A discrete period of ontense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

(1)  palpitiaions, pounding heart, or accelerated heart rate

(2)  sweating

(3)  trembling of 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, lightheaded , or faint

(9)  derealization (feeling of unreality) or depersonalization (being detached from oneself)

(10)  fear of losing control or going crazy

(11)  fear of dying

(12)  paresthesias (numbness or tingling sensations)

(13)  chills or hot flushes

People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning.  They can't predict when an attack will occur,  and many develop intense anxiety between episodes, woorying when and where the next one will strike.  In between times there is a persistent, lingering worry that another attack could come at any moment.

When an attack strikes, most likely your heart pounds and you may feel ssweaty, weak, faint, or dizzy.  Your hands may tingle or feel numb. and you might feel flushed or chilled.  You may have chest pain or somthering sensations, a sense of unreality, or fear of impending doom or loss of control.  You may genuinely believe you're having a heart attack or stroke, losing your mind, or on the verge of death.  Attacks can occur any time, even during nondream sleep.  While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes.  In rare cases, they may last an hour or more.

Panic disorder strikes at least 1.6 percent of the population and is twice as common in women as in men.  It can appear at any age-in children or in the elderly-but most often it begins in young adults.  Not everyone who experiences panic attacks will develop panic disorder-for example, many people have one attack but never have another.  For those who do have panic disorder, though, it's important to seek treatment.  Untreated, the disorder can become very disabling.

Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may spawn phobias, which can develop in places or situations where panic attacks have occured.  For example, if a panic attack strikes while you're riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.

Some people's lives become greatly restricted-they avoid normal, everyday activities such as grocery shopping, driving, or in some cases even leaving the house.  Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person.  Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurs.  When people's lives become so restricted by the disorder, as happens in about 1/3 of all people woth panic disorder, the condition is called agoraphobia.  A tendency towards panic disorder and agoraphobia runs in families.  Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia.

Studies have ahown that proper treatment- atype of psychotherapy called cognitive-behavioral therapy, medications, or possibly a combination of the two-helps 70 to 90 percent of the people with panic disorder.  Significant improvement is usually seen within 6 to 8 weeks.

Connitive-behavioral approaches teach patients how to view the panic situations differently and demonstrate ways to reduce anxiety, using breathing techniques or exercises to refocus attention, for example.  Another technique used in cognitive-behavioral therapy, called exposure therapy, can often  help alleviate the phobias that may result from panic disorder.  In exposure therapy, people are very slowly exposed to the fearful situation until they become desensittized to it.

Some people find the greatest relief from panic disorder symptoms when the take certain prescription medications.  Such medications, like cognitive-behavioral therapy, can help to prevent panic attacks or reduce their frequency and severity.  Two types of medications that have been shown to be safe and effective in the treatment of panic disorder are antidepressants and benzodiazepines.

PANIC / ANXIETY ATTACKS

 This is a most uncomfortable - painful - frightening thing to suffer! It can be terrifying - one of the worst feelings imagineable. We know - we've been there.

TO START

You can start to take control this very minute - right now - using your breath. Here we go...

ONE


Take a deep, deep breath through your nose. Deeeeep - and slow - and release it slowly through your pursed lips - like blowing a kiss - all the way out...

TWO


Once more - another deep, deep breath - in through your nose - count up to 8 -

Sit up straight so you can fill your lungs all the way to the bottom - and very slowly, very gently - out through your pursed lips as you count down from 8...

Close your eyes, relax your muscles and allow the tension to leave your body.

THREE


And one more deeeeep breath - in through your nose - and - blow kiss - out slowly and gently through your pursed lips. And relax your muscles - all over - every muscle - just relaaaax - like butter - like crusty, old snow melting on a warm, sunny day - from the tip of your head to the tip of your toes.

Feel a bit better? We hope so.

Next - while there are some truly helpful techniques for dealing with anxiety/panic attacks and several very helpful books on the subject that we urge you to check out immediately - as soon as possible so you can start getting help for yourself - we believe that anxiety/panic attacks are, at root, about fearful thoughts, feelings or wishes "wanting" to rise to the surface - thoughts that you wish to suppress - need to suppress - at this time - because they're too painful and/or frightening for you to handle now.

You are not crazy - you are not disturbed - you are not even particularly unusual. Loads of people have panic/anxiety attacks. That's why there are so many books on the subject now - and tapes of helpful techniques.

