Panic Attacks

Panic attacks and panic disorder

Panic Attacks and Panic Disorder

Panic disorder is characterised by recurrent and apparently unexplainable panic attacks, accompanied by an intense worry about their possible reoccurrence and behavioural changes due to the attacks. In panic disorder, panic attacks are not caused by a medical condition, substance use or another psychological disorder.

What is a panic attack

A panic attack is a moment of very intense anxiety, lasting about 10-15 minutes, where the person experiences some of the following symptoms:

• heart palpitation;
• sweating;
• trepidation;
• difficulty to breath or a sense of suffocation;
• feeling of asphyxiation;
• chest pain;
• nausea or abdominal pain;
• confusion or disorientation;
• derealisation or depersonalisation: feeling that the world, other people or ourselves are weird or unreal;
• fear of losing control or going crazy;
• fear of dying;
• paresthesia: torpidity or numbness to the body extremities;
• shivers or burst of heat.

What is happening during a panic attack?

The core maintaining factors of Panic Disorder are the related tricky vicious cycles. The first vicious cycle that brings the panic to its peak is caused by the catastrophic interpretation of what is happening. Usually an internal or external stimulus is interpreted as potentially threatening and triggers anxiety’s psychological reactions –> these reactions are interpreted as well as threatening –> the initial anxiety is fostered –> more intense catastrophic interpretation –> more intense anxiety … Other three factors maintain the situation:

1. Selective attention: attention tends to be focused selectively on physiological signals; as a consequence, our perception threshold will get lower and we will be more sensitive. This implies a higher risk of catastrophic interpretations.
2. Safety behaviours: behaviours to prevent the feared consequences (es. keeping in our bag an anxiolytic pill just in case of a possible need). Safety behaviours prevent from disconfirming what we fear.
3. Avoidance: it limits the chance of experiencing anxiety and disconfirming our fears.

Panic attacks treatment

Cognitive Behavioural therapy has been identified by NICE guidelines as the most effective form of psychotherapy in the treatment of Panic Disorder. CBT indeed will work interrupting the aforementioned vicious cycles and restructuring the related cognitive beliefs. An important aspect of therapy will be defeating little by little the avoidances through a gradual and guided exposition.