Whats an anxiety attack

What It’s Like to Have an Anxiety or Panic Attack

Stress, Anxiety, and Then Panic: Neal’s Story

As Sideman says, his attack occurred in the early 1990s, and few people seriously considered the possibility of a panic attack in a 39-year-old man. So he went home thinking all would be fine, only to have another, more severe attack one week later.

Now, looking back, the situation seems clearer.

“I was under a lot of stress — starting a new business, working 16-hour days, a close friend was ill and dying, and on top of all that, I was doing a super heavy workout regimen at the gym with a trainer,” Sideman says. “So it was a lot of physical stress, emotional stress, and a lot of financial stresses.” He says he also can see roots of anxiety in his childhood and teen years as well as in other family members.

In the moment, he didn’t know what to think because it can be tough to know what a panic attack is like until you have one. His second panic attack “was really a full-blown panic attack, where I thought I was going to die,” Sideman says. “I thought I was going to pass out, not wake up, go crazy, have a heart attack.”

He recalled being terrified, and the response he chose was one that can actually make panic disorder worse: He started to avoid the situations where he had attacks.

“I thought I would be smart, take care of myself, and not go out as much,” Sideman says. He managed to find ways to build his business without leaving his home office. After he had a panic attack on a freeway, he decided to avoid driving on the freeway — a tough stand to take in Los Angeles. He kept withdrawing from activities to try to avoid panic attacks, but that never solved the problem, he says, and after two and a half years, he realized the attacks were getting worse.

How to Cope When You Have Panic Attacks

Desperate for help, he reached out to the Anxiety and Depression Association of America, which sent him a list of therapists experienced in treating panic attacks and anxiety. “This is how I got better,” Sideman says. “I found a therapist who understood what panic disorder was, understood agoraphobia, and knew cognitive behavioral therapy, which I had not known about.” He also started practicing meditation.

RELATED: 9 Foods That Help or Hurt Anxiety

Cognitive behavioral therapy has been shown to help with treating panic disorder and agoraphobia. According to a study published in December 2013 in the journal Behaviour Research and Therapy, its effects lasted as long as two years after the initial treatment. And a study published in August 2017 in the Journal of Consulting and Clinical Psychology suggested that it may be superior to traditional psychotherapy in the treatment of this condition.

People generally can overcome panic attacks faster if they seek help after the first one or two, says psychologist Cheryl Carmin, PhD, director of clinical psychology training at the Wexner Medical Center and a professor at Ohio State University in Columbus. When you do seek help, your doctor or therapist will ask about your symptoms and the situations in which they arise, and might also recommend additional medical testing to rule out other health concerns.

Don’t wait too long to seek help, or it might mean you’ll also have to do extra work to undo the habits you may have developed to try to protect yourself — like avoiding triggering situations, which Sideman had tried to do.

“If it’s beginning to interfere with your life, if you’re more fearful, or you’re avoiding doing things that provoke the symptoms, that’s when you need to seek help,” Dr. Carmin says. “At its worst, people with panic disorder become housebound. Or they stop doing things they really like.”

There’s Definitely Life After Panic Attacks

Sideman says that his recovery has also made him a better friend. While he was struggling with anxiety, he would call friends for help. As he recovered, he realized that he could cope on his own and would then call them to share his success.

“I changed the way I talked about my condition,” he says. “Now, I focus on my recovery, not my suffering.”

