Panic Attacks Explained: What They Are and How To Make Them Stop With CBT for Panic Disorders
One of the most common reasons individuals reach out for my help is that they’re experiencing panic attacks. That is, sudden, abrupt surges of anxiety that are very strong and overwhelming. In severe cases, the symptoms of panic can be so severe that they lead individuals to present to the emergency room. Individuals may be convinced they’re having a heart attack. If you ask emergency room physicians, they will tell you that this is a fairly frequent presentation. Their patients are often very surprised, yet relieved, to then learn that the problem they’re having is actually anxiety.
How do Panic Attacks Begin?
Panic attacks do come on very suddenly, and often out of the clear blue. Within seconds or minutes, those struggling with panic may notice pounding heartbeat, shaking, sweating, nausea and GI distress, dizziness or faintness, shortness of breath, hot flashes or chills, tingling sensations, and dissociation (feeling detached from oneself or reality). They may worry that they’re losing all control of themselves or “going crazy.”
Panic Attacks Can Be A Result of A Bigger Underlying Issue
Sometimes these attacks occur within the context of some other mental health issue, such as posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD). In these cases, the attacks are typically cued by something identifiable, like a trauma reminder or a period of overwhelming worry. For others, these attacks seem not to have any identifiable trigger or reason. This can be particularly upsetting, as a person may begin to fear that the attacks will happen at very unexpected and inopportune times. As such, they may start to fear future attacks and make changes in how they live their life. This is a condition termed panic disorder.
This May Cause You to Avoid Certain Situations
Certainly, nobody wants to be out at the grocery store, a restaurant, or a sporting event and suddenly be doubled over, laboring to breathe. For those who’ve gone through something like this, the attention a panic attack brings can feel very embarrassing. It can even lead to isolating at home afterward and avoiding situations from which quick escape would be tricky. Commonly avoided situations include movie theaters, religious services, rush hour traffic, and airplanes. In severe cases, agoraphobia can develop. This is when a person becomes strongly uncomfortable with a variety of such scenarios as those described above and resorts to avoiding many different places.
When discussing panic, it’s important to understand that those struggling with it are often highly attuned to their body’s sensations. Just as a person dealing with PTSD may become hypervigilant to possible threats in their environment, an individual having panic attacks can become hypervigilant of their own physical sensations. Noticing elevated heart rate or sweating can be cause for alarm (e.g., “Am I having another attack?!,” “This will be humiliating – others will judge me,” “Maybe this time I’ll have a heart attack or stroke”). Sometimes those with a panic stop doing things that will evoke such sensations, such as exercising and drinking caffeine.
Can You Experience Panic Attacks While Sleeping?
Nocturnal attacks are also common. These involve being woken from sleep by a panic attack, often gasping for air. Clearly, this is a very harsh way to wake up, and it’s often difficult to calm back down afterward and return to sleep.
Needless to say, panic attacks, panic disorder, and agoraphobia can be quite debilitating. It can be difficult to hold down a job, take a trip, or even go out into public. Given how scary these attacks can feel, it might be easy to assume that there is little one can do in response other than “pop a benzo” (i.e., use a benzodiazepine prescription – drugs like Xanax or Klonopin to relax). Although these types of medications can bring about swift relief, research also suggests that they may make panic symptoms worse over time. It is also important to note that these drugs are habit-forming.
A better solution, and a highly effective one at that, is cognitive-behavioral therapy (CBT). In fact, not only does CBT for panic disorders work well for treating panic. Once in remission, panic tends to stay away in the majority of cases. To understand how this could be, and how panic is treated, it helps to understand how it develops in the first place.
The Origin of Panic Attacks
One lesson that CBT for panic disorder teaches early on is that our thoughts are very powerful things. What I tell myself about the kind of person I am, how my future will go, and how well I can cope with stress has an immediate impact on how I feel and behave. So, thoughts create feelings. They manufacture emotions. The thing about our thoughts, though, is that they’re highly susceptible to bias, particularly when we’re having strong feelings. In other words, feelings also color our thoughts.
For instance, if I wake up one morning feeling down and depressed and I have a job interview scheduled that afternoon, I might not give myself the best odds at getting the position, even if I’m well qualified. My depression convinces me otherwise. It lies to me and distorts my thinking.
With panic, it’s what I tell myself about my own physical sensations that may create problems.
For example, if I’m being good and exercising on my treadmill (something I’m trying to do more of these days!), an increased heart rate doesn’t concern me. It’s very much expected in that context. On the other hand, if I’m sitting around not doing much and those same symptoms arise, it might be tempting to think something like, “There’s something wrong with me! Maybe I’m having a heart attack.” From that point, it isn’t much longer until my anxiety rapidly snowballs into a full-blown attack.
After one or two attacks happen, then the question becomes when will it happen again.
Now my baseline level of anxiety is heightened, biasing my thoughts. It’s hard to really relax when the possibility of panic is lingering nearby. Also, my anxiety has a new target to focus on: physical sensations. So, I started surveying my body repeatedly for possible signs of another attack. And once I find something I don’t like, my anxiety lies to me and convinces me that something catastrophic is happening.
So Now What? How CBT for Panic Disorder Can Help!
A question that you’re likely having, and one that I’m often asked by my prospective clients, is how CBT for panic disorder works. Well, that differs a bit depending on the problem that it’s being applied to but, in the case of panic, it works through severe different mechanisms:
First, a CBT therapist will help you to enhance your self-awareness. They’ll work with you to have faster real-time identification of your thoughts, emotions, and behaviors. Just this step alone can be very therapeutic. It’s a lot easier to cope with exaggerated beliefs when you catch them early (rather than letting them play on and on unabated, sending you into an emotional autopilot).