But we believe that while it's good to use a helpful technique to get control of these usetting symptons, it's most important to start dealing with what's going on under the surface with you. And by help, we mean professional psychotherapy with a qualified therapist - someone understanding and sympathetic, who is well trained to help you on a deep - not-superficial - level.

There is also medication that can help temporarily. But we believe the best help comes ultimately from understanding the source of your feelings - usually deep-seated conflicts that take time to ferret out and resolve.  And usually these can only be dealt with in the context of very sensitive, nuanced, sophisticated psychotherapy with a really GOOD psychotherapist.

And we say beware the psychiatrist who wants to treat you with just medication. Sure you might get some relief. But you'll miss the opportunity to resolve your deeper issues - a resolution that might help you feel better about yourself on a fundamental level, that will help you to create better relationships as well as a better life for yourself, down the road.  And there's always the chance - in fact, the likelihood - if the deeper issues aren't resolved, that they'll be back, in one form or another, (and just as unpleasant, you can be sure!) in the not too distant future. Better to address them now - for longer lasting results.

Understand that this is not some simple thing that can be quickly resolved. It takes time to find the right therapist - time to establish a good working relationship with that therapist - and time to get through some of the surrounding issues before you start dealing with the underlying problems. It all takes time. And patience.

In the meantime, here are:

THREE TECHNIQUES TO HELP YOU CALM A PANIC ATTACK


1. TAKE CONTROL WITH YOUR BREATH


One thing you can do now to start getting a sense of control for the moment, is to simply focus on your breathing - that is, breathing at your natural rate - not fast, not slow - (don't hyperventilate by breathing too quickly!) - just natural breaths - paying attention to your breaths - in, one, two - and out, three, four - and in, one, two.... and out, three, four... slowly - naturally - just your breaths - in, one, two... and out, three, four... - in, one, two... and out, three, four...

Sometimes drawing your attention to your breath like that can help stop a panic attack - just breath in and breathe out - not fast, not slow - just in and then out - and focus on nothing but your breathing - in... and then out... - in.... and then out.... - in.... and then out....

You can shut the world out if you like - and just focus on the fact that you're alive - and all right - and you're breathing - In fact, you know you're alive and all right BECAUSE you're breathing - and that's all you're going to focus on for this moment - all you're going to handle right now - just breathing - you and breathing - no one else - and nothing else - just the fact that you're alive - breathing in, one, two and out, three, four - and in, one, two... and out, three, four....

Here is another technique to deal with anxiety/panic, based on the JACOBSON RELAXATION TECHNIQUE: [Adapted from the book, Loveshock - How to Recover From a Broken Heart and Love Again - by Stephen Gullo, PhD and Connie Church]

STEP ONE: BREATHING CALM


Sit in a chair or lie on your bed. Close your eyes.  As you breathe naturally in and out, on the next breath out, say to yourself, "Relax..." And relax your muscles as you do this.  Breathe in again, and then as you breathe out say, "Calm..." and relax your muscles. Next breath out, say, "Relax..." again. Do this 6 to ten times, alternativing "Calm" and "Relax," while you allow your muscles to relax.

STEP TWO: GET A PICTURE


Now with your eyes still closed, take a deep, long breath and hold it for as long as you can while you picture how you feel at this moment: fear, terror, anger, rage, hurt - whatever is a real feeling for you at this very moment - and then let the picture go as you let your breath go. Do this two more times. On the third time, as you let your breath go, try to release this bothersome picture/feeling for good. Try to blow it away - out of sight - out of your life...

STEP THREE: MUSCLE RELAXATION


Then, still sitting quietly or lying on your back (in a straight line, your hands gently at your side) tense then relax each muscle group in your body. Start by focusing on the muscles in your feet - first tense up the muscles in your feet - hold for a moment - then release and feel those muscles relax. Move up to your legs - tense up the muscles in your legs - hold a moment - then release and feel the muscles relax. Then your thighs, your buttocks, your abdomen, chest, arms, hands and neck - slowly working your way up your body - tensing, holding and releasing every group of muscles as you come to it - your chin, your face, your eyes - 'til you get to the top of your head....

STEP FOUR: BREATHING CALM AGAIN


Now return to the alternating BREATHING CALM / RELAX you did at first.... (same as Step One above.)

STEP SIX: GET A PICTURE AGAIN


Same as Step two above.  Each time an upsetting thought returns, tell that thought to go away. Talk to it as though it were a living object (as it is, in a way). Tell it to go away and leave you alone. Tell it to take a hike - get lost - or just say, STOP!  And tell the thought to go away.  Banish it from your mind. You can always return to the relaxation breathing - using your breath to take control.