Panic attacks are intense periods of fear or feelings of doom developing over a very short time frame — up to 10 minutes — and associated with at least four of the following:

  • Sudden overwhelming fear
  • Palpitations
  • Sweating
  • Trembling
  • Shortness of breath
  • Sense of choking
  • Chest pain
  • Nausea
  • Dizziness
  • A feeling of being detached from the world (de-realization)
  • Fear of dying
  • Numbness or tingling in the limbs or entire body
  • Chills or hot flushes

Panic attacks and panic disorder are not the same thing. Panic disorder involves recurrent panic attacks along with constant fears about having future attacks and, often, avoiding situations that may trigger or remind someone of previous attacks. Not all panic attacks are caused by panic disorder; other conditions may trigger a panic attack. They might include:

  • Mitral valve prolapse
  • Hypoglycemia
  • Hyperthyroidism
  • Heart attacks
  • Social phobia
  • Agoraphobia (fear of not being able to escape, such as flying in an airplane or being in crowds)

Generalized anxiety disorder is excessive and unrealistic worry over a period of at least six months. It is associated with at least three of the following symptoms:

  • Restlessness
  • Fatigue
  • Difficulty concentrating
  • Irritability or explosive anger
  • Muscle tension
  • Sleep disturbances
  • Personality changes, such as becoming less social

Phobic disorders are intense, persistent, and recurrent fear of certain objects (such as snakes, spiders, blood) or situations (such as heights, speaking in front of a group, public places). These exposures may trigger a panic attack. Social phobia and agoraphobia are examples of phobic disorders.

Post-traumatic stress disorder — or PTSD — was considered to be a type of anxiety disorder in earlier versions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. But in 2013, PTSD was reclassified as its own condition. It describes a range of emotional reactions caused by exposure to either death or near-death circumstances (such as fires, floods, earthquakes, shootings, assault, automobile accidents, or wars) or to events that threaten one’s own or another person’s physical well-being. The traumatic event is re-experienced with fear of feelings of helplessness or horror and may appear in thoughts and dreams. Common behaviors include the following:

  • Avoiding activities, places, or people associated with the triggering event
  • Difficulty concentrating
  • Difficulty sleeping
  • Being hypervigilant (you closely watch your surroundings)
  • Feeling a general sense of doom and gloom with diminished emotions (such as loving feelings or aspirations for the future)

Symptoms such as chest pain, shortness of breath, palpitations, dizziness, fainting, and weakness should not be automatically attributed to anxiety and require evaluation by a doctor.

How To Tell If You Are Having an Anxiety Attack

Anxiety attacks (or panic attacks), if you’re going by the more technical name – are intense feelings of anxiety that are so extreme they can cause people to fear their own death.

It’s not surprising that this type of event is difficult to understand for those that have never experienced it. Indeed, when most people think of anxiety, they think of being nervous, possibly shaking – it’s hard for someone to picture what an anxiety attack truly is. That’s why in this article, we’ll describe how to tell you’re having an anxiety attack and what it’s like to suffer from one.

Anxiety Attacks and Severity

What makes anxiety attacks unique is that even though they are a mental health issue, it is often the physical symptoms that get the most attention, This is what those without anxiety (or those that have never had an anxiety attack) often struggle to understand. Anxiety attacks cause intense physical symptoms that mimic serious health disorders. Symptoms include:

  • Chest pains
  • Difficulty breathing
  • Lightheadedness/feeling like fainting
  • Muscle weakness
  • Trouble concentrating
  • Tingling or numbness in the hands and feet
  • Rapid heartbeat/heart palpitations (feeling like you’re overly aware of your heart)

In many ways, anxiety attacks are similar to heart attacks. There may be other unusual issues as well, such as trouble with your vision, your teeth, your muscles, your nerves, and more. For example, some people experience weird jolts, others experience blurry vision, others experience tooth pain or hear unexplained noises.

Not all anxiety attacks are the same, but they all tend to be very physical and result in a feeling like something is terribly wrong.

What makes anxiety attacks worse is that they cause other symptoms that exacerbate the physical problems. One of the symptoms of anxiety attacks is this incredibly intense feeling of doom – as though something horrific is about to happen. That is actually a symptom of anxiety attacks, not just a response to the physical sensations, but when combined with the physical symptoms it can make a person convinced that they are about to suffer from something terrible.

