By Dr. Evian Gordon, MD, PhD on Wed, Apr 4, 2018
Kevin Love and Carson Daly recently gave public acknowledgement to personal struggles with panic attacks. Thanks to their courage and candor, the national conversation about panic attacks and panic disorder has just begun.
Philosophers and physicians of classical antiquity identified excessive anxiety as a medical syndrome. The term anxiety derives from the Latin substantive angor and the corresponding verb ango (to constrict). A cognate is angustus (narrow). Panic is considered a sub-category of anxiety, and these terms precisely describe some of the sensations associated with the condition. An individual suffering from panic activates their fight-flight system so intensely that it feels like they are being physically hijacked. They experience physical sensations of the airways narrowing, suffocation, chest pain, heart palpitations, dizziness or fainting. A surge of fear or a feeling of impending overwhelming doom is not uncommon.
Recurring panic attacks may be clinically diagnosed as panic disorder. The condition is surprisingly common within the general population, affecting an estimated 2.7% of U.S. adults annually. For some, panic attacks may be instigated by certain known triggers. For others, they may emerge “out of the blue.”
The human brain uses the fight-flight system to get out of danger. Humans are wired to try to escape danger. This is a major advantage in terms of the survival of our species. However, 21st century threats are distinctly different from the threats of primitive times, and in the modern era, this fight-flight system hijack is not in sync with the objects or situations that constitute true threats.
So, when someone has a panic attack, what is happening in the brain?
A 2013 comprehensive literature search suggests that when a person is exposed to a trigger, the amygdala activates, along with the brain’s ‘fear system.’ The brain’s fear system consists of the anterior cingulate cortex, and the insula.
What can you do about it?
Simple interventions can serve as incredibly powerful tools in overcoming a panic attack. As soon as you notice the early signs of panic:
1.Consider what may be inducing those symptoms: Is it possible to remove yourself from the triggering object or situation?
2. Focus on deep breathing: Breathing at six breaths per minute has been shown to shut off the internal reflex that induces panic, the ‘fight or flight’ reflex.
3.Visualize a safe place: For example, the beach. Invite your mind to conjure up the sensory perceptions associated with that place ( such as soft sand, scent of sea breeze). Visualization allows an immediate “circuit break” to feelings of intense stress.
4.Relax. Engage in mindful meditation or yoga, infusing some humor into the day, and getting some exercise.
As you practice calmness techniques, your neural network will become more adept at triggering these new habits when stressful or panic inducing situations arise.
Presently, the gold standard for long-term treatment of anxiety disorders consists of cognitive behavioral therapy (CBT). A trained therapist can help individuals develop a personalized approach for managing the condition. Exposure therapy and relaxation breathing techniques have also demonstrated clinical efficacy.
Judicious use of prescription medication may be another option, especially if the person is suffering from additional challenges, such as depression, or addiction.
The brain is very complex and panic diverges neurologically and symptomatically from one person to the next. Consequently, there is not a ‘one size fits all’ treatment approach. Nevertheless, the interventions described have been shown to shift the brain’s state. Neural networks that fire together – wire together. This allows you to reshape yourself. I encourage individuals to be kind to themselves and take proactive steps to discover what works to reshape yourself when it matters most.