TO STOP AN ANXIETY ATTACK IN PUBLIC


Here is a technique you can do if you are having an anxiety attack in public. It only takes about a minute and it really works.

1. Calm yourself with Relaxation Breathing - gently breathe in and out, while saying "calm" and "relax".

2. One at a time, starting from your feet and working your way up your body, tense up all the muscles in your body - like a stiff board.

3. Bring together your first finger and thumb to make a circle (use one or both hands.)  Clench the fingers together as tight as you can.  As you do this, picture all the anxiety within you draining into these two circles.  Say to yourself, "drain, drain," as you picture your anxiety draining out of your system. Release your fingers and try to flick the anxiety away from you.

4. Repeat these three steps two or three times - or however many times you need to feel better.

Also - remember that exercise can be a great way to rid your system of anxiety. So get out there and MOVE YOUR BOD!!

HERE IS AN AFFIRMATION YOU CAN SAY TO HELP YOU CALM DOWN:


Say each statement aloud - softly - to yourself, as you read it. Saying it aloud - to yourself - makes it most effective.

- I take good care of myself;

- I am taking care of myself now as I calm myself;

- I am calming myself;

- I am soothing myself;

- I am taking control.

- I am calming and soothing myself so that I may fall into a deep and satisfying sleep;

- I now allow myself to fall into a deep and satisfying sleep;

- I now release my upset;

- I now release my fear;

- I now release my panic;

- I am letting go of my fear and panic;

- I am taking control.

- As I take control, I let all fear and panic fly away;

- I am letting go of my tension;

- I am letting go of my fears;

- I can picture a little trap door on the top of my head;

- I open this little door on the top of my head - and let all fears and panic fly away from me;

- I am releasing all fear and panic from my system;

- As I release tension, fear and panic, I am feeling more and more relaxed;

- I am letting my muscles relax;

- All the muscles in my body are relaxing;

- I am feeling more and more relaxed and I am getting sleepy;

- I am relaxing and I am feeling more and more sleepy;

- I am giving myself permission to fall asleep;

- I am giving myself permission to drift into a restful sleep;

- I am giving myself permission to fall into a deep and satisfying sleep;

- As I relax I feel myself getting more and more sleepy;

- I feel peaceful,

- I feel peaceful and relaxed,

- I am feeling very peaceful, relaxed and sleepy;

- I am feeling very sleepy;

- I am ready to fall asleep now;

- I'm almost asleep...

- I'm happy to fall asleep.....

Now at this point, you can place yourself in a beautiful, peaceful, pleasurable environment - perhaps some place where you've been in the past, some place where you have happy memories - or maybe some place you can simply imagine - like a lush tropical island, a beautiful garden on a perfect spring day - or a fairytale castle - and see yourself in that lovely, peaceful environment - experiencing a sense of peace and enjoyment .... This concludes the Affirmation.

HERBS TO HELP WITH ANXIETY:


These herbs are available in many pharmacies and health food shops:

(Of course we caution you to check with your doctor first and always try to get preparations that are "standardized" - And do follow the directions on the package.)

Kava Kava (Be careful with this - there is some evidence it could be dangerous if taken in large doses - do check with your doctor....)

Valerian (We do find this helpful in getting to sleep...)

St. John's Wort  (Conflictings reports - some say it works, some say it doesn't do a thing.  We take it -just in case...)

There is also a formula made from flowers called, Rescue Remedy that is supposed to be especially helpful for anxiety. (Look for it in specialized health food shops.)

AROMATHERAPY


You can add these scents to your bath or put a few drops on your pillow. (Be careful not to put essential oils or other strong potions on your skin as they could cause a rash or irritation.)

Try lavender scent for calming - It's the most frequently recommended.

Also try these:

Chamomile

Neroli

Bergamot

Sweet Marjoram

Ylang-ylang

Again, if you suffer from a significant amount of anxiety - anxiety that is very uncomfortable - debilitating, even - anxiety that bothers you, or worse, scares you - we urge you to seek professional help for yourself with someone qualified to help you on a deep level.

You may indeed get some relief with the various techniques and programs that help you to control your anxiety. And you might get some relief with medication, too (through a qualified doctor's prescription).

