Panic/Anxiety Attack

Mmm hmm, all my life, and it started young, and was coupled with depression, which is a common handmaiden to anxiety disorder. I did not take medication.

"I'm too young for this, only 20 years old, and I hate scaring everyone who cares about me over somthing not dangerous to my health. I don't want them worrying about me."

First of all, stress is VERY dangerous to your health, and reducing it is a good thing. Second, rereading that quote, you can see that a lot of your stress is wrapped up in not worrying others who care about you, so you are essentially accepting responsibility for their well-being, at the expense of your own. Their lives are their own responsibilty, as is yours, and together, you can all get through it.

Cognitive Behavioural Therapy worked for me. Here are a couple of links, if you want to find out more:

http://www.panicattacks.com.au/about/anxdis/CBT.html

http://www.psychnet-uk.com/psychotherapy/psychotherapy_cognitive_behavioural_therapy.htm

Cav speaketh sooth - as a matter of fact, young folk have about 25 percent of their ranks suffering clinical levels of anxiety. I forget the incidence of panic attacks in the population generally, but it is surprisingly high.

It is indeed good to read up on the damn things - and to know they cannot hurt you, weird and 'orrid as they feel, since one of the things most likely to cause them to be a problem is fearing them. It is not infrequent in therapy for them to be induced, so that people get to really believe this.

CBT IS the treatment of choice - though a number of panic attack prone folk do use the odd tranquilizer to settle their nervous systems down when they have gone into a hyperdrive phase - you are right, though, they can be very addictive.

A lot of the weird feelings come from unconscious hyperventilation - plus your mind misinterpreting the physiological sensations of arousal (ie your body responds to your stress by triggering its flight or fight response, as a good body ought, it not knowing, bless it, that there is no actual threat, and it releases adrenaline and such, gets your heart pounding, moves oxygen to the muscles - leaving head and tummy and such feeling weirdish, if you ain't running or hitting) the resultant feelings tend to trigger more anxiety, and you get into a nasty feedback loop for a while - with accompanying feelings of doom and fear that you are dying and all that.

Understanding is the first step - once you understand what is going on, there are good strategies for helping.

Drugs for me have always appeared to be a band-aid solution. I would stick with the CBT. Not only is it effective, it is fairly quick as well, as compared to conventional psychotherapy. If this is Portal's first attack, I hardly see a reason for any drugs.

I also agree with bunny regarding reading up a bit more on anxiety disorders. Here is a good primer page to look at:

http://my.webmd.com/medical_information/condition_centers/anxiety_panic_disorders/default.htm

Agree with what has been said here. The main thing is to learn as much about panic attacks as you can, so that the mystery is taken out of them.

I have had a few panic attacks in my life. I have learned to focus on my breathing, making it slow and deliberate, which is very calming. Also, I keep saying to myself that this is just a panic attact, and I can be in control of it. My atttacks come with cold sweats and dizziness. When it happens (and it has not happened in a long, long time) I take an over the counter drammamine, and go to sleep, until it passes.

Slow, diaphragm breathing has a two-pronged beneficial effect.

One, it inhibits hyperventilation (the old remedy of breathing in and out of a paperbag is also making a comeback, as lots of the weird feelings associated with panic attack seem to be from hyperventilation leading to too much oxygen in the blood which, oddly, inhibits cell take-up of the oxygen - the paper bag returns more normal blood chemistry by increasing carbon dioxide)

Two - it seems the stretching of the diaphragm triggers a relaxation response.


One, initially, lies down - with one leg flexed - gently expels air from the lungs - pauses - slowly breathes deep into the lungs - with out straining - until you can feel your tummy rise. This occurs as the diaphragm lowers to allow the lungs to fill properly.

You pause - count to three slowly - gently let out air again - pause - repeat.

Once you learn how to do it, you can do it anywhere. It is very soothing.

One thing I can assure you of is that the most of the medicines are NOT addictive. The medication I've recently gotten off is used for both depression and anxiety (at different dosages), but as far as addiction, not a problem at all. So long as you've got a good physician, you shouldn't have any trouble in that way. But if you can deal with the problems with out medication all the better. But don't totally avoid something for the wrong reasons.

