Panic attacks. Causes and methods of treatment.

Panic attack is an attack of severe anxiety, fear, panic, which is accompanied by certain vegetative (bodily) reactions.

The duration of attacks can vary from several minutes to several hours, averaging 15-30 minutes.

For an anxiety attack to be identified as a panic attack, it must have at least four of the following core symptoms:

• Rapid pulse;
• Sweating;
• Feeling short of air, shortness of breath, difficulty breathing;
• Chills, tremors, internal trembling;
• Pain or discomfort in the left side of the chest;
• Nausea;
• Dizziness, lightheadedness;
• Derealization, depersonalization;
• Fear of going crazy or doing something uncontrollable;
• Fear of death;
• Feeling of numbness or tingling in the extremities;
• Insomnia;
• Confusion of thoughts;

Other (additional) symptoms may be present:

• Abdominal pain,
• Elevated temperature
• Stool disorder
• Frequent urination,
• Feeling of a lump in the throat
• Gait disturbance
• Visual or hearing impairment
• Cramps in the arms or legs,
• Motor function disorder
• High blood pressure.

Patients often talk about the spontaneity (unprovoked) of attacks. However, during the conversation it often turns out that along with spontaneous manifestations of PA, there are also situational attacks that occur in places perceived by a person as potentially dangerous. Such places and situations include:

• Using public transport;
• Staying in a large crowd of people or, conversely, in a confined space;
• And sometimes even, simply, the need to leave your own home.

This list can go on for a long time, but we will stop here.

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Panic disorder

Panic attacks are a symptom of what is called panic disorder.

Panic disorder (episodic paroxysmal anxiety) is a mental disorder that is characterized by the spontaneous occurrence of panic attacks from several manifestations per year to several times a day and restless anticipation of their occurrence.

“Panic disorder” is recognized worldwide as an independent disease. It is included in the International Classification of Diseases, 10th revision (ICD-10)

Some Russian doctors use outdated terms that are not in the ICD, but they emphasize the type of disorder of the autonomic nervous system depending on the leading symptom:

• "vegetative crisis";
• “sympathoadrenal crisis”;
• "cardioneurosis";
• “VVD (vegetative-vascular dystonia) with a crisis course”;
• “NCD” (neurocirculatory dystonia)

What the alarmists are silent about

As a rule, the main symptoms of panic disorder reported by people suffering from it are fear, anxiety, and discomfort in the body. But few people point out such signs as depersonalization and derealization .

Derealization is an unrealistic perception of the world, manifested as a feeling of fog enveloping the patient. Through him, everything seems somehow distant, vague, detached.

The girl describes her attacks of derealization as an alien perception of everything that habitually surrounds her. Even when she is in her room, she does not recognize her. It's like she's an alien who accidentally came down here from outer space. Things around are fuzzy and lifeless. I want to find some kind of support, a landmark, but I can’t. Close people look like strangers.

Depersonalization is felt by her as existing outside her body, as if she is looking at herself from the outside. At such moments, she cannot control her thoughts and movements, she does everything automatically.

People with PD often experience auditory and visual hallucinations , especially before bedtime. They appear in the form of a distinct squeak or rustling sound, blurred visual images, and voices talking to each other.

Causes and development of panic attacks

Panic attacks occur when anxiety levels are extremely high.

If with phobias anxiety is increased and is looking for a way to rationalize itself, turning into a specific fear, then with panic attacks the level of anxiety is even higher and it is no longer looking for a specific object to realize. Anxiety just comes out and takes a person by surprise. This can happen anywhere: in the subway, in a bank, in a store, just on the street, etc.

As a rule, a panic attack occurs when a person’s anxiety is further “stimulated.” For example, a person finds himself in a crowded place and it seems to him that for some reason he looks “different” today and that everyone is looking at him. This can create fear in him of being judged and provoke PA.

Self-esteem

An important fact is that people suffering from panic attacks generally always have low self-esteem. They are very critical of themselves. And the triggers for panic attacks are often their thoughts about how they look from the outside and what others think about them. These obsessive thoughts cause internal tension and anxiety. Fear of condemnation makes a person afraid to express himself spontaneously. He fears that someone may not like this behavior of his and cause negative emotions in this dissatisfied person, which he can somehow express.

Comfort zone and anxiety control

Very often, the comfort zone of anxious people is very narrow and cramped, and it is very easy to accidentally push them out of there. At the same time, any exit from the comfort zone causes additional anxiety and threatens the appearance of another panic attack.

With all this, being in the comfort zone, a person with this anxiety-phobic disorder does not feel completely calm. He's still worried. But being in familiar conditions, he learns not to notice his excitement.

When everything is under control, such a person has the mental resource to repress his anxiety, not to think about what causes it, being in the illusion of comfort. He fills his head with unimportant considerations that have no effect on anything.

But as soon as he leaves the usual conditions of existence, his neuropsychic energy becomes aimed at adapting to a changing environment and there is no resource left for restraining anxiety, which leads to its release in the form of panic attacks.

Upbringing

If during psychotherapy we dive into the deep layers of the psyche and look for the origins of a given mental disorder, then we will always come to childhood and the relationship that this person had with his parents.

Parents of a person with panic disorder constantly emphasized his inferiority in one way or another:

• They might not believe that he would succeed;
• They often shamed him, making him feel unworthy of something or guilty of something;
• They were constantly saying that someone was better than him;
• In general, by all means they taught him to depend on someone else’s assessment so that he would meet some non-existent standards.

The fact is that a person with PA does not allow himself to criticize the upbringing that his parents gave him and idealizes them, forgetting that they are ordinary people who, like everyone else, tend to make mistakes. This approach to one’s personality and the personality of one’s parents becomes one of the reasons for the occurrence of PA.

