An occurrence that was once taboo, ignored, frowned upon, and even swept under the carpet has pivoted to the forefront of perception in recent times – thanks to increased awareness of anxiety and its sometimes crippling symptoms in a pandemic world.
These occurrences are panic attacks: often brought on by increased anxiety and stress. Dr Elizabeth Berryman is a leading psychologist from New Zealand and also the founder of chnnl.app, a digital platform providing insights, information and data on employee mental health and wellbeing.
She states that one in five people experience poor mental health at some point in their lifetime. So the odds are that you or someone you know will experience a form of anxiety.
In light of this fact, it is especially important to invest in a deeper understanding of the struggles that those around us face, as well as develop an awareness of such symptoms in ourselves.
It can be argued that the question of poor mental health has become more accepted as a serious and growing global problem as a direct result of the lockdowns and restrictions happening around the world because of COVID-19.
However, while there is an increased awareness surrounding mental health and how it directly affects our peers, loved ones and families, there is still so much more to be done. There is still a gap as to what action should be taken when it is apparent that all is not ‘OK’. Or when poor mental health starts to manifest itself via physical, scary symptoms, which can sometimes feel out of control for those experiencing them.
One of these ‘symptoms’ is a panic attack, which is distinct from the ordinary feelings of anxiety we all occasionally have.
Some of the questions around panic attacks are: What causes them? What is happening when they occur? And how we can help those suffering from them?
What is a panic attack?
Panic attacks are more common than many people might assume. Dr Katie Dobson, a clinical psychologist at cognitive behavioural therapy provider THIS WAY UP, advises that nearly half (about 40 per cent) of Australians will experience a panic attack during their lifetime, which is backed up by figures from the Australian Bureau of Statistics.
Meanwhile, in New Zealand, about one in four Kiwis will be affected by an anxiety disorder at some stage in their lives, with 15 per cent of the population affected at any one time.
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Sarah-Jayne Duryea, the founder and principal psychologist of happyminds.net.au, describes panic attacks as sudden, intense feelings of fear which accompany some of the physical symptoms of anxiety, such as dizziness, shortness of breath, trembling and sweating.
These attacks often occur with a strong sense of wanting to run away and an overwhelming feeling of panic. Dr Berryman explains that people who experience panic attacks as a common occurrence report a “sudden, unexpected and spontaneous onset of fear or discomfort, typically reaching a peak within 10 minutes”.
Panic attacks fall under the category of Generalised Anxiety Disorder and usually present in those with a background of high levels of anxiety, according to Dr Berryman.
What are the symptoms?
She explains that to meet the criteria for a medical diagnosis of a panic attack, four or more of the following must be present: palpitations, pounding heart or accelerated heart rate; sweating, trembling or shaking; shortness of breath or feeling of smothering; feelings of choking, chest pain or discomfort; nausea or abdominal distress, feeling dizzy, unsteady, lightheaded, or faint.
Additional symptoms include chills or heat sensations, paraesthesia (numbness or tingling sensations), derealisation (a feeling of unreality) or depersonalisation (being detached from oneself), fear of losing control or going crazy and finally, fear of dying.
Those experiencing these symptoms firsthand describe a sense that something is very wrong. Symptoms such as breathing problems can result in feeling that a serious medical event is taking place, such as a heart attack or suffocation.
Dr Berryman states that it can be scary and advises that if these symptoms aren’t resolved quickly, it is usually best to go to the emergency department or call an ambulance. Clinical psychologist Dr Kirsten Hunter advises that panic attacks can be different for everyone, but are universally unpleasant and frightening experiences.
A panic attack involves the experience of a sudden, intense level of anxiety in the form of physical symptoms that often leave the person feeling as though something terrible is about to happen.
She also flags that it is important to recognise that panic attacks – while a very real and frightening thing to experience – are not physically harmful. In fact, it is our misinterpretation of these physical sensations as being dangerous that can often keep the cycle of panic in progress.
Can a panic attack be prevented?
Dr Dobson advises that panic attacks often occur when we are under additional stress, adjusting to significant life changes, or when we are more vulnerable to experiencing intense emotions. She recommends keeping an eye on our overall health and wellbeing to help keep anxiety and stress levels down.
Dr Dobson advises that a good place to start is by making sure you are getting enough sleep, eating a balanced diet, prioritising movement and exercise, and taking time out to do the things you enjoy and that give you a sense of achievement.
She adds that it is important to make time to connect with others, whether that’s broadening your social network or spending quality time with friends and family.
Minimising the effect
Many people also find that relaxation can help to reduce anxiety levels, which makes us less prone to experiencing panic symptoms.
Examples of ways we can help ourselves and encourage loved ones to relax are spending time outdoors, using relaxed breathing exercises, or practising mindful meditation: all helpful things for your daily routine.
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Meanwhile, Duryea says that aiming for minimising the chances of getting a panic attack makes more sense than trying to avoid them all together, however unpleasant they are to experience.
She continues: “Trying to stop any feelings of anxiety tends to put more pressure on us, which can lead to more anxiety and stress. “Reaching out for help from a professional experienced with dealing with panic is important so you can learn effective techniques to cope when panic hits.”
