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	Panic Attacks
	The Panic Experience This experience has many names such as the panic attack (or habit or disorder or reaction), anxiety attacks (or disorder or reaction), acute stress disorder, etc. Some people equate it with agoraphobia or social phobia.  The term `panic attack' is used to describe a uncomfortable and upwardly spiraling state of anxiety, fear, and intense mental and physical arousal coupled with an intense fear of the state itself.  If you experience panics it is important to remember that it is a learned behavioural habit and not a ' personality disorder ' nor a reflection of some inherent character weakness. And because it is a learned behaviour it can be 'unlearned' and replaced. This takes a little time and quite a bit of dedication - but it can be done. How the panic habit begins The 'panic' habit often begins with an unexpected and apparently unexplainable surge in adrenaline - an 'anxiety rush'. Because we do not understand what is going on or why it is occurring we `panic'. We loose confidence in our ability to manage the situation. And this causes more adrenaline to be released which causes even more fear. And so the state becomes more and more intense.  After our first `panic' we become more aware of, and apprehensive of, our body sensations and begin to carefully monitor ourselves for any feelings of excitement. This increased attention soon produces the evidence that it dreads - sensations of arousal. Our fear of another `panic' is maintaining the pattern.  The connection with agoraphobia or social phobia The panic habit is not the same as agoraphobia or social phobia. However unless we deal with this ways of reacting to stressful situations it can develop into agoraphobia or social phobia. This tends to occur when we repeatedly experience panic in certain situations, particularly when we are not at home, and then begin to fear these situations because we believe that they are responsible for our panics. In reality the anxiety reaction can be provoked by just about any situation that is a little unusual or challenging. Trying to avoid such situations rather than deal with the thinking and feeling pattern the produces the panic misses the point.  More significantly if you begin trying to avoid such situations you could end up fearing any unfamiliar situation - and then you are into the agoraphobia or social phobia pattern. It is more useful to deal with the internal way in which the panic occurs rather than the multitude of eternal stimuli that provoke the internal activity. Why the panic habit begins Because panics commonly begin for no apparent reason the question Why is this happening? is a common initial response to them. Understanding how and why they begin certainly helps in dealing with them because we then have a rationale for their occurrence. Panic - a delayed reaction Panics commonly begin as a delayed response to how we have been living our lives in recent months or years - how we have been responding to everyday stressors, adjusting to significant life changes, and dealing with our emotions.  The reactions can occur during the period of stress but they often occur quite some time afterwards, just when we thought we had put it all behind us.  This is can be extremely disquieting because there is no apparent connection between the reaction and what is currently, or has recently been, occurring in our lives. So recognising that they are frequently a delayed reaction explains the apparent lack of cause.  How long can this delay be? As long as a few months or as little as a few days. For example, when assisting someone in resolving the panic habit I generally ask them about life events in the six to twelve months prior to the onset of the reactions.  A delayed reaction to... The follow are three of the more common categories of contributory causes  1. Everyday stressors How we deal with life's challenges and hassles affects our feelings towards life, towards other people and towards ourselves. If we have not been handling things effectively this can cause a lowering of confidence and self esteem and a buildup of underlying mental and physical tension  2. Life Changes Major changes in our living patterns require us to re-adjust to new situations. The more common changes include moving house, financial pressure, serious illness or operation, setbacks or alterations in working life, relationships ending or beginning, problems in a relationship, bereavement, accident, etc.  This readjustment calls for considerable mental and behavioural flexibility, rather than a conservative attitude that wants things to remain as they were. Such flexibility is common in children and teenagers but frequently diminishes as we progress into adulthood.  Lacking this flexibility we may find these life changes extremely stressful - even if the symptoms do not immediately appear. Often, in the midst of the crisis or upheaval, we can appear to be managing effectively, because we have things to do. This doesn't just fool others it also fools ourselves and afterwards, when things settle down again, we experience our delayed response.  3. Internally generated stress While all emotional stress is internally generated this refers to stress resulting from how we manage (or do not manage) our own thoughts and feelings.  