Your body has a mind of its own during a panic attack. A built in fight or flight alarm mobilizes the body to react in an extreme fashion to neutral and sometimes indeterminable triggers. Psychological rather than physical dangers become threatening. You perceive a situation as overwhelming and your body reacts. An argument with your boss, going to a party, driving in a new area, or virtually any situation is seen as dangerous and can lead to a sudden episode of extreme fear and apprehension.

Panic Attacks are a type of anxiety disorder.  They are characterized by out of the blue, recurrent episodes of extreme fear and apprehension.  Fear of death, loss of control, or illness, or more generally fear that something bad will happen accompany these attacks. The attacks can last a few moments or can continue in waves over a few hours. It is estimated that 10-15% of the population experience panic attacks occasionally with about 2% developing a panic disorder.  These panic disordered individuals begins to avoid circumstances that remind them of the prior panic attacks.

The causes of  these frightening attacks are not clear.  Genes appear to have some influence as twin studies show at least a 40% likelihood of occurrence. There are numerous factors that contribute to their onset including biological triggers, environmental triggers, childhood triggers and an accumulation of stressors. Both nature and nurture converge to launch an individual into this pattern. A combination of predisposing factors which occur biologically, environmentally or in lifestyle contribute to the development of  this condition.

Panic attacks occur in the area of the brain called the amygdala which is the fear center of the brain. This area becomes over activated during a panic attack.  When people experience stress, the sympathetic nervous system mobilizes quickly, energy is released and the body prepares for action to cope with predators or other survival threats. When the parasympathetic system , whose job is to to calm the body down, is unable to cope with this sudden arousal and stabilize the body, the individual may experience the heightened arousal state of panic where feelings of choking, a heart attack, fainting, going crazy or dying erupt.

These episodes of panic usually occur rapidly, abruptly and intensely. The adrenals release a large amount of adrenaline which revs ups the body leading to feelings of dread or terror. An individual experiences shortness of breath, excessive sweating, cold hands and feet, shaking or trembling, dizziness, contractions in the chest and throat leading to a sensation of being unable to breathe. The body is jolted into preparation to run or fight even though muscle contractions activated by the sympathetic nervous system can trigger a freeze response and a sense of immobility.

The panicked body triggers a change in breathing which affects carbon dioxide levels in the blood. The amount of carbon dioxide in the body accumulates building up quickly and activating a terror generating system in the body. Carbon dioxide experiments at the University of Iowa indicate that not all individuals with these imbalances in the body experience panic. For those that due, the panic feels unbearable.  Those with panic attacks appear to be more sensitive to carbon monoxide inhalation than those without the condition.

Hyperventilation occurs if you over breathe or breathe through your mouth either causing panic attacks or contributing to them through the aggravation of physical symptoms. The body increases in alkalinity resulting in feeling jittery. The level of carbon dioxide decreases and causes your heart to pump harder and faster. This can  result in lights appearing brighter or sounds appearing louder. Brain vessels constrict  and decrease the amount of oxygen that gets to the brain resulting in dizziness, disorientation, or a sense of unreality.

Due to the multi causality of panic attacks, a multidimensional approach to dealing with them is appropriate.  A few effective approaches include:

1. Reevaluate breathing patterns: Although conventional wisdom has recommended deep, slow purposeful breathing techniques for coping with panic attacks, current research is suggesting something different. Breathing shallowly, as though sipping air, can reverse shortness of breath, dizziness and other panic attack symptoms. Breathing slower and shallower can feel strange at first as though you are not getting enough air. Treatment modalities are available that employ objective mechanical feedback on the level of oxygen in the blood as you get used to this new type of breathing. The daily practice of 15 minutes of breathing twice a day is recommended to develop good breathing habits. There are many other types of breathing whose goal is to regulate the breathing pattern and slow the breath. Practicing these techniques when you are not anxious is of great benefit.

2.Do regular exercise: Exercise contributes to a reduction in muscle tension and stress and therefore all types of anxiety. There is growing evidence that  developing an enjoyable exercise regime that incorporates light aerobic exercise 4 times per week can reduce both anxiety and panic. Exercise has been shown to enhance mood, improve sleep quality, reduce physical and mental tension and improve energy levels. It can reduce stress hormones implicated in the development of anxiety symptoms, produce mood enhancing chemicals such as endorphins which regulate stress reactions in the body. It decreases anxiety sensitivity which is an individual’s sensitivity to the symptoms of stress. Research also indicates that exercise reduces the intensity and frequency of panic attacks.

3. Streamline your diet: Identify and eliminate food triggers through keeping a food diary. Certain foods appear to contribute to either the likelihood of anxiety or the intensification of the symptoms of anxiety or panic, decreasing sleep quality and increasing panic attack frequency. One of the biggest culprits is caffeine. It can trigger feelings of nervousness, irritability, anxiety and panic. Sugar can also lead to panicky feelings in the body.  Research indicates that heavy sugar consumption followed by abstinence can cause a dopamine imbalance that can increase anxiety. Other studies indicate that sugar consumption can affect the body’s ability to fight anxiety. It can cause mood swings, agitation and blood glucose irregularities which can all contribute to anxiety. Monosodium glutamate, a flavor enhancer, can cause dizziness, sweating, nausea and panic attacks. Observing and keeping track of your own reactions to what you eat and drink can assist in deciding what to increase or decrease in your diet to reduce anxiety symptoms.

4. Alcohol: Although many people drink alcohol as a way to calm down and relax, it can increase anxiety.Alcohol consumption causes blood sugar fluctuations and a build up of lactic acid which can increase agitation, stress, and anxiety. Limiting intake can be an effective part of an anxiety reduction program.

5.Observe, problem solve or distract: Catch your symptoms at an early stage: Although panic attacks appear to come from out of the blue, research indicates that changes in  physiology occur about an hour before a full blown attack. Recognizing your own anxiety warning signs and developing a constructive response can alleviate or minimize symptoms. Exit a situation that is increasing tension until the symptoms subside. Talk to someone to distract yourself and to decrease the extra stress that comes from trying to hide the anxiety. Remain in the present moment by noticing the details of external objects preferably using your other senses such as smell, touch and hearing. Use your ability to focus and concentrate on an activity such as a game, planning your day’s activity, solving a puzzle, or counting backwards by 3. Move to a different area.  Go outside or to a different room. Practice breathing along with coping statements such as I can ride through this, all is well and this too shall pass.

Seeing a physician to rule out any physical causes for your symptoms or to discuss the possibility of a short term course of medications is a good initial step to take in beginning your treatment  for panic attacks.  It is a treatable condition.  Many options for treatment are available and can be successful in ameliorating symptoms and in developing a panic free lifestyle.  The right approach can result in much needed relief for this condition.