Here is a handout on anxiety/panic attacks which may be useful:

UNDERSTANDING ANXIETY

If you don't know the reason behind the mental and physical symptoms of an anxiety attack, then it is not unreasonable that you look for reasons why you are experiencing these symptoms. The symptoms of an anxiety or panic attack are certainly unpleasant to say the least, but at the right time and place they have survival value. This is why every human being, from time to time experiences anxiety. The surge of anxiety, this emergency response, prepares you for action. It is often called the "Fight or Flight" response (FF).

The very same sensations occurring without threat to your welfare are termed an anxiety or panic attack. Because most people don't understand what is happening when they have an anxiety attack, they invent reasons to explain the situations, and these reasons frequently fuel the anxiety even further.

Understanding Your Nervous System

The Autonomic Nervous System consists of two parts. One part, the Sympathetic Nervous System is that part of the ANS which produces the emergency response of Fight or Flight, releasing energy into the body and priming it for action. Most panic or anxiety attacks involve many symptoms.

AUTONOMIC NERVOUS SYSTEM

Sympathetic Nervous System

Adrenalin released
Increased heart rate
Digestion slowed
Breathing rate increased
Muscles tense for action
Sweat glands stimulated
Decreased blood to skin
Increased blood pressure


Parasympathetic Nervous System

Adrenalin countered

Normal heart rate

Digestion normal

Breathing rate normal

Muscles relax

Sweat glands normal

Skin blood supply normal

Blood pressure normal



Let's now consider in more detail how the symptoms of anxiety occur.

When the Sympathetic Nervous System triggers off, it releases chemicals into your body.

Heart.

Your heart rate will increase in both speed and volume. This is a useful part of the Fight or Flight response because it prepares your body for physical action, speeding up the flow of blood and removing the waste products that are produced by muscular activity. Although your heart is working harder, you are not having a heart attack.

Circulation effects.

The Fight or Flight response is preparing your body to either fight the danger or escape from it.

Temperature Control.

During the Fight or Flight response you will sweat more.

Breathing.

The Fight or Flight response brings with it an increase in the speed and volume of your breathing. If you are going to fight or escape your muscles will need an extra supply of oxygen. There are a number of other non harmful effects produced when the Sympathetic Nervous System triggers the emergency Fight or Flight response.

Breathing and Keeping the Body in Balance


One of the effects of the Fight or Flight response is to produce an increase in breathing rate. In an anxiety attack, breathing rates of in excess of 30 breaths per minute are not unusual. Even if you feeling comfortable you may find your breathing rate is fairly fast. This is not at all unusual for people who experience anxiety attacks.

Your body uses carbon dioxide to maintain the correct balance in your blood, and if you breathe off too much CO2 by overbreathing, then the pH in you blood will get out of balance, and it will become more alkaline than normal. Alkaline blood has an important effect. If you were actually fighting or escaping the danger, then your body would be producing a lot more carbon dioxide and everything would operate normally to ensure your survival, however you are not producing more carbon dioxide when you have an anxiety attack, and thus the overbreathing leads to the development of further mental and physical symptoms. The mild oxygen deprivation will also trigger off other symptoms.

Your brain recognises the drop in oxygen level and will trigger off an increase in heart rate in order to get more oxygen. Your legs may turn to jelly and you may feel light headed,

I'm Having a Heart Attack


If you have noticed palpitations, difficulty breathing, tight chest, and tingling sensations when you have been having an anxiety attack, you might have though that you are having a heart attack.

During a heart attack there will be electrical changes in the heart muscles which show up on an Electrocardiogram (ECG), whereas during an anxiety attack the only change which shows up on the ECG is an increase in the heart rate itself.

It comes as a surprise to many people to learn that the majority of people admitted to hospital for investigation of a heart attack are in fact having an anxiety attack instead.

Additionally, Schizophrenics do not experience the wide range of physical symptoms that accompany a panic attack, so if you have noticed a range of symptoms that have been described previously in these notes, then you can be pretty certain that you are not going crazy, you are not Schizophrenic, but are simply experiencing an anxiety attack.