Anxiety attacks also have other frightening psychological symptoms as well, such as:

  • Disaster thinking, where the person starts to uncontrollably imagine bad things happening to them, like getting hit by a car or collapsing in a public place.
  • An intense feeling of needing to run away or flee, or feeling helpless in your current situation.
  • A loss of touch with reality, called “derealization,” which is when the brain shuts down your connection in reality as a coping mechanism for intense stress. (Less Common)
  • Feeling as though your brain isn’t working or that a seizure is coming. Many people feel as though they are living inside of their own head, unable to escape. (Less Common)

These are just a few examples of psychological symptoms that add to the fear. They do not occur with everyone, but they create an even more disabling environment. That explains why anxiety attacks can be so severe, and so strange, to those that struggle with them.

It’s actually common for those with their first anxiety attack to consider or possibly even call an ambulance. Thousands of people end up hospitalized because they are unaware that this physical attack is anxiety, only to have it calm down once they get to the hospital.

How to Tell If An Attack is Anxiety or Something Else

The biggest question people have is whether or not they suffered from an anxiety attack or something more physically serious, like a heart attack.

Unfortunately, the symptoms are so close to each other that the only way to tell is to talk to a doctor. The important thing to realize is that anxiety attacks are quite common, and heart attacks/serious health issues in those that are younger and are generally in good health are less common. There are a few differences as well:

  • Although both may cause vomiting, heart attacks are more likely to lead to vomiting.
  • Chest pains during heart attacks tend to radiate more throughout the shoulder.
  • Anxiety attacks are more likely to have a “peak” (although not always) at about 10 minutes.

It is always a good idea to speak with your doctor at least once.

What to Do About Your Anxiety Attacks

In some cases, a person has one anxiety attack and then they’re done. Often this occurs when a person is under extreme stress and the body loses its ability to cope. But many people develop panic disorder, which is characterized by recurrent anxiety attacks or a fear of anxiety attacks.

Remember, this disorder isn’t something someone can control. Many people think that rational thinking is all a person needs to get out of it, but anxiety attacks are much more like a disease. You need to find something effective to treat it, like cognitive behavioral therapy, rather than try to ride it out and hope that they go away.

That’s why if you do feel like you’ve had an anxiety attack or have anxiety attack problems, it’s important that you take action right away. The longer you wait, the harder they may be to cure and the more they affect your life.

How to help someone having a panic attack

Panic attacks can come on suddenly, without warning. Become familiar with the signs and symptoms, so that you can recognise when it happens and have an idea of what you can do to support your friend. Here’s what to do if someone is having a panic attack:

  • Ask the person if they have had a panic attack before, and what they think might help them.
  • Encourage them to breathe as slowly and deeply as possible.
  • Ask them to count backwards slowly from 100.
  • Help them to get comfortable (have them sit or lie down).
  • Reassure them that they’re experiencing panic and that it will go away.
  • Call 000 if the symptoms continue or become worse.

How to help someone with an anxiety disorder

A good place for you to start is to learn more about anxiety disorders, so that you have a better understanding of what your friend is going through. Check out these suggestions on the best way to help someone with anxiety:

  • Be open and welcoming: tell them you are there to support them.
  • Validate their experience: acknowledge that their anxiety must be difficult to handle; don’t tell them their anxiety is stupid or unfounded.
  • Point them to professional help: encourage them to visit their GP to talk about options for support.
  • Recommend ReachOut NextStep: this anonymous online tool recommends relevant support options based on what the person wants help with.
  • Challenge their thoughts: ask them if there are other ways to view a situation. You can challenge their thinking while still validating their anxiety. For example, if they say ‘I’m definitely going to fail this exam’, you can acknowledge that worrying about an exam is normal, but you can also reassure them that they’ve studied hard and have done well on exams in the past.
  • Encourage them to face their fears: they may avoid certain situations as a way of not feeling anxious about them. Tell them you believe they can overcome their fears by facing them head-on, and offer to support them while they do so.
  • Celebrate their successes: when a friend takes a step towards confronting their fears, congratulate them and do something fun together. Help them feel proud of themselves for addressing the issue.