For many suffering with panic attacks, reassurance that they can be managed can be very comforting. ‘Talk therapy’ is recommended by Dr Berryman as a potentially helpful ongoing management method. This involves a therapist and patient working towards planning together for managing panic attacks.
This is a bespoke treatment plan, which differs from patient to patient, but usually involves breathing techniques, meditation and other distraction techniques.
Dr Dobson advises that we know that anxiety can run in families, so it can be helpful to put into practice some relaxation skills if you are aware that you might be more vulnerable to experiencing panic. “If you recognise these symptoms as part of your own experience, the first thing to do is see a medical professional to rule out any possible medical causes of your symptoms,” she says.
“It is a good idea to visit your general practitioner and talk through your physical symptoms and related worries. If, after seeking medical advice, you learn that there is no physical cause to these symptoms, it is likely that you are experiencing panic attacks.”
Providing reassurance for those who suffer, Dr Dobson adds: “The good news is, panic attacks are not harmful, and there are really effective treatments available.”
Dr Berryman also says that if the underlying causes of panic attacks are addressed, they can potentially be managed such with ‘talk therapy’ such as Cognitive Behaviour Therapy (CBT) or Acceptance And Commitment Therapy (ACT).
Medications can also help, such as selective serotonin reuptake inhibitors (a type of anti-depressant), and in some severe cases, a low dose of benzodiazepines can be helpful for situations known to trigger panic attacks, according to Dr Berryman.
Dr Berryman advises that a full medical examination should be done by a medical professional if panic attacks are ongoing. She says: “As with all mental health diagnoses, all potential causes need to be explored before a diagnosis is made.
Especially with panic attacks, there is a long list of potential underlying medical conditions that need to be ruled out first. Other physical conditions such as anaemia or asthma can exacerbate panic attacks and, therefore, need to be professionally managed.”
Panic in the workplace
Dr Berryman provides an anecdote highlighting the importance of the knowledge and presence of soft skills in the workplace to support and combat mental health in colleagues.
“I heard a heartwarming story from a CEO who had been informed about an employee who had been having panic attacks at work,” she says. “He himself had experienced anxiety, so he asked if she would like to bring her therapist in for a meeting with her manager and himself about how they could best support her.
“The small changes enacted and acceptance in the workplace allowed the employee to ease her way back into the workplace setting and try ‘graded’ exposure – which is small doses of the trigger scenario with a support person available.”
Dr Berryman advises that if you are the sufferer of panic attacks or know of a colleague who is suffering, try to initiate an open conversation with management about the best way they can offer you support. Training in soft skills, such as active listening can be arguably as important in the workplace as first aid training.
Panic attacks in public: how to approach?
To observe a stranger suffering from a panic attack in a public space can be a very confronting experience. Dr Berryman advises that if we do encounter someone having a panic attack, it is important that we approach them, with caution.
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“Even to just be present and to sit with them to reassure them that they are not alone can provide overwhelming reassurance and a calming presence.
“If someone is hyperventilating (struggling to catch their breath), a tried and tested technique is to ask them to breathe slowly in and out of a paper bag,” she says.
Dr Berryman advises that if you cannot find a paper bag, ask them to cup their hands around their mouth and rebreathe the same air.
“Make sure you call an ambulance if things do not improve after 2-3 minutes, or if you aren’t 100 per cent convinced that it is a panic attack,” she says.
Tips to manage panic attacks
Dr Katie Dobson, a clinical psychologist at THIS WAY UP, provides some great advice to help manage panic attacks, both for yourself and others.
- Learn about the cycle of panic. Knowledge is power. Educate yourself on how the body’s fight-or-flight response can cause us to experience a panic attack. Understanding how these sensations can be experienced and also not be harmful can itself reduce your worry and anxiety about panic attacks.
- Slow down your breathing. When anxious, we often breathe too quickly, which unfortunately only increases feelings of tension and worry. Take time each day to slow your breathing down. Try breathing in for three seconds, out for three seconds, and practise this for several minutes each day.
- Allow the symptoms to rise and fall like a ‘wave’ and challenge your interpretation of them. Rather than misinterpreting your racing heart as evidence of a medical emergency, try to notice these symptoms as anxiety, remind yourself that they aren’t harmful, and allow the feelings to come and go. This is called ‘panic surfing’ and becomes easier with practice.
- Take note of your triggers. Make a note of the situations or places that tend to trigger your panic attacks. Common examples include small indoor environments, heights, cardio/aerobic exercise that increases heart rate and public speaking situations. If you’ve been actively avoiding these triggers, try to make a plan to gradually reduce how often you are staying away from these situations.
- Try not to let the panic ‘take over’. Anxiety can make you want to avoid certain situations or change your life circumstances to ensure we don’t experience feelings of panic. However, avoidance can actually prolong panic symptoms in the long run. Try to keep your regular routine and activities in place, despite feelings of anxiety.
- Seek support. Panic attacks can be frightening but are very common and very treatable. There is support available to you. Cognitive behavioural therapy is an effective form of psychological treatment for panic attacks. Consider speaking with a psychologist for individual support. If you’re unsure where to start, have a discussion with your GP about a referral to a mental health clinician or other treatment options