Many people who have experienced panic attacks say that they fear "going berserk", running and screaming, or alternatively becoming totally paralysed. The Fight or Flight Response prepares your body for action, and so physically and mentally you are being prepared to either fight or escape rapidly. Many people experience their first anxiety attack in situations that are crowded or noisy, or associated with much hustle and bustle. Virtually everyone who's ever had an anxiety or panic attack fears fainting, but in reality, very few have done so. In any event if a person did faint, then their body would quickly return to normal because of the activation of the Parasympathetic Nervous System. The Parasympathetic Nervous System counteracts the activity in the Sympathetic Nervous System and restores a normal balance to bodily functions.

The Fight or Flight Response which produces the symptoms is Nature's way of preparing you to face or escape from a threatening situation. Although an anxiety attack is certainly not pleasant it is not damaging to your physical health, and noone has ever died from having an anxiety attack.

Why Do People Misinterpret?

Deep Comfortable Slight Mild Moderate Strong PANIC
Relaxation Anxiety Anxiety Anxiety Anxiety

If you have habitually breathed quickly, then your system will be very finely balanced. If your breathing rate exceeds this then you are breathing too quickly. Do you breathe too deeply? If there is excessive chest movement you will be breathing off too much carbon dioxide, and maintaining a state of imbalance. It is important that you thoroughly understand the basis for the symptoms that makeup an anxiety or panic attack.

Here is a simple demystified meditation/relaxation method: Only bother looking if interested, of course!!!! - these things can help your body not get to anxiety attack stage.

RELAXATION RESPONSE

Meditation is a word that for some people is a no-no. Without knowing what it really is, it?s often rejected on ethnic or religious grounds. Meditation is no more than a technique that produces something called the Relaxation Response. Every cultural group in the world has over the centuries developed its own way of producing the Relaxation Response, and the technique that you?ll learn in these notes is based on the principles common to all types of meditation.

It?s easier to understand what is meant by the Relaxation Response if we consider its opposite, the Fight or Flight Response. Could you leap over a two metre fence? Probably not. Now imagine that you were being chased by a savage bull with huge horns, and between you and safety was a two metre fence. Could you clear it? Certainly. The Fight or Flight Response pushes our body to a peak state of arousal, giving us the capacity to exceed normal physical limits.

There are a number of bodily changes involved in the Fight or Flight Response. In the Relaxation Response we see the opposite, as described below:

BODILY REACTION FIGHT or FLIGHT RESPONSE RELAXATION RESPONSE
Breathing rate Increased Decreased
Blood Pressure Increased Decreased
Oxygen usage Increased Decreased
Muscle tension Increased Decreased
Metabolic rate Increased Decreased
Heart rate Increased Decreased

In addition, during the Relaxation Response there is an increased amount of alpha wave activity in your brain. Alpha waves are patterns of electrical activity found in your brain, but only during periods of deep relaxation.

Since the 1960?s there has been an immense amount of research published on the beneficial effects of meditation. The benefits include:

1. Reduction in Anxiety and Tension. The quieting effects of meditation differ from the effects of drugs. Drug induced relaxation may slow a person down and cause grogginess. The relaxation effect of meditation doesn?t bring any loss of alertness, and some studies have shown an increase in alertness. Meditation can be used in place of, or as a supplement to drugs to relieve anxiety.

2. Improvement in Stress Related Diseases. A more relaxed body is more effective fighting the causes of many illnesses. You?ll know that when you?re under prolonged stress and run down you?re much more susceptible to things like influenza and the common cold. When you are under stress your immune system is less effective, and so you?re far more vulnerable to the viruses and bacteria causing these problems. When you meditate regularly your immune system is kept at peak efficiency.

3. Increased Productivity. Meditators often notice a beneficial surge in energy, shown in reduced need for day time naps, increased physical activity and increased productivity.

4. Increased Self Acceptance. The non critical state of mind experienced during meditation often carries over into the person?s everyday life, leading to a lessening of unproductive self blame, increased tolerance for the human faults of others, and resulting in an improvement in relationships with others. Research points to a marked reduction in irritability, within a relatively short time of commencing meditation.

5. Reduced Hypertension. Several research studies have shown significant reductions in blood pressure amongst people suffering from essential hypertension. In many cases a person will be able to totally eliminate their need for anti-hypertensive drugs. Note though \that you should not change your use of any prescription drugs without medical advice.




The Meditation Technique

There are five basic requirements to elicit the Relaxation Response.

