What are Panic Attacks?

To understand panic attacks, let’s look at the way panic affects you. There are three separate levels: physiological (your physical feelings), cognitive (your thoughts), and behavioral (your actions).

The physical feelings of a panic attack vary from person to person, but common symptoms are heart palpitations, chest pain or discomfort, choking or smothering sensations, dizziness, tingling in your hands or feet, feelings of unreality or disorientation, sweating, faint-ness, trembling, or shortness of breath.

In your case, one symptom—shortness of breath, for example — might be the strongest and most troublesome, and this single sensation, associated with fear, can trigger your panic. In this case, you might begin to monitor your breathing in certain situations, trying to detect the slight­est change. Any perceived change in breathing, even when a change is due entirely to a benign cause such as exer­cise, can trigger fear which can lead to a panic attack. When the initial, mild signs of anxiety, exertion, or excite­ment no longer frighten you, you will be well on your way to recovery.

Now, let’s look at your thoughts and how they influence your feelings. Panic attacks occur suddenly and can be very intense. The physical sensations are accompanied by fearful thoughts. Because there doesn’t seem to be any reasonable explanation for what you’re feeling, your thoughts may turn to various kinds of catas­trophes that could possibly happen in the future. You may think, “I might have a heart attack, hurt myself or others, faint, scream, jump out of the car, or lose all con­trol and go crazy.” These thoughts naturally aggravate the fear and can actually make the physical symptoms worse, as well as convince you that something terrible is about to happen.

So, a cycle begins: the physical symptoms are fol­lowed by fear, which leads to catastrophic thoughts, which leads to greater fear, which leads to more marked physi­cal symptoms, and so on. You may already realize that your thoughts are alarming you and making your anxiety worse. However, what many people don’t realize is that what they’ve become so terrified of is their own physical sensations, and so they try to avoid them in order to stay calm and in control. It is certainly true that these sensa­tions are distressing, but it is just as true, as we said earlier, that through understanding and practice, you can bring this episode of your life to an end, no matter how long you’ve suffered!

Regarding your actions, panicky feelings give rise to an instinct to flee from the situation and escape to a safer place. This can lead to a hasty departure! If you feel less anxious when you escape, you strengthen your impulse to escape when you are in a similar situation again. Escape reinforces your faulty logic that your panic is connected to place. (More about this later.)

A second kind of avoidance involves trying to escape from your physical sensations by distraction. Trying not to feel those things associated with the onset of panic, you may pretend to be elsewhere, or perform repetitious tasks unrelated to the situation in order to block these feelings. You may fight to stay completely in control by “white-knuckling,” tensing, and catastrophizing all the while. These strategies can cause you to believe that these unpleasant, but harmless sensations are dangerous, but this is simply not true. While these strategies may allow you to carry on with your routine, they may reinforce your fears. On later pages we will acquaint you with coping techniques designed to lower your panic level while you remain focused on your usual routine.

Although there is no single treatment that works for everyone, there is one essential ingredient in overcoming panic and that is exposure to the places and the physical sensations you now associate with panic. (You didn’t always feel this way, remember?) Also, since probably your greatest fear is of how bad you’ll feel, it is essential that you reduce your fear of the anxiety attacks themselves, by learning new ways to cope with anxiety — using some simple skills and lots of hard work.

Remember: you have a greater capacity to influence your level of anxiety than you think!