The following are common causes of, or factors that contribute to, the panic habit: on-going uneasiness, inner conflict, self-criticism or self-hatred, anger, resentment, guilt, emotional blocking, over-seriousness (with regard to ourselves or others), trying to be too 'strong' and to support everyone else at the expense of our own needs, etc.  Summary of the causes Ineffectiveness in dealing with one or more of these three areas will result in a gradual rise in physical and mental tension plus a gradual loss of self confidence.  This can get to the point where even an innocuous event such as waiting in a queue, sitting in a traffic jam, being alone, being with too many people, attending a meeting, or eating in a restaurant can produce uneasiness. This uneasiness can eventually, or sometimes, quite suddenly rise to the level where we experience panic.  Once the first `panic' has occurred we are then likely to attribute the panic to the situation in which we were when it occurred and we will likely try to avoid such situations - even though they were simply the 'final straw' - the precipitating event. The true cause of the panic is more likely to be how we have been dealing with stress in recent months.  How we maintain the habit Irrespective of the original cause it is usually our worrying about the next `attack' that turns what might have been a one-off event into our habitual response to any slight change in our state resulting from a rise adrenaline. Soon even thinking about potentially difficult or challenging situations can produce the reactions. It is interesting and, for some people it is reassuring, to determine what gave rise to the habit. However when it comes to dealing with the habit it is important to remember than the key area of interest is "how I maintain this habit?" This search or observation exercise will provide important clues as to how we can weaken and replace this extremely unpleasant and debilitating experience and get on with living a normal life.  Who gets panic attacks? Controllers The most likely people to develop the panic habit are, in my experience, those who believe in being 'strong' in the sense of being good at controlling their emotions.  Controlling or suppressing or denying one's emotions is unhealthy and there is an eventual price to pay - and this price sometimes manifests itself as a series of panic attacks.  However these people are also likely to be the most determined to stick with a programme of eradicating the panic habit. Given the right methods they will apply themselves to sorting things out, providing that months or years of panicking has not so undermined their confidence and self esteem that they are demoralised.  People-helpers Another group who are susceptible to panics are those who are great at supporting and helping others in distress. They often so this at the expense of their own needs.  Often they will have learned as quite young children to suppress their own needs to look after their brothers, sisters, or even their parents. Years later they are so immersed in their unconscious crusade to help other people and protect them from pain and suffering that they have forgotten how to look after themselves.  Panics - Dealing with them To effectively replace the panic habit with more normal ways of thinking, feeling, and reacting takes a little time. And a little determination. Even more importantly it takes a decision - that you will do it. Whatever it takes. There's no quick fix It also requires you to recognise that there is no simple 3-step solution. And that, even with really effective counselling, you are the one who will have to face the issues, work your way through the adrenaline rushes, and continuously experiment to discover what works best for you. No one can hold your hand - you are in there alone. No amount of understanding, or support groups, or sympathy will absolve you from the tough work of finding your own solution. Sounds a bit depressing? It could be. But it is the reality that, I believe, you must face before you can focus yourself and go ahead and beat the habit. Now the good news The good side to all of this is that it is immensely empowering. When you do beat it - and you can - nothing will ever really scare you again. You have been there. You have stopped and faced your fears. You have figured out your own solution (with or without professional help) and you have beaten it. Your confidence and self esteem will soar. And, because you will have done it yourself, you will know that should the pattern recur in the future you can handle it. So where's the catch The only 'catch' is that you do have to work at it. Perhaps for a few weeks and more likely for a few months. Even if you have professional help it still takes time. But it's worth it. Three stages There are two stages in eradicating the habit. 1. Immediate steps to reduce the intensity of the panic experience and to restore your confidence in your ability to be in charge of you 2. Learn the lessons from having had the experience. What does it indicate about how you have been living your life? What do you need to change. 