1. A Comfortable Position. Pick a position that supports your body, and keeps your neck and head supported. A chair that holds you in an upright position is ideal. Lying down on a bed is unsatisfactory, because of its tendency to induce sleep. From both a physical and mental point of view, sleep and the Relaxation Response are different states.

2. Minimal Distractions. The ideal environment is one where there are no external distractions to complete with the meditation process. Practically speaking an environment totally free of distractions may be almost impossible to achieve, but you can minimise distractions of the outside world by following these ideas.

Visual Distractions: Close your eyes, or fix your gaze on a blank wall without any moving objects in view. Eyes closed is preferable.

Sound Distractions: Close doors and windows, unplug the phone, and ask the children to keep away. If this doesn?t give you a quiet place, try a constant background noise to mask distractions. A fan, airconditioner, or TV tuned to a channel with no signal are all suitable. Normal music is not recommended, but you can purchase commercial tapes which feature natural sounds such as waves breaking on a beach, or wind blowing through trees, and these may be useful.

Physical Distractions. Avoid the glare of bright light bulbs, being too hot or cold, sitting in a draught, wearing tight clothes.

3. Physical Relaxation. If you?re too tense to begin with your attempts to meditate will be unsatisfactory. It may be necessary then to begin with a few minutes of relaxation, covering the following muscle groups:

Feet, calves and thighs
Hands, lower and upper arms
Buttocks and stomach;, chest, shoulders
Jaw, mouth and lips, eyes, forehead and neck

Tense up a muscle group as you breath in. Hold the breath and tension for 5 to 8 seconds, then as you let the breath out, Let Go the tension slowly. You may take 2 or 3 breaths to let go all the tension, but don?t increase the tension as you breath in on the 2nd or 3rd breaths. Then Breath Slowly for 20 - 30 seconds, before repeating the ?Tense - Hold - Let Go - Breath Slowly? cycle two or three times. Work through all muscle groups that are tense.

Having relaxed physically, then switch to focusing on your breathing, using a comfortable breathing style that is slower and smaller than normal, and from the diaphragm. When you?ve settled into that rhythm, add the next step of the mental focus.

4. A Mental Focus. All meditation techniques use a mental focus to help you narrow your awareness of the outside world, and the normal everyday ?chatter? of conscious thoughts that flow through your head. An ideal mental focus is a thought or thoughts that are:

free of ideas, associations or specific memories
cyclical, repetitive or forming a sequence
over-learnt, so you don?t have to think what comes next
linked to the physical process of your breathing

A mental focus that has stood the test of time is to use a sequence of numbers, linked to your breathing. For example

In out in out in out in out in out in out in out in out
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
or 1 2 3 4 5 6 7 8 9 10 9 8 7 6 5 4
or 1 out 2 out 3 out 4 out 5 out 6 out 7 out 8 out etc

5. A Passive Attitude. Just as you couldn?t jump the two metre fence by trying to jump it, but could do so in the right context, so it is with the Relaxation Response. You won?t achieve it if you ?try? to achieve it, but if you simply provide the right context for it to occur, it will. A passive attitude is a matter of allowing the meditation process to occur, rather than trying to achieve it or force it into being.

If you?re asking yourself the following questions, you haven?t got the right attitude. ?Am I doing this right?, indicates a concern with performance. ?How long does this take? indicates a concern regarding time. ?What?s a good result?? indicates a concern with achieving something, rather than with the process itself.

Many meditation teachers consider the passive attitude to be the most important feature of all. In our Western society with its emphasis on ?Achievement through Effort? many people find the correct attitude elusive at first.

Distracting thoughts will almost always occur at some time during meditation, they are a normal occurrence. A passive attitude allows you to acknowledge the presence of a distracting thought, and then let it go, rather than focusing and developing it. Simply refocus your thinking on the next breath, and to any number that you wish in order to regain your mental focus.?

How Often and How Long? Research and clinical experience suggest that two periods of 15 to 20 minutes a day is ideal. But if your routine permits only one such period, schedule it in the morning before breakfast. Have a clock or watch handy to check the time, and if some minutes remain then simply return your attention to your breathing and mental focus.

The Meditation Experience

You don?t have to be aware of all the elements of the Relaxation Response in order to benefit from meditating. There is a benefit simply taking time out from the normal hectic routine of life to make an effort to improve your health. The second benefit is a noticeable increase in bodily relaxation.