We encourage you to use whatever can help you with this uncomfortable problem - and as soon as possible.  But you will feel another kind of relief once you get yourself started on a PATH TO FUNDAMENTAL MENTAL HEALTH - in other words - once you've taken some steps to get yourself therapy help - you'll feel better - just realizing that you've started to take control of the situation. (In fact, anxiety/panic attacks can be one indication of underlying issues involving power and control - so taking control of your situation - FOR YOURSELF - can be your first step toward health and towards feeling much, much better.)

We urge you not to put off getting help. The sooner you start on that path, the sooner you will feel better. We wish you the best.  You might want to check out our segment on Seeking Professional Help.  See the navigation bars to the left for additional help.

Good night.  We wish you sweet dreams...

* All information is intended as a guide only and should be used in association with your health professional
~Lindsay


anxietyhotline

The Causes of Anxiety and Panic Attacks
Ron Rapee, Michelle Craske, David Barlow


PHYSIOLOGY OF ANXIETY

Anxiety is probably the most basic of all emotions. Not only is it experienced by all humans, but anxiety responses have been found in all species of animals right down to the sea slug. Anxiety experiences vary tremendously in their severity from mild uneasiness to extreme terror and panic. They can also vary tremendously in their length from a brief, almost fleeting flash, to a constant, all day affair. While anxiety, by its nature and definition, is an unpleasant sensation, it is not in the least dangerous. It is this last point which forms the basis of this article. The aim of the next few pages is to teach you about the components (physical and mental) of anxiety in order that (1) you realize that many of the feelings which you now experience are the result of anxiety and (2) you learn that these feelings are not harmful or dangerous.

Definition of Anxiety

While an actual definition of anxiety which covers all aspects is very difficult to provide (indeed whole books have been written on the subject), everyone knows the feeling which we call anxiety. There is not a person who has not experienced some degree of anxiety whether it is the feeling upon entering a school room just before an exam, or the feeling when one wakes in the middle of the night, certain that they heard a strange sound outside. What is less known, however, is that sensations such as extreme dizziness, spots and blurring of the eyes, numbness and tingling, stiff almost paralyzed muscles, and feelings of breathlessness extending to choking or smothering can also be a part of anxiety. When these sensations occur and people do not understand why, then anxiety can increase to levels of panic since people imagine that they must have some disease.

Fight/Flight Response

Anxiety is a response to danger or threat. Scientifically, immediate or short term anxiety is termed the fight/flight response. It is so named because all of its effects are aimed toward either fighting or fleeing the danger. Thus, the number one purpose for anxiety is to protect the organism. Back in the days when we were cave people, it was vital that when faced with some danger, an automatic response would take over causing us to take immediate action (attack or run). Even in today's hectic world this is a necessary mechanism. Just imagine if you were crossing a street when suddenly a car sped toward you blasting its horn. If you experienced absolutely no anxiety, you would be killed. However, more probably, your fight/flight response would take over and you would run out of the way to be safe. The moral of this story is a simple one - the purpose of anxiety is to protect the organism, not to harm it. It would be totally ridiculous for nature to develop a mechanism whose purpose is to protect an organism and yet, in doing so, harms it.

Anxiety manifests itself through three separate systems and it is important to identify these systems since each one can be primary in any individual person. The three systems are: the mental system (which includes the actual feelings of nervousness, anxiety and panic and also includes thoughts such as "there is something wrong"); the physical system (which includes all the physical symptoms such as dizziness, sweating, palpitations, chest pain, and breathlessness); the behavioral system (which includes the actual activities such as pacing, foot tapping and avoidance). In panic attacks the physical system becomes the most important since it is these symptoms which are most easily mistaken as indicating some serious disease.

Systems of Anxiety

The best way to think of all of the systems of the fight/flight response (anxiety) is to remember that all are aimed at getting the organism prepared for immediate action and that their purpose is to protect the organism.

Physical System

Nervous and Chemical Effects
When some sort of danger is perceived or anticipated, the brain sends messages to a section of your nerves called the autonomic nervous system. The autonomic nervous system has two subsections or branches called the sympathetic nervous system and the parasympathetic nervous system. It is these two branches of the nervous system which are directly involved in controlling the body's energy levels and preparation for action. Very simply put, the sympathetic nervous system is the fight/flight system which releases energy and gets the body "primed" for action while the parasympathetic nervous system is the restoring system which returns the body to a normal state.

One important point is that the sympathetic nervous system tends to be largely an all or none system. That is, when it is activated, all of its parts respond. In other words, either all symptoms are experienced or no symptoms are experienced; it is rare for changes to occur in one part of the body alone. This may explain why most panic attack involve many symptoms and not just one or two.

