Panic attacks - what sustains them and what helps in recovery

Your first panic attack

Having a panic attack can be an incredibly frightening experience. Many become so scared when suffering from one for the first time that they believe they're about to die and need urgent medical treatment, calling emergency services.

Moreover, most people will experience a panic attack at some point in their lives. Some only experience a single attack, while others suffer from constant new attacks of panic, leading them to developing what we call a panic disorder.

When we first meet a client whom we suspect may be suffering from panic disorder, before diagnosing them, we usually first ask if they have been medically evaluated by a physician. Even though it is very rare, it is true that certain medical conditions can cause symptoms that resemble a panic attack. 

Additionally, ruling out physical factors is also beneficial for recovery as it helps in shifting your focus from the physical to the mental state.

What exactly is a panic disorder?

Panic disorders can be described as a fear of experiencing symptoms. This is especially common if you believe that a panic attack can be harmful to your health and safety (e.g., suffocation, a heart attack, etc.). If you suffer from panic disorder, you start to monitor for things that may induce or announce an oncoming panic attack - and you'll do what you think is necessary to keep this from happening.

But despite the fact that panic attacks can be both frightening and physically painful, fortunately, it is far less dangerous than it seems. You cannot pass out, lose control, go crazy, or die as a result of panic attacks alone. It is also interesting to see how a panic attack evolves into a disorder for some and not for others. Let's take a look.

Different strategies

Let's go back to the moment you experienced your first panic attack. Likely today, you remember this as one of the most frightening experiences in your life and certainly don’t want this to happen again. So far we're all the same. What we do in response to this desire, however,  says a lot regarding our risk of developing a panic disorder.

Because we all choose our own ways to deal with this traumatic experience (and what this means for the future). So we adopt one or more coping strategies going forward. For some, it's a conscious choice of strategy, while others take on these strategies subconsciously. Let's explore some common strategies of people suffering from panic disorder.

Avoiding triggering situations

If you suffer from a panic disorder, you probably spend a big chunk of your energy avoiding panic attacks. Logically, anything that could have contributed to your previous panic attack is a suspect. In practice, this typically identifies anything related to the location and environment of the attack. Was I at work? Was it in a small room? Were there many people or was I alone? It could also have to do with your physical state at the time. Was I tired? Did I work out that day? Was I stressed? What did I drink during lunch? Was it coffee? Alcohol? People often refer to elements that induce a feeling of anxiety as a trigger.

Bodily symptoms

Even if you took all precautions to avoid these triggers, you probably feel that there's still a risk of experiencing another panic attack. Many sense that there isn’t one specific trigger, rather feel a general restlessness. And, when observing bodily symptoms to that degree (such as being out of breath after climbing the stairs or feeling a rapid heartbeat), you may quite suddenly experience the onset of a new panic attack.

Some perceive that the body is giving physical signs - resembling the same symptoms as in your first panic attack. These can include an elevated pulse, dizziness, sweating, heart palpitations, faster breathing, dry mouth, shaking, a certain emotion... you name it. This pushes some to adopt the strategy of monitoring, so that if they recognize it in time, they might be able to avoid the attack or, at least, be prepared for it to come.

Being prepared

But if the worst is to happen, and you are going to have a panic attack, it makes sense to be best prepared. So, when you are about to enter a meeting at work, you make sure to bring your water bottle. You ensure that you are the first in the meeting room so that you can sit closest to the door in case you need to suddenly leave. Maybe it's smart to carry a paper bag with you in case of hyperventilation. Then, make sure you didn't eat anything wrong and are well rested. And doing breathing exercises before entering the building.

Of course, this is just a collection of possible strategies; these do not necessarily describe you. But if you are suffering from panic disorder, you may recognize yourself in some of these preparation strategies.

What's the issue with these strategies?

Engaging with negative thoughts in order to avoid and prepare for a potential panic attack is understandable. Unfortunately, it has one really big drawback: You end up thinking about it all the time. For most, this results in planning your life around the suspected triggers. Moreover, often the number of suspected triggers becomes increasingly greater, and over time, you limit yourself in what you can and cannot do. Also, you may eventually find yourself getting stuck in habits and rituals which are dictated by these strategies.

The paradox of planning your life around the risk of having a new panic attack is that you are constantly reminded that you might get a panic attack. This further increases feelings of anxiety and vulnerability - which leads to you feeling even more strongly that a panic attack is a real possibility. Suddenly, just like that, you land in a self-reinforcing negative cycle.

(If you are familiar with our other articles, you'll know that we GAD-Specialists use methods from metacognitive therapy, which considers spending too much focus on feelings of anxiety to create self-reinforcing negative cycles. We believe this is the root cause of almost all anxiety-related disorders.)

Our thoughts, feelings, and symptoms regulate themselves when we relate to them passively and give them room to self-regulate. An absence of effort can therefore be considered the best effort. While putting effort into the strategies we discussed earlier, unfortunately, they only help to maintain the problem.

The first step is becoming aware of your coping strategies and exploring whether they follow unhelpful (destructive) patterns. For some, doing this exercise is already enough to recover from panic disorder as they are able to break the self-reinforcing negative cycles. However, this is not easy. Most people need a bit of professional help to achieve this.

(Pro tip: in our popular 12 week GAD Workshop, we train our participants to recognize these exact patterns and provide practical tools to break them)

What can you safely stop doing?

First of all, although they are wildly unpleasant, you can stop considering panic attacks as something dangerous. If you don't have a panic attack, that's great. If you experience one, then so be it. You'll be fine whether you get one or not. That may sound somewhat insensitive but working toward adopting this attitude is a helpful exercise towards recovery.

Also, there is no need to excessively monitor your symptoms. We are lucky to have a self-regulating system for our heart, breathing, and other essential bodily functions. And while it may sometimes feel like they are quite a bit more active, they are still self-regulating. Your body doesn't need your help to settle down. So, if you are otherwise healthy and think that your heart rate, breathing, nausea, or anything else is increasing, just trust your body to take care of it. You can safely spend your time and energy on things in your life that are much more meaningful to you.

Finally, and most importantly: You can safely stop engaging with all the negative thoughts that pop into your head. Any strategy that focuses on bringing your bodily symptoms under control is likely making the problem worse (this is also why breathing exercises won't work for most people). Let's explore this more in the next section.

What can you do instead?

To start, let's make one thing clear: A thought is just brain activity that has no power over your reality. When you start engaging with a negative thought, you are classifying it as a real threat and, thereby, as something real. You also perceive it as something that needs to be dealt with.

You cannot control which thoughts you get or when you get them. What you can control is what you do with them after they enter your mind.

Hidden here lies a solution. Simply put, you don't need to do anything with your thoughts.

For many, it's hard to accept at first, but you can actually choose to not engage with them. Also, it may help you to know that all thoughts will certainly disappear on their own - regardless of how negative they are. Just like any other thought you've had in your life.

(And yes, they'll probably come back a number of times. Quite frequently, even. But they will also disappear again if you let them.)

So, next time you get a thought about how something you did in the past may now trigger a panic attack, you can try to simply postpone the worry. A very easy technique is to make a "worry appointment" with yourself. When a negative thought crosses your mind, you could say something like:

"I will make a mental note of this worry, and today from 6pm-7pm, I will visit all these collected worries and evaluate how important they are."

Gently try out this technique. Maybe after some days or weeks, you'll notice that you've become better at postponing worries. In fact, in an earlier blog post, 7 Tips against worrying that actually work, we discuss more techniques that may help you recover from a panic disorder.