3. Your on-going stress-reduction programme where you recognise the way in which everyday stress is contributing to the habit Phases 2 and 3 are the long-term ones. (They will later be dealt with in these pages).  Your immediate priority is Phase 1 - learning to manage the experience and to rebuild your confidence and your self esteem Panic Attacks The first panic attack can be terrifying. It appears to come out of the blue and we don't know what it is or why it is occurring. Understanding what is going on demystifies the panic habit and provides a route to managing it.  Why panics occur They start… usually as a delayed response to a period of intense or prolonged stress: to how we have been handling everyday stressors, adjusting to significant life changes, and dealing with our emotions. They often begin some months after the stressful period, just when we thought we had put it all behind us.  Imagine a glass of water - half full - that's a typical person's stress-level. As long as it doesn't overflow we feel we are coping - even if, in reality, the level is a bit too high. But when things happen too fast, one after another, our coping ability gets a bit frayed and the 'glass' overflows. That's the panic experience.  They are maintained… by our fear of them. Even when the cause of the glass 'overflowing' has passed our fear of another panic prevents the level dropping - we're into the panic habit! The level of water is right up to the rim and is maintained there by our fear of having a panic attack.  What to do about them Remain very clear about what is going on. Remind yourself frequently that (1) they are a delayed response to a stressful period, (2) that fearing the next attack makes it more likely to occur and (3) there's nothing wrong with you - panics are very common and can be eliminated by practical self-help methods.  Look after your adrenal glands. Panics are largely a fear of the effects of excessive adrenaline!  Get some 'wins' to boost your confidence in your ability to eliminate them. Panics are very undermining of self confidence so each little success will boost your flagging self confidence.  Action Plan: 1. Eliminate caffeine. Each coffee, cola, or tea drink causes a release of adrenaline and adds to the anxiety and jittery feelings. (Reduce caffeine very gradually over a period of about two weeks. Eliminating this powerful drug too quickly will produce uncomfortable withdrawal symptoms.)  2. Reduce sugar-rich foods. They indirectly re-activate your adrenals. For the same reason eat small amounts of food frequently and ensure you do not get hungry.  3. Sip water or eat small amounts of fruit to keep your mouth moist - a dry mouth sends a 'fear' signal to the brain.  4. Use relaxing breathing methods hourly. Panic is usually accompanied by mild to severe hyperventilation. The breathing methods will help reduce this and will calm you.  5. Regain the ability to relax deeply. At first this will be a little difficult since you are likely to be like a coiled spring so aim for three or four sessions of 3-5 minutes each. Get this up to about 10 minutes after a few weeks. (A good relaxation tape will be helpful but listen to some of it before you buy as many of them sound dreadful.)  6. Sort out your thoughts. Use pen and paper to get your thoughts on paper at least once a day. Just get a few sheets of paper and start writing. Keep the pen moving. Write everything down as it pops into your mind. When finished destroy the notes. (This technique is fully explained here).  7. Keep physically active. Exercise such as swimming or brisk walking helps get rid of accumulated stress hormones and physical tension.  8. Monitor your self-talk to avoid too much negativity. Some negative thinking is understandable - it's an uncomfortable period you are going though. (More on self-talk)  9. Replace negative self talk with affirmations such as "little by little I am learning to manage these episodes and to get myself back to normal".  Answers about Panic What will I tell people? Q. I had a panic attack and I was unsteady on my feet and I couldn't swallow. How can I explain myself to people? How can I explain how I am feeling at this time?  A. First of all, are you sure that other people actually noticed anything - or noticed as much as you think they may have seen? Most people, other than perhaps very close friends, are not very perceptive. Secondly, I usually suggest to people that they avoid calling it a 'panic attack' but rather minimise its apparent importance by describing it, to yourself and to others, as 'a funny turn' or some such trivialising name.  The key thing with panics is to learn to manage them quickly so that you do not build up a stock of memories of having panicked. In doing this a trial and error approach is called for - you need to discover what works best for you.  Definitely start with physical methods - relaxing muscles and breathing methods.  Your focus on what others may be thinking or noticing is very common. And yet it is more important to devote your attention to discovering what will reduce the symptoms before they have had a chance to reach the stage they did with you. Your brief description suggests two possibilities, which not necessary mutually exclusive.  (1) The difficulty in swallowing is likely to be something called 'globus hystericus' or a lump in the throat caused by excessive fear and (2) the unsteadiness may be due to inadequate breathing - possibly a degree of hyperventilation. Both are very common. And both respond well to breathing methods especially Buteyko Breathing. Will the Panic ever stop? Q. I have been suffering from severe panic attacks for a year now. I have attended counselling and have visited a Chinese doctor.....who prescribed natural herbal drink, adding that my anxiety was caused through an in-balance of the liver and kidneys. Will the panic and anxiety ever stop...and is solely down to me to amend this problem?  A. I can imagine what's behind your final comment! At times it does seem like there'll is no end to the panic feelings. And I'm not going to offer platitudes such as 'it will sort itself out in time' as that is not necessarily the case.  The various complimentary medicines can alleviate some symptoms. And can help prevent damage to the internal organs. But, as you will have read from the website, panic is a delayed response to stress and is fuelled by the on-going fear of the next panic. Counselling, alone, can be can helpful. But unless it provides you with practical strategies to handle the panics it is not enough.  To answer directly - the panics are unlikely to stop... of their own accord...  BUT...  You can learn to manage them and this will undermine their recurrence - leading to freedom from them. Because this is one area where passively waiting is certainly not the answer. Nor is passively putting yourself in the hand of therapists.  You do need to act.  Follow-up question: Q 2 Thank-you for replying so soon. I have found the web-site most useful and reassuring. When Adrenaline is not flowing, I feel very confident... but like so many others when it does flow the confidence goes!  I am determined to beat this. I feel angry that I have allowed myself to get into this state. I do wonder at times what caused it... I have had stress before, and not suffered from these horrible side-effects. Now I do!!  Does diet (cutting carbohydrates) help?... or is this just a fad?  I am aware a lot of the work (nearly all of the work ) is down to me, the doctor tried to pump anti-depressants down my neck... I refused as I am not depressed. I just suffer from anxiety and stress.  A 2 Imagine a glass of water - half full - that's a person's typical stress-accumulation.  As long as it doesn't overflow we feel we are coping - even if, in reality, the level is a bit too high. But when things happen too fast, one after another, our coping ability gets a bit frayed. That's when the 'glass' is overflowing. That's the panic experience.  Even after the cause of the overflow has passed our fearful anticipation of another panic prevents the level dropping - we're into the panic habit! That sounds like where you are currently. The level is up to the rim and maintained there by your (quite understandable) fear of panicking. Diet can be involved... First of all ensure it's balanced - wide variety of foods and avoid becoming faddish. Cut down on and slowly eliminate caffeine - it hits the adrenals hard. Take at least 2 weeks to cut down. Go easy on sugar-rich foods - they also indirectly over-work the adrenals.  Finally.....  Get a good relaxation tape - check it before you buy - some of the accents can be very off-putting when heard the 10th time!!!  Relax about twice a day.  (Follow-up question 2) Q 3 Thanks for your kind words. I will reply in two weeks time. You certainly hit the nail on the head. Over the past year it has been one thing leading to another. First of all my (relative) died, I then got married, then fell out with my (relative) and this problem has still not been eradicated), I then bought a house, etc. etc. All this in the space of 12 months!!! I don't think there is anything left to do!!!  A 3 Yes, sounds like a typical set-up for a panicky period  And... Having a rationale for it will certainly help by demystifying the thing! Good luck  Is this Claustrophobia or not? Q. I have worked for the same company for (__)years. (__)years ago I was promoted to ___. This was a very stressful position with a lot of responsibility. After about 1 year I felt that I could take no more pressure as I had begun having panic attacks and feeling that I did not want to leave the house although I did have anxious feelings while at home.  Since the promotion I have gradually developed a need for a fan to blow on my face constantly while I am at work and at every possible moment I must have the window open. I just feel that I constantly need fresh air and have convinced myself and others that I am always hot. I dread going into shopping centres and shake and go light headed until I get out. I have to build myself up to go shopping and will not go anywhere without my husband.  I had to run out of meetings at work because I thought I was going to pass out. I asked my manager to de-mote me to see if the symptoms would get better but they have not. I do not enjoy going out and always worry in case it is too hot or there are too many people. I will never walk into or sit in a room full of people. Do you think I am suffering from claustrophobia?  