One of the major effects of the sympathetic nervous system is that it releases two chemicals called adrenalin and noradrenalin from the adrenal glands on the kidneys. These chemicals, in turn, are used as messengers by the sympathetic nervous system to continue activity so that once activity in the sympathetic nervous system begins, it often continues and increases for some time. However, it is very important to note that sympathetic nervous system activity is stopped in two ways. First, the chemical messengers adrenalin and noradrenalin are eventually destroyed by other chemicals in the body. Second, the parasympathetic nervous system (which generally has opposing effects to the sympathetic nervous system) becomes activated and restores a relaxed feeling. It is very important to realize that eventually the body will "have enough" of the fight/flight response and will activate the parasympathetic nervous system to restore a relaxed feeling. In other words, anxiety cannot continue forever, nor spiral to ever increasing and possibly damaging levels. The parasympathetic nervous system is an inbuilt protector which prevents the sympathetic nervous system from getting carried away. Another important point is that the chemical messengers, adrenalin and noradrenalin take some time to be destroyed. Thus, even after the danger has passed and your sympathetic nervous system has stopped responding, you are likely to feel keyed-up or apprehensive for some time because the chemicals are still floating around in your system. You must remind yourself that this is perfectly natural and harmless. In fact, this is an adaptive function because, in the wilds, danger often has a habit of returning and it is useful for the organism to be prepared to activate the fight/flight response.

Cardiovascular Effects

Activity in the sympathetic nervous system produces an increase in heart rate and the strength of the heartbeat. This is vital to preparation for activity since it helps speed up the blood flow, thus improving delivery of oxygen to the tissues and removal of waste products from the tissues. In addition to increased activity in the heart, there is also a change in the blood flow. Basically, blood is redirected away from the places where it is not needed (by a tightening of the blood vessels) and toward the places where it is needed more (by an expansion of the blood vessels). For example, blood is taken away from the skin, fingers, and toes. This is useful because if the organism is attacked and cut in some way, it is less likely to bleed to death. Hence, during anxiety the skin looks pale and feels cold and fingers and toes become cold and sometimes experience numbness and tingling. In addition, the blood is moved to the large muscles such as the thighs and biceps which helps the body prepare for action.

Respiratory Effects

The fight/flight response is associated with an increase in the speed and depth of breathing. This has obvious importance for the defense of the organism since the tissues need to get more oxygen in order to prepare for action. The feelings produced by this increase in breathing, however, can include breathlessness, choking or smothering feelings, and even pains or tightness in the chest. Importantly, a side effect of increased breathing, especially if no actual activity occurs, is that blood supply to the head is actually decreased. While this is only a small amount and is not at all dangerous, it produces a collection of unpleasant (but harmless) symptoms including dizziness, blurred vision, confusion, unreality, and hot flushes.

Sweat Gland Effects

Activation of the fight/flight response produces an increase in sweating. This has important adaptive functions such as making the skin more slippery so that it is harder for a predator to grab, and cooling the body to stop it from overheating.

Other Physical Effects

A number of other effects are produced by activation of the sympathetic nervous system, none of which are in any way harmful. For example, the pupils widen to let in more light which may result in blurred vision, spots in front of the eyes, etc. There is a decrease in salivation, resulting in a dry mouth. There is decreased activity in the digestive system which often produces nausea, a heavy feeling in the stomach and even constipation. Finally, many of the muscle groups tense up in preparation for fight or flight and this results in subjective feelings of tension, sometimes extending to actual aches and pains as well as trembling and shaking.

Overall, the fight/flight response results in a general activation of the whole bodily metabolism. Thus, one often feels hot and flushed and, because this process takes a lot of energy, afterwards the person generally feels tired, drained, and washed out.

Behavioral System

As mentioned before, the fight/flight response prepares the body for action - either to attack or to run. Thus, it is no surprise that the overwhelming urges associated with this response are those of aggression and a desire to escape wherever you are. When this is not possible (due to social constraints), the urges will often be shown through such behaviors as foot tapping, pacing or snapping at people. Overall, the feelings produced are those of being trapped and needing to escape.

