Panic – symptoms and treatments

Panic is a state of bodily hyper-awareness and readiness for danger, accompanied by mental distress.  Physical symptoms include:

• fast heartbeat
• chest pain
• increased sweating
• feeling nauseous
• shaking or trembling
• feeling unusually hot or cold
• constriction in the throat
• upset or churning stomach
• a ‘freezing’, or inability to move/act

THE FEAR RESPONSE

Most of these symptoms are related to the physiology of fear.  The human body has an inbuilt danger response, and fear is what triggers it.  What triggers a fear response can be very particular to the individual.

Every human has an amygdala – a part of the brain which manages the fear response.  It takes in stimuli from your environment, and outputs instructions to your autonomic nervous system (a system largely outside conscious control which affects functions such as heartbeat).  The amygdala is a network rather than a single thing, and a moderating management system rather than a simple alarm.  Within reasonable parameters, it plays a role in both the learning and unlearning of fear.

Tastes and appetites are intimately linked to elements of the fear response.  You may have noticed that, when in panic mode, you suffer strong aversion to particular stimuli.  Some sufferers need to retreat to a safe place with a familiar and easy-to-manage set of stimuli.  You may also have noticed that panic changes your usual appetites – for instance, your response to food, making you either crave familiar food, or making you temporarily unable to eat at all.
The fear response can be moderated by chemical influence – for instance, your body can produce oxytocin, which reduces fear expression.

Medically, panic is termed a disorder when phases of fear response (anxiety, fearfulness or panic attacks) interfere significantly with a person’s abilitiy to lead a functional life.

TREATMENTS

Treatments can be divided into pharmaceutical, lifestyle changes, and psychological therapy.

PHARMACEUTICAL TREATMENTS

One of the most common medicines for panic is SSRIs (Selective Serotonin Reuptake Inhibitors).  These medicines help you keep more serotonin in your system.  Serotonin is a chemical messenger involved in the regulation of mood, and in general more serotonin seems to be associated with less distress.  Some negotiation with a doctor is often necessary to find the right drug and dose, as different individuals have different responses to different SSRIs.  They are popular drugs, because they are relatively harmless, and there is reasonable evidence that, on balance, they work.

LIFESTYLE CHANGES

Because fear tends to freeze a person, getting out and about, active and social, seems to be an important helping behaviour.  The trouble is, someone experiencing fear or anxiety often has an aversion to exactly that behaviour.  There is a chicken-and-egg situation in which fear leads to staying in and remaining isolated andf inactive, which can in turn lead to more fear.

Joining interest groups, having coffee with friends, and just getting out of the house each day, are all examples of behaviours which seem to help relieve fear for those liable to panic.  It seems that, in particular, the presence of other humans, and a stream of changing stimuli, serve to calm the mind.

PSYCHOLOGICAL THERAPY

Panic can be a vicious circle, in which a sufferer ends up fearing their own fear response.  If this happens, it can help to use psychological therapy to moderate and change the fear cycle.  One therapy which focuses on this approach is CBT (Cognitive Behavioural Therapy).  Examples of types of CBT for panic include:

• Mindfulness training – this method teaches the mind to break the cycle of fear by learning to experience physical symptoms without a hyper-response.  Essentially, one is using conscious techniques to damp down an overactive fear system
• Pattern awareness – this method teaches the mind to become aware of its own self-destructive patterns and assumptions.  For instance, many people ‘catastrophize’ (react to one bit of panic by generally melting down about everything in their world).  Being aware of the patterns, and implementing techniques to interrupt certain unhealthy responses, can help.
• Exposure therapy – sometimes it helps to face your fears alongside a sympathetic therapist.  Repeated exposure to a trigger, done constructively, can help to dampen down the fear response, teaching the body to remain calmer.  Clients can find themselves able to act more flexibly in previously feared situations.

For those who want to take more time to explore their own world, and the patterns of meaning and feeling that make up their fear response, there are more relational therapies.  Generally, relational counsellors and psychotherapists offer a more wholistic, less technical service than CBT providers.  The focus is on a wider, more flexible process of joint exploration, in which a client can develop themselves at their own pace.  Many find that the experience of relational psychotherapy helps them to accept themselves, rewrite their own story, and face life with renewed comfort and courage.

A SUMMARY

Panic is a mental health issue characterised by a strong physical fear response.

Three ways of treating panic are:

1. Medication prescribed by a doctor (e.g. SSRIs)
2. Lifestyle changes (in particular, getting out and about, and into the company of trusted others)
3. Psychological therapy (e.g. CBT or relational therapy)