Look after yourself

Helping a friend who experiences severe anxiety can be difficult and exhausting. Make sure you care for yourself as well:

  • Set clear boundaries about what you are and aren’t willing to do to help them. For instance, you can tell them that you’re there for them if they need someone to talk to, but that you won’t be available when you’re in class or at work.
  • Make sure you keep up with your social life, especially if supporting your friend is starting to get you down.
  • If looking after your friend starts to weigh you down emotionally, speak to someone you trust about how you feel.
  • Consider talking to a mental health professional if you feel overwhelmed.

Panic Attacks

If you’re having a panic attack

  1. Don’t fight your feelings – the intense anxiety you are feeling is likely to be out of proportion to any danger you are actually facing. The attack will pass in a few minutes.
  2. Relax – use breathing control (counting slowly/slow breathing) and relaxation techniques (meditation) at the first sign of an attack.
  3. Challenge your fear – be aware of what you’re thinking and question yourself about your symptoms, what you know from past attacks and what you would tell someone experiencing the same symptoms.
  4. Give yourself time – Don’t distract yourself or ignore your feelings. Acknowledge what you’re feeling as “just symptoms” that will pass.
  5. Don’t avoid activities/situations – don’t let your panic prevent you from activities you enjoy. Ease yourself into these activities if you start fearing/avoiding them.
  6. Avoid self-medicating – some medication can be addictive. Get appropriate medical advice before taking any medication.
  7. Get help – talk to a friend, family member or a helpline like Lifeline (13 11 14). Visit your GP who can help identify the best treatment for you. If the panic attacks recur, and cause you distress, professional help is warranted. Seek a referral to a psychologist or other mental health professional. Panic attacks are very treatable.

Similar to “anxious” and “depressed,” the words “panic attack” are often watered down in everyday jargon. “I’m having a panic attack!” is code for “I’m freaking out about this test” or “I’m really stressed about a problem I don’t know how to solve.” Exaggerated panic attacks also make great comedy, it seems, as lovable but slightly anxious characters breathe into paper bags while giving the appearance of a complete loss of control over something fairly insignificant.

Panic attacks are anything but funny in reality, however, and people who suffer panic attacks don’t have the ability to state, “I’m having a panic attack” or search out a brown paper lunch bag when in the throes of an actual attack. Anyone who has endured a panic knows that the symptoms are sudden, frightening, and difficult to manage.

Loved ones and other important people in your life (teachers, coaches, good friends) can be great sources of support during a panic attack if you help them understand what a panic attack means and how they can help.

Try breaking it down to make it easier to process.

I don’t get any warning.

One of the most difficult parts of panic attacks is that they typically occur without warning. They can swoop in from out of nowhere, with no oncoming symptoms.

Panic attacks are sudden and include a wide range of physical and emotional symptoms. This makes them feel overwhelming and difficult to manage. People can have panic attacks just about anywhere, even when they appear perfectly calm just moments before the attack.

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I feel like I’m in physical danger or losing control of my mind.

Common symptoms of panic attacks can include the following:

  • Chest pain
  • A feeling of choking
  • Trembling
  • Dizziness
  • Nausea
  • Shortness of breath
  • Sweating
  • Feeling like your limbs are going numb or tingling
  • Fear of dying
  • Fear of losing control
  • Intrusive, highly anxious thoughts

Panic attacks don’t last as long as they feel like they do.

Panic attacks feel like an eternity to the sufferer, but the reality is that your body can’t sustain them for very long. The brain goes into fight or flight mode when people experience panic attacks.

Panic attacks typically reach their peak within ten minutes and resolve within thirty minutes. They rarely last more than an hour. That thirty-minute period is so physically and emotionally overwhelming, however, that it feels like much longer and requires a significant recovery period after. Panic attacks are very draining and it’s difficult to jump right back into school, work, or family fun immediately following an attack.