Second, it’s common to incorporate relaxation techniques into treatment. These are helpful for reducing your overall stress level and giving you some tools for experiencing some short-term relief from anxiety.
Third, your anxiety therapist will provide lots of explanations on what happens in your body during panic attacks. You’ll hear about the reasons why your body may be tingling, for instance, or why lightheadedness often accompanies attacks. One of the key takeaways from this phase of the treatment is that panic attacks aren’t actually harmful. Really. Not only do panic attacks not hurt you, but even fainting is a pretty rare occurrence (including among those who have lightheadedness during attacks).
Fourth, CBT for panic disorder techniques will be used to find the beliefs that are stoking the flames of your panic symptoms, give you ways of challenging these thoughts, and aid you in correcting them. As is also the case with the self-awareness and relaxation techniques mentioned above, these cognitive skills can be applied broadly and are not limited to being a tool just for panic (cognitive therapy is also frequently used to improve mood, regulate anger, and manage stress).
Finally, exposure therapy techniques are implemented. This is a cognitive-behavioral approach that is sometimes misunderstood but is highly effective at treating anxiety-based issues. It’s where the rubber really hits the road, so to speak.
Here is an Example of What We May Do in CBT for Panic Disorder
A simple example of exposure therapy can be seen in a short story about my older daughter and our family’s vacation to the beach a couple of years ago. I remember the moment well: it was the first day of our trip and my then 6-year-old was in the ocean enjoying the feeling of the waves. Suddenly, she began crying and screaming out in pain. A damn jellyfish had stung her! I felt terrible for her. Not only was the pain pretty bad, I’m sure, but I think the shock of it made matters worse. Unsurprisingly, she wasn’t super keen on going back into the water after that. Somewhat reluctantly, however, I was able to get her to accompany me back to the beach (only the sand) the next day. Just for a stroll. Soon after, she was letting the tide wet her feet. Not much longer after that, she was waking up to her knees…then her belly…and eventually, by the last day, all the way up to her neck. I was proud of her. Although she had to get out of her comfort zone each step of the way, she took on the challenge of the ocean incrementally, one step at a time, which is how exposure therapy typically works.
In short, my daughter had faced her fears and realized that things weren’t as bad as they might have seemed in the immediate aftermath of the sting. The ocean wasn’t teeming with jellyfish chomping at the bit to sting her! By exposing herself back to the ocean, she was able to get corrective evidence against this type of fear and adjust her views on swimming in the ocean.
CBT for Panic Disorder May Include Two Forms of Exposure
Exposure therapy can be done in a variety of different formats. When applied to the treatment of panic attacks, panic disorder, and agoraphobia, there are generally two principal types used: in-vivo exposure and interoceptive exposure. Sounds fancy, right?! Psychologists love overly complex terms like these. Don’t let their names scare you…both are pretty straightforward.
In-vivo is Latin for “within the living.” It entails facing real-world situations that uncomfortable situations like elevators, theaters, crowds, planes, open spaces, malls, etc. My daughter’s exposure was in-vivo. And just like she did, we would approach your feared situations systemically, starting with those that are a little out of your comfort zone, and eventually working up to the ones that intimidate you the most.
The second type of exposure therapy used for treating panic, interoceptive exposure, involves confronting your own physical sensations. Remember, it’s the catastrophic interpretation of these that is triggering attacks in the first place! Here’s where things get kind of interesting, if not a little odd. Psychologists have developed different motions and mini-activities that serve to elicit physical sensations approximating the ones you have during actual panic attacks. Spinning in a chair and intentionally dizzying yourself is just one example. Interestingly, the resulting sensations are similar enough to the real deal that they elicit a fear-response in those living with panic. And just as we work to overcome this gradually when doing in-vivo exposure, the same applies here.
Next Steps for Getting Online Therapy in Ohio!
So, there you have it. A pretty quick overview of panic attacks, how they form, and how we treat them. Although dependent on the individual, a typical course of CBT for panic disorder generally lasts 8-12 sessions. And, as mentioned above, once in remission, attacks tend to stay there in the majority of cases. For those who have attacks come back, clients are able to simply fall back on the tools that they’ve developed in CBT and apply them independently. Alternatively, they are welcome to schedule a “booster” session with me and brush up as needed.
Begin CBT Therapy for Panic Disorder in Ohio and Start Living Again!
Simply put, panic attacks, while debilitating, are absolutely treatable. This isn’t a condition that one needs to live with forever. And it isn’t one that will necessarily go away on its own without professional help. If you have any questions about Ascend Psychological Services in Ohio or wish to learn more, I would love the opportunity to speak with you! Please consider signing up for one of my free, 30-minute consultation calls! To get started follow these simple steps:
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Other Services at Ascend Psychological Services
If you need additional support, I offer many additional services that can help you alongside CBT for social anxiety. On top of offering support for depression, insomnia, grief, anxiety, psychological assessments, couples, PTSD treatment, and trauma therapy, I offer many treatment approaches to support you. Treatment modalities that, I offer to include CBT therapy, prolonged exposure, written exposure therapy, accelerated resolution therapy, cognitive processing therapy, and person-centered approaches among many more. When you’re ready to begin services, I am here to support you.