isolation

When Panic Sneaks Up and Attacks

by Annabelle Parr 

It’s a regular Thursday morning and John is driving to work along the same stretch of freeway that he drives every day. He is having a stressful week, but his mind isn’t dwelling on anything in particular. His thoughts bounce from what to make for dinner to an errand he has to run during lunch to a meeting he has this afternoon. He doesn’t feel particularly anxious.

Suddenly, his heart starts racing and his palms begin sweating. He can’t explain what is happening; it doesn’t make sense to him. First he feels confused, then he begins to worry that something is wrong. He starts to feel short of breath and then he begins to feel as if he is going to faint. Because he is driving, he is afraid that if he passes out, he will crash and die.

John doesn’t know what happened to him. He worries it may have been a heart attack, but when he goes to the doctor, he learns that it was actually a panic attack. He is confused because he didn’t feel afraid or anxious prior to the attack. His doctor explains that you don’t have to feel panic to experience a panic attack.

Our body is built to respond adaptively to danger.

At some point or another, we have all experienced the feeling that our safety is being threatened. We know what it’s like to feel consciously afraid and to feel our body physiologically preparing for danger. Our heart starts racing, our palms start sweating, our breathing gets shallow, and our muscles tense up. Our body goes into fight-flight-or-freeze mode to help us respond adaptively to whatever threat we are facing.

Panic attacks are the body’s way of trying to prepare us for an unconscious perceived threat.

Sometimes, our body responds to a threat that our conscious mind is not aware of. This is what happened in the above example. When we do not feel afraid, the physiological response itself can feel threatening and overwhelming. This exaggerated and unexplained response can result in a panic attack. Panic attacks create the feeling that your body is turning against you rather than working to help you. What may once have been an adaptive response to an external threat has morphed into what feels like a threat coming from within.

What is a panic attack?

A panic attack is defined as the abrupt onset of intense fear or discomfort that peaks within several minutes. Panic attacks can emerge from a calm state or an anxious one, making them difficult to predict. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V), a panic attack includes at least four of the following symptoms:

  1. Palpitations, pounding heart, or accelerated heart rate
  2. Sweating
  3. Trembling or shaking
  4. Sensations of shortness of breath or smothering
  5. Feelings of choking
  6. Chest pain or discomfort
  7. Nausea or abdominal distress
  8. Feeling dizzy, unsteady, light-headed or faint
  9. Chills or heat sensations
  10. Paresthesia (numbness or tingling sensations)
  11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  12. Fear of losing control or “going crazy”
  13. Fear of dying

What’s the difference between a panic attack and panic disorder?

Panic disorder can develop when a person experiences recurrent and unexpected panic attacks, and develops a persistent concern or worry about additional panic attacks or their consequences and/or significant maladaptive behavior changes related to the attacks. It is possible to experience panic attacks without having panic disorder.

Are panic attacks dangerous?

People experiencing panic attacks often end up in the Emergency Room worried they are having a heart attack. While uncomfortable and overwhelming, a panic attack itself is not dangerous. But because they can arise unexpectedly, it can feel as if they are. If we have just been on a long run or are about to give a big presentation, we know why our heart is pounding or our palms are sweating. But when our heart begins pounding and we start trembling and we can’t figure out why, these symptoms are frightening. They seem to originate within our body rather than as a response to something external.

Is it all in my head?

Absolutely not. While panic attacks are psychologically rooted, they result in a very real physiological response. And though a panic attack may seem to arise out of the blue, there is always an external trigger. Our minds detect a threat, whether consciously or not, and our body responds accordingly. A feedback loop then ensues as our mind interprets our physiological response as threatening, and our body continues to attempt to prepare us to address a threat.

If you experience a panic attack, there is nothing to be ashamed of. It’s not a sign of weakness or that you are going crazy. It’s not your fault. Though it doesn’t feel this way, a panic attack is your body trying to help protect you.

Are panic attacks permanent?

No, panic attacks do not have to be a permanent fixture in your life. Though you do not cause yourself to have a panic attack, you can learn how to prevent and manage them. Panic disorder is one of the most treatable disorders, and Cognitive Behavioral Therapy has been proven to be a highly effective form of treatment.

Cognitive Behavioral Therapy

Psychoeducation and understanding what is happening in the mind and body during a panic attack is a big part of healing. Treatment also involves examining triggers, teaching clients skills to address the acute symptoms of the attack as well as the overall stress level, and using repeated exposures. Exposure therapy incorporates an experiential piece into treatment, where the client is incrementally exposed to the feared situation and learns that they will survive.

Cognitive Behavioral Therapy can help clients to overcome the fear of panic attacks themselves, and empower them to face the situations that they may have previously avoided in order to try to prevent an attack. Clients can learn that not only will they survive a panic attack, but that they can actually move on and begin to thrive.

beth-tate-188119.jpg

If you are experiencing panic attacks, avoiding situations you fear could trigger an attack (driving, crowded spaces, public speaking, etc), or find that your day to day functioning is impacted by anxiety, you could benefit from Cognitive Behavioral Therapy. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.