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There’s no clear cause of panic attacks.

Not every person who struggles with anxiety also has panic attacks, but there can be a genetic predisposition to them. People with anxiety disorders and mood disorders are at a higher risk, and panic attacks do tend to run in families.

Panic attacks are also associated with major life transitions (graduating from college, changing jobs, getting married, having a baby), severe stress (death of a loved one, divorce, job loss), and certain medical conditions. Panic attacks can be triggered by stimulant use, including caffeine, and withdrawal from medication.

The anticipation of future attacks triggers me.

Due to the sudden and unpredictable nature of panic attacks, it can be difficult to make plans to venture too far from home. Anticipatory anxiety can make ordinary outings, like watching a baseball game, feel overwhelming due to intrusive thoughts about the difficulty of finding an escape route or getting caught in a crowd.

You can help guide me through a panic attack.

The best thing you can do if you see me having a panic attack is to stay calm and talk me through it. When a panic attack strikes, I will feel a combination of overwhelming fear and some of the scary physical symptoms listed above. This is what helps:

  • Deep breathing: I don’t need the paper bag, but it helps if you count my breaths with me. Breathing in for four, holding for four, and releasing for four helps slow my heart rate and decrease the physical symptoms I experience.
  • Coping statements: Talking back to my irrational thoughts with assertive coping statements helps me work through the attack. Saying, “I’m not dying, I’m feeling anxious,” disrupts the irrational thought process.
  • Distraction: Once I’m using my deep breathing, it helps to shift my focus.

Once the panic has passed, I need time to unwind and recover. Taking a walk or simply getting outside can help.

Your loved ones might never truly understand how you feel when you have a panic attack, but educating them helps them better understand what a panic attack is, symptoms to look for, and how they can help you when they see you in distress.

Last Updated: Dec 17, 2019

I Think I Just Had a Panic Attack: What Do I Do Next?

Source: Yehsong Kim, used with permission

This guest post was contributed by Yehsong Kim, a graduate student in the USC Psychology Department’s Clinical Science Program.

Your first question may be: Is what just happened to me really a panic attack?

A panic attack features a sudden and intense fear or discomfort that usually lasts a few minutes. This fear or discomfort can be accompanied by bodily symptoms, like a pounding heart, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, chills, and a fear of losing control or dying. Panic attacks are different from ongoing anxiety because of how quickly they come on (within a few minutes) and how intense they feel.

Rest assured, you’re going to be okay. You’re not going crazy, and you are not going to die. Your body has gone into survival mode for a few minutes, and that’s OK.

Panic attacks are surprisingly common: about 15 percent of the U.S. population has had a panic attack in their lifetime. For many people, the occasional panic attack isn’t too disruptive to their lives. For others, panic attacks might escalate into panic disorder. I know, I know, now you’re thinking: Wait, what is a panic disorder, and do I have that?

Source: Steve Lyon, Creative Commons license

To meet the criteria for panic disorder, you have to have had multiple panic attacks and then developed a consistent worry about having more panic attacks in the future or changes in your behavior due to the panic attacks. For example, you had a panic attack in the past while on a run, and now you avoid exercising to avoid having another panic attack—this is a behavioral change that’s happened because of a panic attack.

I’m sure some of you are now relieved and are excited not to have to read the rest of the post. But for some of you, I’ve only worsened your concerns. Don’t worry—there’s only good news from here.

Is panic disorder treatable?

Yes, it absolutely is. There are therapies to treat panic disorder with lots of evidence behind them (though, fair warning, there may be some “treatments” with no evidence out there, too).

The most common evidence-based treatment for panic disorder is cognitive-behavioral therapy or CBT. The goal of this therapy is to change your thinking about bodily sensations related to panic attacks. Up to 70-80 percent of those receiving cognitive-behavioral therapy for panic disorder reported having no more panic attacks, and most people report much improvement.