A. Sounds more like panic attacks, from what you've described, possibly brought on by the promotion. (Were there other stressful events in your life over the 6-12 months prior to the promotion?)  The fan/temperature thing is likely to be the body's thermostat mechanism being thrown out of kilter by the on-going stress response, too. Same with the inability to be in a meeting - you probably are continually monitoring your physical and mental state while in meetings and thinking 'I hope I don't have to leave etc.' Same with the being in public places.  So, the important thing is "what to do about it?" My suggestion is begin treating it as if it is the Panic Habit that you've got into. Use whatever help you can. A few sessions of counselling with a good listener (not advice-giver) would help too - BUT only to get things off your chest and into perspective. Then you have to begin changing your habits of thinking, acting, and feeling. The panic pages on this site will help you get started. Also the book 'Feel the Fear and Do It Anyway' is excellent - and compliments the material on my site rather than contradicts it.  Finally... 1. Panic is very common - it's just that many people are highly skilled at concealing their symptoms.  2. It is a habit you've got into - and you can work your way out of it.  3. It is not an illness!  4. With persistence you can beat it.  My first panic while flying Q. "I had my first claustrophobic panic attack on a "small" 6.2 feet ceiling, 2 seats each side, very narrow aisle, fully booked commercial plane yesterday.  I have been on these planes many times before without problem. It happened in 30 seconds. I was amazed. Two minutes after sitting down I suddenly HAD to get off, and I did. After about 5 minutes just outside the plane door, I got back into my seat, scared *****, but convinced I had to deal with this. I was 1000 miles from home on Sunday and I had to work Mon.  I read intently, and was annoyed with everyone who closed their shades or walked by in the incredibly narrow aisle, but I survived. Horrible! Any suggestions as to what type of treatment is best? What medicine hypnotherapy/desensitisation should I consider?  A. Sounds like you had a panic rather than a claustrophobic episode. (This could quite easily develop into a fully fledged flying phobia - but treat the panic and you'll soon be comfortable flying again, I'd say).  Panics often occur as the result of a period of fairly intense worry or stress or disruption of one's lifestyle. Start using the web pages to deal with it.  Anxiety Attack Symptoms Q. "I am a 17 year old male who may be experiencing symptoms of anxiety attacks. I had previously conjectured that these adrenaline induced destabilizations were caused by a lack of oxygen brain damage or an exposure to some toxic substance. I have underwent a series of tests and they have facilitate negative results when searching for toxins, brain damage, or deficiency in oxygen, an imbalance in blood sugar, or seizures. The only thing that has not been ruled out is sleep apnoea. I occasionally have feelings of discomfort in the morning, when I true to remember things or when I am under a great deal of anxiety. It could be that the uneasiness in the morning is the result of a self induced headache, lack of sleep or the expectancy of having one. I would like some more information about anxiety disorders and if they can cause a disturbance in trying to recall things and thought. thank you  A. From your email it sounds like you are working very hard to identify a name for your situation/condition. Understandable - if we have a name we have an explanation - and hopefully a solution.  I'd keep it simple, though. It's then easier to know what action to take. And I believe that it is action - rather than diagnosis or treatment - that is needed for dealing with anxiety states.  When we experience anxiety we temporarily enter a short-term state commonly called Fight or Flight.  If the anxiety episodes are frequent they merge and we are in a chronic (i.e. ongoing) state of Fight or Flight. This can lead to a 'Freeze' state in which we become so paralysed by fear we are afraid to do anything.  Then there is the huge loss or vitality/energy. On-going anxiety drains us of energy - and soon it can get to the point where we feel more tired on waking than before sleep. The symptoms you mention (memory, distraction, lack of concentration, etc.) can be related to anxiety states - and, of course, to other things.  It sounds like you have done the rounds of the specialist tests with (happily) negative results. Rather than spend further time and energy looking for experts to tell you what is going on - or to diagnose you - I'd suggest that you may achieve more by taking action to reduce the anxiety, first. And remember that there are different levels of anxiety/stress - the obvious one is where you are aware of worrying about things - less obvious is the anxiety programme which 'runs in the background' - the underlying uneasiness or the refusal to think about certain things. These affect us more powerfully than the worrying we are consciously aware of.  Take action to slowly (at first) reduce the more uncomfortable symptoms. Use the tips on to get started. Email me directly if you want further suggestions. And just decide that you're going to beat this one - and learn from it.