “anxiety attacks,” panic attacks involve a handful of distressing physiological symptoms, such as racing heart, shortness of breath, choking sensations, numbness or tingling, sweating, and/or catastrophic thoughts such as “I’m dying” or “I’m going crazy,” as well as possibly feeling detached from one’s body or surroundings. Panic attacks typically peak within about 10 minutes, though it can feel like much longer. They can occur seemingly out of the blue, or they can follow an identifiable trigger.
If I’ve had a panic attack, does that mean I have panic disorder?
Many people have experienced a panic attack before; anyone who has can tell you that panic attacks are unpleasant to say the least. But what distinguishes a panic attack from panic disorder is how the person responds to the panic. Panic disorder can develop when the person begins to fear panic itself, including intense anxiety about the possibility of subsequent panic attacks, changes in behavior designed to avoid or prevent future attacks, and significant functional impairment, lasting for at least one month.
For example, if you are struggling with panic disorder you may begin to avoid activities that raise your heart rate, such as drinking coffee, exercising, or walking up or downstairs out of fear that an increased heart rate will trigger a panic attack. Avoidance of these activities may make it difficult to leave the house or go to the office, and can get in the way of engaging in your life and relationships in the ways you desire.
Attempts to avoid anxiety are at the core of every anxiety disorder.
It makes sense to want to avoid the intense anxiety that comes with panic attacks. The problem is that when we become so focused on trying to avoid anxiety, our lives can begin to revolve around trying to prevent it. This restricts our behavior and makes our lives smaller; instead of making choices based on what is important to us, we make choices driven by fear.
What’s the alternative?
The good news is that avoidance is not our only option. Both Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are evidence based treatments for anxiety disorders, including panic disorder. Each approach typically involves at least some component of exposure work, which essentially involves a therapist working with you to help you begin to learn that anxiety is uncomfortable, but not dangerous. The purpose of exposure is to elicit the feared discomfort and to help you learn more flexible ways to respond to it.
From a CBT perspective, we view anxiety disorders as driven by two main errors in thinking:
We overestimate the likelihood of catastrophe or our feared outcome.
We underestimate our ability to handle it if the feared outcome were to occur.
Exposure is designed to help you face the things you fear, and generate new learning around these faulty beliefs. From an ACT perspective, the goal is to increase your ability to flexibly respond to uncomfortable experiences so that you can begin to make conscious choices about what to do based on your own personal values, rather than based on a fear of fear itself.
IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.