What is cognitive-behavioral treatment like?

Great question. CBT can be as short as 12 sessions, during which you gain tools to stop having panic attacks. The treatment begins with education around what causes panic and anxiety, and how feedback loops among your physical sensations, thoughts, and subsequent actions work to keep your panic and anxiety high. Ultimately, you’ll be working to break those feedback loops.

Therapists then seek to identify patterns around the situations in which panic attacks are likely to happen—things like negative thoughts, scary imagery, and physical sensations. For “homework,” you’ll monitor yourself for panic attacks, anxiety, and your mood.

Because panic attacks are frightening, and anxiety can warp thinking, this monitoring helps you become more accurate in your observations of what’s really happening in your body and mind. Next, you learn a few other important skills, including breathing re-training—learning to take deep breaths from your diaphragm, a skill meant to help you cope with anxiety-provoking situations—and cognitive restructuring, just a fancy term for changing your thinking.

Therapists help you examine potential errors in your thinking (e.g., “I’m afraid I’m going to die during a panic attack”) to understand that these thoughts may be unfounded (e.g., “Does the feeling that you will die mean that you really will die?”).

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With these important skills under your belt, therapists then move onto exposing you to those sensations or situations that you have avoided since you started having panic attacks. Why? Why would they do something so scary?

Well, the idea is that those scary situations are actually not so harmful, and learning to cope with those situations will eventually help rid you of your panic attacks. Therapists won’t throw you into the deep end—you develop an exposure hierarchy to start from a situation that only provokes a little bit of anxiety and build up to those things you really fear.

You are encouraged to use your newfound breathing and cognitive restructuring skills to cope with the fear and anxiety that may come up during exposure. Eventually, with enough exposure, you’ll get so used to those once scary sensations and situations that they won’t trigger panic attacks in you anymore.

How do I find help?

Finding a therapist can feel like a daunting task. The first question to ask yourself is how you’ll be paying for it. If you can afford therapy out of pocket (usually between $50-$150 a session), you can type in your city or zip code on the Psychology Today page to find a therapist near you. You can look at each therapist’s profile for the types of issues they treat (panic disorder) and their treatment approach (Cognitive Behavioral or CBT). Sometimes therapists have long lists of their treatment approaches, and it may be worth giving them a call to see if they’ve been trained in treating panic disorder with CBT.

If you’ve got health insurance that will cover behavioral treatment, you can search within your health care website for providers that are covered under your health insurance. Be sure to check your deductible to see how much you will need to pay out of pocket before insurance kicks in and your co-pay to see how much of the session you’ll have to pay thereafter.

What if I can’t afford it?

Therapy can be expensive, and some health care plans may not cover therapy. A more affordable option might be group therapy, which you can often find in community mental health centers, though you’ll want to find one specific to panic disorder.

Another option is to find a university near you with an accredited clinical psychology program with an in-house clinic. They often offer low-cost, evidence-based treatments as clinicians will be trainees. In some cases, medications can be helpful, which you can talk more to your doctor about.

What if I’m not sure I need therapy and want to try some strategies on my own?

The first thing you can do is recognize that anxious bodily sensations will not hurt you and are part of your body’s normal, adaptive stress response. Panic can be a vicious cycle—the more you focus on and worry about your anxiety sensations, the worse they can get. Soon you may be white-knuckling your way through situations wondering when the next panic attack will come on, which puts your body into a revved-up state that ironically makes you more vulnerable to anxiety.

Notice the sensations rather than catastrophizing, and recognize that they do eventually go away. Practice staying in the situation and building tolerance, even if your impulse is to escape. In those situations, you can try deep breathing, breathing from the diaphragm and taking longer on the exhale, to help your body relax.

If you’re up to it, you can create your own exposure hierarchy. If you panic in enclosed spaces, see if you can build up the number of minutes you stay in the closet or try traveling just a few floors in an elevator. You can gradually work yourself up.

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