Panic attacks occur suddenly and often without an obvious trigger. Symptoms include sweating, chest pain, fast heart rate, difficulty breathing, dizziness, and an intense feeling of dread. According to the National Institute of Mental Health (NIMH), six million American adults suffer sudden and repeated panic attacks in any given year.
While the typical panic attack lasts about ten minutes, symptoms may last longer, and it is not uncommon for a panic attack to be mistaken for a heart attack. Some people have just one attack and never have another. But many suffer frequent, repeated attacks, a condition known as panic disorder. Untreated panic disorder can become disabling. As people try to avoid places and activities that they fear might trigger an attack, their lives become more and more restricted.
Panic Disorder is Rooted in Anxiety
Panic disorder is a type of anxiety disorder. Patients usually suffer from intense anxiety about having an attack and avoid situations in which they might occur. In fact, according to the NIMH, one-third of people with panic disorder also have agoraphobia – fear of being in places where escape might be difficult – and avoid public places, crowds, travel, or even leaving the house. Fortunately, panic disorder responds well to treatment, especially if caught early.
Coping with Panic Disorder
Panic disorder is generally treated with medication, psychotherapy, or a combination of the two. The most commonly used medications are antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines. One of the most effective therapies for panic disorder is a form of Cognitive Behavior Therapy known as Exposure Response Prevention (ER/P).
Exposure Response Prevention "Reprograms" the Brain
ER/P therapy is based on the premise that a primary problem with panic disorder is the patient's fear of attacks and avoidance of situations that might trigger them. It is comprised of two components: exposure to the anxiety-producing thoughts or situations and prevention of the typical avoidance response. In ER/P therapy, the patient and therapist work together to identify the patient's feared outcome, then devise a careful plan of graduated exposure. For example, they can identify the patient's fear as fainting when trapped in a crowded bus, then slowly work towards exposing the patient to more crowded buses. Response prevention means that during exposure, the patient does nothing to avoid, escape, or reduce his or her anxiety. By recognizing the fear that drives the anxiety and providing exposure in a safe, controlled manner, ER/P therapy gradually neutralizes the fear and its ability to cause anxiety.
ER/P counteracts the avoidance behavior that characterizes panic disorder. While avoidance or escape may provide temporary relief, they reinforce dysfunctional patterns of behavior and do nothing to improve the patient's quality of life. ER/P works through the natural processes of habituation and extinction. For example, as the patient becomes used to the anxiety-provoking experience, the fearful thoughts and emotions associated with it dissipate and disappear. Over time, the brain is rewired and the patient learns that the feared outcome won't occur and that avoidance or escape isn't necessary.
Anxiety is not Harmful
Occasional anxiety is a natural reaction to life's stresses and strains. But when it begins to take on a life of its own and makes you feel as if a potential disaster lurks around every corner, it is important to get help early—before anxiety overwhelms your life and disrupts work and personal relationships. With therapy, stress reduction, lifestyle changes, and possibly medication, you can overcome panic attacks and open yourself up to a new life full of great possibilities.
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Date of original publication: July 30, 2014
Updated: January 29, 2018