Another feature of meditation is that of feeling unaware of the outside world, or the passage of time. This can be experienced as a mental blank, although to think ?I?ve stopped thinking? would be in itself a distracting thought, and should lead to a renewed attention to your breathing and mental focus. Mental blanks are not unusual. You may have experienced a similar mental blank when driving a familiar journey. You get to your destination and are unaware of the trip because your conscious mind has switched off, but obviously you were not asleep or else you would have crashed the car.

Some people experience a state of very deep tranquillity, a deeper peace of mind, an alteration in their normal sense of time and space, a feeling of detachment from one?s body, and an enhanced sense of reality and meaning.

Precautions and side effects of mediation. When meditation techniques were first introduced into Western society it was felt that they would be beneficial for everyone, and there were no negative side effects. Certainly it is one of the most thoroughly researched and widely used relaxation techniques since its introduction by the Transcendental Meditation (TM) movement. The technique here taught is derived from Westernised versions of this technique with the mysticism and non essential elements eliminated. Benefits of meditation are many and varied, and may be enjoyed with regular practice. Like jogging, the benefits continue as long as the practice is maintained. There are however some precautions to be kept in mind.

1. Loss of Reality Contact. If you?re being treated for mental disorders associated with thought disturbance you should meditate with care. Persons suffering from schizophrenia, or suffering hallucinations and delusions should seek psychiatric advice.

2. Drug Reactions. Producing the Relaxation Response may intensify the effect of any medication or other drugs you are taking. Persons taking insulin, sedatives or cardiovascular medication should be monitored by their medical practitioner.

3. Panic States. Panic state may be characterised by high level of anxiety concerning loss of control and insecurity. With such people muscle-tension based relaxation techniques, such as isometric or progressive relaxation, may be a more desirable approach than the unstructured approach of meditation.

4. Temporary Light Headiness. In the Relaxation Response you will produce a decreased level of bodily arousal. (See the comparison of the Fight/Flight and Relaxation Response). If you rush to stand up straight after meditating you may experience a sudden drop in blood pressure, known as postural hypertension, causing temporary dizziness, headaches or light headiness. When you?ve finished meditating take a minute or so to stretch and take a few deep breaths before standing up.

5. Fatigue. A very few (less than 1%) of people meditating experience fatigue rather than relaxation. This reaction may be linked to the person trying too hard to relax. If you?re doing this, see if you can allow the relaxation to occur, rather than trying to make it happen.

6. Not After Eating. There is some evidence that meditation after a meal is less effective in producing the Relaxation Response, perhaps because of the disruptive effect of an active stomach and digestive system on the overall process of achieving a more relaxed body state. Therefore don?t meditate within two hours or so after a meal.

Beginning Meditation

When you begin meditation you will probably have some difficulty taming the tendency of your mind to wander, and to follow distractions. One authority of meditation describes the early reactions of students as ?itching, twitching and bitching?. The process of meditation involves learning to hold your attention.

When you begin meditating you may feel bored, distracting thoughts such as ?what am I doing here, am I doing it right, what?s happening?, and so on will emerge, and you?ll probably also have distracting thoughts about things you?ve done, or are going to do. Each time a distracting thought arises, simply refocus your attention on your breathing and the mental focus. With practice you?ll get it, so stick with it. Just remember that learning to walk was difficult to begin with, and so was reading, writing, and just about any other skilled task that you now do automatically.

Enjoying the benefits of meditation does require you to discipline yourself to create the time to practice, but once you?ve got into the pattern, then the benefits are so noticeable and valuable that they?ll be a reward in themselves for continuing the practice. Literally millions of people in the western world have paid often exorbitant sums of money to learn how to meditate, and because of the benefits that they enjoy it becomes an essential part of their day, along with sleep and eating.

In learning to meditate you may find it very useful to practice a number of ?mini-meditations? during each day.

Mini Meditation

There are many opportunities during the day when you can take a minute or so to practice a mini-meditation. Waiting in a long supermarket queue, standing in the shower, washing the dishes, waiting for something to happen or at any other time during the day, take a few seconds off to do a ?mini- meditation? exercise. Don?t close your eyes, and carry on with whatever you happen to be doing at the time. Switch to controlled breathing and when its settled to a slow regular pattern simply hold your mental focus for 10 breaths. It may help to focus your eyes on a distant point, and then when you?ve finished simply refocus your attention fully back to the task in hand. The same rules apply to distractions with mini-meditations as they do with the full practice. If they crop up simply refocus back on your breathing and the mental focus.

