If panic attacks: Panic Disorder

‘Our anxiety does not empty tomorrow of its sorrows, but only empties today of its strengths'  Charles Haddon Spurgeon

 

This post is about the form of anxiety called Panic Disorder. However, as it is the first in a series of posts about specific types of anxiety, I would like to start by giving some basic definitions and simple explanations of what anxiety is from a medical and therapeutic perspective.

Anxiety can be defined as..

.. a feeling of unease, worry or even fear and it can be both an emotional and a physical sensation.

Anxiety is healthy..

... in that it is a normal response to perceived threats. It is oftern linked to what is called the Fight-or-Flight response - a primitive reaction to danger - we run away or we retaliate. It is a deeply embedded, instinctive part of our being rooted in survival.

Anxiety is normal ..

... around things which are important to us or which have the potential to have some significant impact on our lives.  Examples include attending a job interview; sitting an exam; or giving a speech.

How anxiety is experienced is quite diverse, ..

... people may feel anxious about completely different things, and can experience anxiety about the same things in a completely different way. As no two people are identical, so no pattern of anxiety are quite the same.

Anxiety can become a mental health issue..  

...when it is prolonged, severe and feels overwhelming.  

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A simple way to establish if anxiety is an issue ..

... for you is to ask yourself - is this affecting my ability to live my life the way I would like to?

If you feel that you are suffering from anxiety it is important that you first consult your GP in order to establish if there is a physical cause for the symptoms being experienced and if not, to obtain a formal diagnosis of an anxiety disorder.

So what, specifically, is Panic Disorder?

Firstly, it is not simply having a panic attack.  A panic attack can be one of the symptoms of most of the anxiety disorders.  A panic attack is an acute state of fear or dread and is accompanied by physical symptoms which can include:

  • Racing/pounding heart
  • Rapid breathing
  • Trembling
  • Dizziness/lightheadedness
  • Sweating or feeling hot
  • Numbness and tingling
  • Choking
  • Chest pain
  • Feeling detached or unreal

Panic disorder is..

.. when there does not appear to be any apparent trigger to having a panic attack.  With other types of anxiety disorder there are definable causes of the panic attacks - be they general anxiety disorder, phobias, re experiencing past trauma or compulsive thoughts (see other posts on these anxiety disorders in the anxiety series). 

The symptoms of panic disorder are:

  • sudden attacks of fear or extreme nervousness
  • regularly occuring panic attacks at any time
  • no apparent trigger to the panic attacks
  • physical symptoms such as sweating, pounding heart, shortness of breath
  • Constant thoughts and/or fear of having another attack - anticipatory anxiety
  • Constant thoughts and/or fear of particular bodily sensations associated with anxiety and panic
  • Change of behaviours to attempt to avoid another attack - phobic avoidence

The causes of panic disorder..

.. are not clearly understood but are thought to include family history, pre-disposition to anxiety, substance abuse, major life issues.

How can counselling or psychotherapy help?

The National Institute for Health and Care Excellence (NICE) recommend that GP's offer counselling before prescribing medication to clients experiencing an anxiety disorder, including panic disorder.  Rather than only treat the symptoms with medications, therapy aims to identify and address the source of the anxiety. A common therapeutic approach with Panic Disorder is Cognitive Behavioural Therapy (CBT). CBT aims to change patterns of thinking and this approach can be successful in managing the symptoms, including anticipatory anxiety and phobic avoidance.

Counselling or longer-term psychotherapy is recommended where there are felt to be underlying emotional or psychological issues involved in generating the anxiety.  The self-reflective process of therapy enables people to unravel, understand and transform the causes of their anxiety.

In such circumstances the first step of therapy would be to gain an understanding of the meaning and content of the panic symptoms.  Concurrent with that would be advice and guidance on managing the often distressing symptoms of a panic attack.  These include breathing exercises, grounding techniques, reflexive thinking and gaining an understanding of the natural flight or fight response behind the psychical response to a sense of threat. 

Therapy would then explore the core factors underlying the symptoms.  Often these can be one or an accumulation of major life stresses.  If the source of the panic disorder appears to result from substance abuse, counselling and psychotherapy is strongly recommended as substance abuse itself is very often a symptom of more deep-seated issues.