Mental System

The number one effect of the fight/flight response is to alert the organism to the possible existence of danger. Thus, one of the major effects is an immediate and automatic shift in attention to search the surroundings for potential threat. In other words, it is very difficult to concentrate on daily tasks when one is anxious. Therefore, people who are anxious often complain that they are easily distracted from daily chores, that they cannot concentrate, and that they have trouble with their memory. This is a normal and important part of the fight/flight response since its purpose is to stop you from attending to your ongoing chores and to permit you to scan your surroundings for possible danger. Sometimes, an obvious threat cannot be found. Unfortunately, most humans cannot accept having no explanation for something. Therefore, in many cases, when people cannot find an explanation for their sensations, they turn their search upon themselves. In other words "if nothing out there is making me feel anxious, there must be something wrong with me." In this case, the brain invents an explanation such as "I must be dying, losing control, or going crazy." As we have now seen, nothing could be further from the truth since the purpose of the fight/flight response is to protect the organism not harm it. Nevertheless, these are understandable thoughts.

Panic Attacks
Up until now, we have looked at the features and components of general anxiety or the fight/flight response. However, you may be wondering how does all this apply to panic attacks? After all, why should the fight/flight response be activated during panic attacks since there is apparently nothing to be frightened of?

Following extensive research, it appears that what people with panic attacks are frightened of (i.e., what causes the panic) are the actual physical sensations of the fight/flight response. Thus, panic attacks can be seen as a set of unexpected physical symptoms and _then_ a response of panic or fear of the symptoms such as illustrated below:

     pounding heart             fear  -------->  pounding heart
                     -------->
     dizziness, etc.            panic <-------- dizziness, etc.
The second part of this model is easy to understand. As discussed earlier, the fight/flight response (of which the physical symptoms are a part) causes the brain to search for danger. When the brain cannot find any obvious danger, it turns its search inward and invents a danger such as "I am dying, losing control, etc." This is illustrated below:

     pounding heart          misinterpretation         fear  ----> symptoms
                     ---->                      ---->                 |
     dizziness, etc.         e.g., "I'm dying"         panic   <-------
The first part of the model is harder to understand. Why do you experience the physical symptoms of the fight/flight response, if you are not frightened to begin with? There are many ways these symptoms can be produced, not just through fear. For example, it may be that you have become generally stressed for some reason in your life and this stress results in an increase in production of adrenalin and other chemicals which from time to time produce symptoms. This increased adrenalin could presumably be maintained chemically in the body even after the stressor has long gone. Another possibility is that you tend to breathe a little too fast (subtle hyperventilation) due to a learned habit and this also can produce symptoms. Because the over-breathing is very slight, you easily become used to this level of breathing and do not notice that you are hyperventilating. A third possibility is that you are experiencing normal changes in your body (which everyone experiences but most don't notice) and, because you are constantly monitoring and keeping a check on your body, you notice these sensations far more strongly than most people.

Even if we are not exactly certain why you experience the initial symptoms, we can assure you that they are a part of the fight/flight response and therefore are _harmless_.

Thus, our final model of panic attacks (simplified) looks like this:

hyperventilation      pounding heart       misinterpretation       fear

arousal         --->  dizziness      --->  e.g., "I'm dying" --->  panic --
                                                                  ^      |
adrenaline            breathlessness                               |      |
                                                               symptoms <- normal body changes etc.
Obviously, then, once you truly believe (100%) that the physical sensations are not dangerous, then the fear and panic will no longer occur and you will eventually no longer experience panic attacks. Of course, once you have had a number of panic attacks and you have misinterpreted the symptoms many times, this misinterpretation becomes quite automatic and it becomes very difficult to consciously convince yourself during a panic attack that the symptoms are harmless.

In Summary
Anxiety is scientifically known as the fight/flight response since its
primary purpose is to activate the organism and protect it from harm.
Associated with this response are a number of physical, behavioral, and
mental changes.  Importantly, once the danger has gone, many of these
changes (especially the physical ones) can continue, almost with a mind of
their own, due to learning and other longer term bodily changes.  When the
physical symptoms occur in the absence of an obvious explanation, people
often misinterpret the normal fight/flight symptoms as indicating a serious
physical or mental problem.  In this case, the sensations themselves can
often become threatening and can begin the whole fight/flight response over.


                     
MYTHS AND MISINTERPRETATIONS

Going Crazy
Many people, when they experience the physical symptoms of the
fight/flight response, believe they are "going crazy."  Within this belief,
they are most likely referring to a severe mental disorder known as
schizophrenia.  Let us look at schizophrenia to see how likely this is.