A mini-meditation is another brief and unobtrusive relaxation technique, which you can add to the skills already learnt (isometric relaxation, controlled breathing, mental trip). Don?t use mini-meditations, or indeed any other brief technique, only before or during times of stress. If you do, then they will become associated with tensions, and you?ll have difficulty getting any benefit from them. The exercises should be done throughout the day so that the skills are available at other times if they?re needed.

Modern anti-depressants have a somewhat anti-anxiety effect, Wilso, because they inhibit re-uptake of serotonin in the brain, which has a mood-elevating and calming effect.

Tranquilisers CAN be addictive - and are usually what is prescribed in ERs by doctors when we have a panic attack - they work very differently.

Dlowan wrote:


*Many people who have experienced panic attacks say that they fear ?going berserk?, running and screaming, or alternatively becoming totally paralysed. The Fight or Flight Response prepares your body for action, and so physically and mentally you are being prepared to either fight or escape rapidly. Many people experience their first anxiety attack in situations that are crowded or noisy, or associated with much hustle and bustle. Virtually everyone who?s ever had an anxiety or panic attack fears fainting.


I suffered from this on vacation...it was one of the scariest moments of my life..I didn't understand what was going on. Felt totally helpless. I wanted to run screaming a few times, and felt completely out of control. Until I figured out that it was panic attacks that I was suffering from, I had a hard time coping with it.

dlowan- Wonderful articles- Thanks!

I have done yoga in the past. At the end of a session, we would do a relaxation exercise. Many times I would get myself into the "alpha" state. It is a very blissful experience. You are not asleep, but not fully awake, and are very relaxed. Many a time the yoga teacher would have to pull me out of the state, because the building was closing, and I wanted to stay just where I was!

I still get them, especially at night. I take many long breaths and tell myself two simple things to calm the storm of worries: I am not dying, and there is absolutely nothing I can do about any of this at this moment. Then I either do a little meditation and go back to sleep, or pop on the radio and come here, as I did this morning. Healthy diversions are always good.

It makes me shiver, Makemeshiver, how many people seek medical help when they have panic attacks, and never receive education or anything except the odd tranquiliser.

I work with kids, and more often than I can remember, as I am explaining anxiety to the young person, mum or dad will suddenly exclaim that they understand THEIR symptoms for the first time - and they have suffered for years!

Lots of doctors, at least here, in Oz, do not know about CBT and cannot or do not educate re anxiety.

Thank goodness you were smart enough to figure it out!

Damned things often come when we are relaxing!

This is one of the reasons it can be hard to convince people it is anxiety - "But I wasn't ANXIOUS!" - almost never seem to come when we are in the middle of a situation.

We often have odd feelings as we relax to sleep - especially in the "hypnagogic" state 'twixt sleep and wake - this is often when a palpitation or summat will come - I wonder if these can trigger anxiety, or is it a learned response to settling for sleep, if we have had anxiety symptoms then? Kind of a bedoraphobia?

Peri-menopausal hormonal changes seem to trigger the things in many women, too.

Yep, I would not recommend tranqulisers. I was put on them during a 2 week hospital stay, and when I got out didn't sleep for 4 days. But the anti-depressants don't have that addictive effect.

Yeah, you pretty much hit it on the marker Catfancier - that's one of my hugest worries, I'm very maternal with everyone. I hate therapy and distrust therapists but maybe that would be a good option... I think the university councelors are free. Still, I feel like I should be burdening my friends, forum members, and parents with troubles, not a stranger .

They wanted to give me the shot, but I asked if it cost more and they said yes (so I politely said "no.") But they prescribed me Ativan which I hear is pretty strong. I think I'll keep it around just in case but not take it.

Thanks for all the help, everyone. I will do more research.

I used to suffer anxiety attacks. They started from one of those love/hate relationships that I was involved in but continued on and off for the next few years. I would get them while driving on the freeway or sometimes for no reason at all. But I never felt like I wanted to scream and run. I always felt like I was suffocating and having a heart attack. Horrible.

I cured myself with yoga and breathing excercises. I don't have them anymore.