Agoraphobia. Panic anchors.

A special type of phobia can also be formed based on panic attacks.

If with the usual version of the formation of phobias some kind of logic of events is needed, then for the formation of phobias under the influence of panic attacks it is not needed. Since a panic attack can happen anywhere and anytime, a phobia can form for anything. And such a phobia will not be one, but there will be many of them, since each place and circumstances in which a panic attack occurred will become an anchor reminding a person of the incident in which he fell into a panic. And during the course of the illness, such anchors will accumulate more and more, due to the fact that a panic attack happens each time in new places and in new conditions. Thus, panic attacks expand their domain and over time a person begins to be afraid to leave the house, since a phobic state arises in him almost everywhere.

The result is agoraphobia

- fear of crowded places.

What to do during such an attack of fear

So, if there is an attack of sudden fear, then you can use a folk remedy that has already helped many, such as breathing exercises. It helps to significantly relax, and also come to a state of complete calm and balance.

To completely eliminate the manifestation of such a syndrome, it is necessary to make rare and deep breathing movements. The exhalation should be twice as long as the inhalation. Such people must learn to “breathe with their belly” using the diaphragm.

You can also use a method such as breathing into a bag. You should take a paper bag and take a long breath, and then hold your breath for about 8 seconds and very slowly, moderately exhale all the air again into the bag. Breathing into the bag usually continues for about 5-8 minutes.

Treatment

Increased self-esteem

One of the areas of treatment for panic attacks is to work on increasing self-esteem and self-confidence. And also on the ability to be critical of the personality of your parents. The ability to criticize the upbringing that was given to him by his parents will allow a person to move forward, working on his personal characteristics and developing his own individuality, rather than freezing in place, afraid to change what the adults who are significant to him have created.

In the process of psychotherapy, a person goes through the following stages:

• Understanding that parents are not perfect, since they are ordinary people;
• Protest against the methods of education that parents used and against the parents themselves;
• Separation - mental separation from parents;
• The beginning of the formation of one's own personality;
• Acceptance and gratitude to parents for doing everything they could and as best they could to raise their child.
• Accepting yourself as you are and starting to build your life in accordance with your own preferences.

Disclaimer

It is worth noting that all the procedures described in this section are best carried out under the supervision of a psychotherapist or psychologist. Or at least visit him periodically and tell him about the work done in order to receive the necessary recommendations and make adjustments to your wellness actions.

Self-treatment

Simultaneously with working on self-esteem, it is necessary to carry out procedures that help reduce anxiety.

Helps reduce anxiety:

• Breathing exercises;
• Sports activities;
• Autogenic training;
• Relaxation exercises.

Medicines

Also, if a psychiatrist or neurologist prescribes medications, then you should not neglect them, just as you should not get carried away.

Medicines should be treated as an auxiliary tool that facilitates psychotherapy and the dosage of which should be constantly reduced as psychotherapeutic treatment progresses.

Psychotherapy

Psychotherapeutic treatment can be carried out in various directions:

• Cognitive behavioral therapy. It will help you develop the habit of not being afraid of panic attacks.
• Body-oriented therapy. Will teach you to understand the body signals that precede panic attacks, as well as manage bodily reactions to reduce symptoms.
• Hypnotherapy. It will help create new internal attitudes that promote mental immunity, helping to predict and prevent panic attacks.

In addition to all of the above, a psychotherapist will help you understand the causes of PA. During psychotherapeutic sessions, it will become clear what underlies this disorder and what events or series of events led to it.

Complex treatment

In order for the treatment of panic attacks to be successful, a certain number of vectors must converge:

• A doctor prescribing medications must respect psychotherapeutic methods of treatment and understand that medications do not fully treat a mental disorder, but only relieve certain bodily symptoms and adjust the chemical and hormonal background of the body. As soon as a person stops taking them, his body stops producing the chemical elements necessary to maintain health. Therefore, in the long term, medications lead to addiction.
• The psychotherapist should also not sabotage drug treatment, but should enter into collaboration with the doctor to discuss the results of drug-psychotherapeutic treatment, as well as determine and adjust the dosage of medications.
• The third condition is the cooperation of the patient himself with the specialists treating him. He should try to be honest with them and follow all their instructions. In other words, the patient must feel responsible for what happens to him and not shift it to the people treating him.

Treatment results

If client-doctor-psychotherapist cooperation is established, then a decrease in the number of panic attacks will gradually be observed, as a result of which they will stop completely.

As treatment progresses, the dosage of medications should be reduced until they are completely discontinued. All this should happen against the background of psychotherapeutic treatment.

As general anxiety decreases, both phobias and panic attacks will go away, that is, complete physical and mental recovery will occur.

Author: Dmitry Malin - clinical psychologist

Symptoms

Panic fear is the main manifestation. Other symptoms of panic fears and panic attacks:

• fear of death;
• fear and tightness;
• chest pain;
• cardiopalmus;
• shortness of breath, tachycardia;
• lump in the throat;
• lack of air;
• nausea;
• muscle tension and trembling;
• sweating and pallor;
• dizziness;
• abdominal cramps, nausea and even vomiting;
• noise in ears;
• severe anxiety;
• bad feelings;
• fear that panic may happen again anywhere or in similar situations.

Panic attacks, which require treatment, can develop into panic attacks over time. When a person constantly experiences panic fear, when he finds himself in certain situations, over time it can become a habit. A person will get used to experiencing panic fear in specific life circumstances. It’s difficult to get rid of any habits, especially panic fears that have turned into panic attacks. Although, panic attacks can occur before panic fears and even cause them.