Schizophrenia is a major disorder characterized by such severe symptoms as disjointed thoughts and speech, sometimes extending to babbling, delusions or strange beliefs (for example, that they are receiving messages from outer space), and hallucinations (for example, that there are voices in their head). Furthermore, schizophrenia appears to be largely a genetically based disorder, running strongly in families.

Schizophrenia generally begins very gradually and not suddenly (such as during a panic attack). Additionally, because it runs in families, only a certain proportion of people can become schizophrenic and, in other people, no amount of stress will cause the disorder. A third important point is that people who become schizophrenic will usually show some mild symptoms for most of their lives (such as unusual thoughts, flowery speech, etc.). Thus, if this has not been noticed in you yet, then the chances are you will not become schizophrenic. This is especially true if you are over 25 since schizophrenia generally first appears in the late teens to early 20's. Finally, if you have been through interviews with a psychologist or psychiatrist, then you can be fairly certain that they would have known if you were likely to become schizophrenic.

Losing Control
Some people during a panic attack believe they are going to "lose
control."  Presumably, they mean that they will either become totally
paralyzed and not be able to move, or that they will not know what they are
doing and will run around wildly killing people or yelling out obscenities
and embarrassing themselves.  Alternatively, they may not know what to
expect but may just experience an overwhelming feeling of "impending doom."

From our earlier discussion, we now know where this feeling comes from. During anxiety the entire body is prepared for action and there is an overwhelming desire to escape. However, the fight/flight response is not aimed at hurting other people (who are not a threat) and it will not produce paralysis. Rather, the entire response is simply aimed at getting the organism away. In addition, there has never been a recorded case of someone "going wild" during a panic attack. Even though the fight/flight response makes you feel somewhat confused, unreal, and distracted, you are still able to think and function normally. Simply think of how often other people even notice that you are having a panic attack.

Nervous Collapse
Many people are frightened about what might happen to them as a result
of their symptoms, perhaps because of some belief that their nerves might
become exhausted and they may collapse.  As discussed earlier, the
fight/flight response is produced chiefly through activity in the
sympathetic nervous system which is counteracted by the parasympathetic
nervous system.  The parasympathetic nervous system is, in a sense, a
safeguard to protect against the possibility that the sympathetic nervous
system may become "worn out."  Nerves are not like electrical wires and
anxiety cannot wear out, damage or use up nerves.  The absolute worst that
could happen during a panic attack is that an individual could pass out at
which point the sympathetic nervous system would stop its activity and the
person would regain consciousness within a few seconds.  However, actually
passing out as a result of the fight/flight response is extremely rare, and
if it does occur, it is adaptive since it is a way of stopping the
sympathetic nervous system from going "out of control."



Heart Attacks
Many people misinterpret the symptoms of the fight/flight response and
believe they must be dying of a heart attack.  This is probably because many
people do not have enough knowledge about heart attacks.  Let us look at the
facts of heart disease and see how this differs from panic attacks.

The major symptoms of heart disease are breathlessness and chest pain as well as occasional palpitations and fainting. The symptoms in heart disease are generally directly related to effort. That is, the harder you exercise, the worse the symptoms and the less you exercise, the better. The symptoms will usually go away fairly quickly with rest. This is very different to the symptoms associated with panic attacks which often occur at rest and seem to have a mind of their own. Certainly, panic symptoms can occur during exercise or can be made worse during exercise, but they are different to the symptoms of a heart attack since they can occur equally often at rest. Of most importance, heart disease will almost always produce major electrical changes in the heart which are picked up very obviously by the EKG. In panic attacks the only change which shows up on the EKG is a slight increase in heart rate. Thus, if you have had an EKG and the doctor has given you the all clear, you can safely assume you do not have heart disease. Also, if your symptoms occur any time and not only upon exertion, this is additional evidence against a heart attack.

* All information is intended as a guide only and should be used in association with your health professional
~Lindsay

Panic disorder

OCTOBER 2005

Have you ever had an episode when your heart pounded and you felt dizzy, shaky, and scared even though you weren't in any danger? You may have had a panic attack. People who experience a panic attack often think they are having a heart attack or are going crazy or losing control, but these fears aren't realized. An attack, which can cause nausea and sweating, may last from a few minutes to a day.

About 2.4 million US adults have a panic attack each year, although some children also experience them; women are twice as likely as men to have a panic attack. A pattern of panic attacks, called panic disorder, increases the risk of depression, phobias, suicide, alcohol abuse, and drug dependence.