When Pain Demands To Be Felt

by Annabelle Parr

We all struggle at some point in our lives. To hurt is to be human, no matter how much we want to avoid it. For most of us, our natural, reflexive reaction is to try to move away from pain. But avoidance will not serve us; it only brings us more anguish in the long run. The response that will serve us best is to feel. As author John Green (2012) wisely put it, pain demands to be felt.

Instead of viewing emotional pain – grief, loss, sadness, anxiety, stress, fear, or even depression – as a threat or as something inherently bad, we can get curious about these feelings, the wisdom they offer, and the purpose they serve. As Rumi reminds us in the poem The Guest House, every emotion is simply a guest. No emotion is ever permanent, but each one serves a purpose. “Each has been sent as a guide from beyond,” so we should learn to sit with each emotion and ask why it is present.  

It can be scary to make contact with the pain that life brings, especially if that is exactly what you have been trying to avoid doing your whole life. It can feel overwhelming and unknown. A therapist can model for you how to approach your pain with mindfulness and compassion, showing you how healing that experience feels, and teaching you to approach yourself and your emotions in the same way. They can help you learn that leaning into the feeling does not mean that the emotion controls you, but rather that you are simply giving it the space it needs to move through you. They can help you to come alongside whatever is causing you pain, and look at it more deeply with you so that you can begin to heal, instead of staying stuck. In fact, the connection that comes from leaning in with someone who profoundly sees and hears you can be incredibly healing.

The more we are able to embrace the pain in our lives, the more deeply we will feel those things that we all desire: love, joy, connection, and peace. Because emotions are not actually opposites, but two sides of the same coin. To know love is to know loss, to know joy is to know sadness, to know connection is to know isolation, and to know peace is to know conflict. And as Brené Brown (2010) reminds us, “you cannot selectively numb emotion. When we numb [hard feelings], we numb joy, we numb gratitude, we numb happiness.”

Here are some tips based on mindfulness and cognitive behavioral therapy for you to begin this process of being with pain, thereby allowing the wisdom inside you to emerge:

  • Practice RAIN (Brach, 2013). This mindfulness acronym can help us to connect to the moment and to our feelings in a meaningful way.
    1. Recognize what is happening. Name your thoughts or emotions, or any feelings or sensations you are experiencing.
    2. Allow life to be as it is. Do not try to suppress or push away the discomfort that may accompany your thoughts or feelings. Simply allow yourself to be as you are.
    3. Investigate with kindness. Connect more deeply with what you are experiencing, using a gentle curiosity to delve into your experience. You might think about how you are experiencing your feelings in your body, or perhaps ask what it is your feelings want from you.
    4. Nonattachment. Rest in the natural awareness that your thoughts and feelings do not define you or your identity.
  • Pick up a good book that offers some helpful wisdom regarding being with our emotions. Here are some suggestions: Constructive Wallowing by Tina Gilbertson, Radical Acceptance by Tara Brach, Daring Greatly by Brene Brown.
41wstyPkVNL._SX310_BO1,204,203,200_.jpg
  • Remind yourself that pain is a universal.  No person is impervious, although its content varies by person. Therefore, try not to compare your pain to others.  "Pain, no matter, how large or small, is still painful," and needs our attention.
  • Consider the Acceptance and Commitment Therapy (ACT) concept, "pain can be our ally." When we are hurting, often that pain can remind us of what is most meaningful, and help you to turn your attention to how you can get your values better fulfilled.
  • Practice using compassionate self-talk and self-love. For example, say to yourself “no wonder I feel this way.” Put a hand on your heart, cradle your face, or even give yourself a hug. Small gestures and touch have been shown to be very healing. Try this self-compassion exercise from Kristin Neff if you need a little guidance:

http://self-compassion.org/exercise-2-self-compassion-break/

  • Reach out to a friend or family member for support.
  • Contact a professional if you feel you could benefit from some deeper exploration. 

If you or a loved one might be interested in mindfulness, acceptance and commitment therapy (ACT) or cognitive behavioral therapy (CBT) for stress, anxiety, depression, trauma, grief, weight, eating, body image, substance use, or challenges related to relationships, work, or other life transitions, Dr. Shoshana Shea can help. If you would like more information or if you are interested in setting up an appointment, please contact her at 619-269-2377 or shoshanashea@gmail.com.

References: 

Brach, T. (2013). Working with difficulties: The blessings of RAIN. Retieved from https://www.tarabrach.com/articles-interviews/rain-workingwithdifficulties/

Brown, B. (2010). Brené Brown: The power of vulnerability. [Video file]. Retrieved from http://www.ted.com/talks/brene_brown_on_vulnerability

Green, J. (2012). The fault in our stars. New York, NY: The Penguin Group.