What causes panic disorder?
People who have repeated, frequent panic attacks are typically considered to have panic disorder. Although the cause isn't clear, it probably is a combination of family history, stress load, and other factors. Many panic attacks are triggered by consuming too much caffeine or stimulating drugs. In other cases, attacks occur in connection with depression or drug withdrawal. Some health problems, such as a heart attack or an overactive thyroid gland, can cause symptoms that may be confused with those of a panic attack.

Some people who have panic disorder are so worried about having another attack that they begin to avoid situations that they fear will trigger one. This anticipatory anxiety and avoidance can keep them from leaving home.

How can panic disorder be managed?
Treatment, usually in the form of medication and cognitive behavior therapy, is available to help keep the disorder from progressing. Regular exercise and a healthy diet can also reduce stress and help you relax.

* Antidepressant drugs and antianxiety medications, alone or in combination, are often prescribed to prevent or reduce the number and severity of panic attacks and decrease anticipatory anxiety. There are many antidepressant and antianxiety drugs available; your doctor will help you choose the one that is best for you. These drugs are used as long as it takes for you to get and stay better.
* Cognitive behavior therapy is designed to help you recognize situations that trigger an attack and to change thinking and behaviors that contribute to the cycle of fear. A therapist can help you learn how to cope with anxiety, stress, and hyperventilation using relaxation, breathing, and imaging techniques. Patients usually meet with a therapist for 1 to 3 hours a week for 8 to 10 weeks.

For more information on panic disorder

Anxiety Disorders Association of America
8730 Georgia Ave, Suite 600
Silver Spring, MD 20910
240-485-1001
http://www.adaa.org

Freedom From Fear
308 Seaview Ave
Staten Island, NY 10305
718-351-1717 (Ext. 24)
http://www.freedomfromfear.org

National Anxiety Foundation
3135 Custer Dr
Lexington, KY 40517
http://www.lexington-on-line.com/naf.html

National Mental Health Association
2001 N Beauregard St, 12th Floor
Alexandria, VA 22311
800-969-6642, TTY line: 800-433-5959
http://www.nmha.org

This information is not a substitute for medical treatment.

SOURCE: Post Graduate Medicine Online

Can these panic attacks happen out of no where when u never had a condition like it before?

I'm familiar with some of the cases. Sometimes when I'm just laying in my bad, I thing about my featured commitments, and I get scared. I'm freaked out only thinking about the possible result of getting out of the bad, and deal with society and unavoidable acts. I'm terrified; worried the attacks will strike me again.

Sometime I'm convinced I really had lost my mind. Especially when I'm around too many people, then the panic gets worse.

Then I get impulsive, and start hurting my self.

I've been through several treatments. Include Cognitive behavior therapy.

And a long list of psychiatric medication.

I guess I'm better now.

BUT

Not enough to make through a normal day, with out this unbelievable suffering.

Yeah, I totally know that feeling. I've been diagnosed.
Usually a panic disorder is if you've had more than three in a week (from what I've heard).
What angered me is I had about 5 a day. I kept asking doctors for help, what did I get? "Oh well, lets wait till you have more"
I finally got help once I begged a doctor for medicine cause I couldn't go to class and I was sick of having them.
Well, I got help once I went through bad side effects of anti-depressents. But its okay! I got help (I really dont know if Im being sarcastic or serious there...a bit of both i guess haha)

I just kept wishing it would go away, so I know that you aren't really being sarcastic. I wondered what I would have to do to get out of this terrible mode my body had gone into as my thoughts were causing physical resonses, with the anxiety attacks. I had to stop working for 6 weeks to let the med get adjusted and the attacks to subside. I had to go on a benzo for about 7mo. to be able to jump back into the life I took a break from. My doc told me that meds would be the only thing that would help, and I know this was so true. I'm sorry that your doc didn't take you seriously. It's a disorder that I wouldn't wish on my enemy. It makes daily life near impossible. On top of it, I had gotten the feeling that I didn't want to even go outside. It took lots of internal rearranging of thoughts to get me back out there, and plenty of good meds...

I hope you continue to feel better. What med did you go on? I initially took Lexapro.

Jackie

This describes me to a 't'. Panic argh!! How do i avoid feeling like this ARGH. The anticipatory anxiety....AAAAAAAAARRRRRGGGGHHHH , I'm starting to panic thinking about it. The pounding heart, the sweats and shakes and at what? NOTHING (in reality perhaps a small issue). So i avoid, avoid situations that cause me to feel anxious by staying at home