By Brian Robinson.
What is the difference between a panic attack and an anxiety episode, or, is it simply that different people experience the same thing differently? The first thing to say is the experts seem to be agreed that there is a real difference between General Anxiety Disorder and Panic Attack Disorder. For the sufferer, however, things can be blurred. For example, it is possible for an anxiety sufferer to have panic attacks, and likewise, someone with Panic Attack Disorder can experience general anxiety. To clarify, we first need to ask what is anxiety and panic; how is it activated; and what parts of the nervous system are involved?
Anxiety and panic exist to serve two fundamental purposes. Firstly, it is a spur to action. When fight or flight is engaged the fear encourages us to escape from the danger. Secondly, it facilitates that escape. When stress hormones are released in the body they facilitate the action. You can run faster, run further, and if you have to stand and fight, you will be able to hit harder and endure longer. However, flight is always the preferred option. Fight or flight offers the encouragement to run: but it offers little in the way of courage to fight.
There is only one way that anxiety or panic can be activated and that is by increased tension levels. These can rise in two ways. Over time, tension can gradually build up in the body as we become more and more stressed. And when the tension reaches a certain critical level fight or flight is automatically activated. We can call this background tension and this is more associated with General Anxiety Disorder.
However, the brain also has the ability to increase tension levels and this is the more natural way for fight or flight to become aroused. When we find ourselves in real danger, the brain increases tension levels dramatically and we become anxious and experience panic. This type of tension is more closely linked with panic attacks. We can say then, that General Anxiety stems from the peripheral nervous system, and Panic Attack Disorder is initiated by the central nervous system i.e. the brain. This may be an oversimplification, but it can help with our understanding.
With General Anxiety Disorder anxiety can wax and wane over time. We may feel anxious for quite short periods, or long periods of time. The feelings themselves may be quite strong or fairly weak, but they do not usually reach the intensity of a panic attack. Panic attacks, on the other hand, are fairly clearly defined. They usually peak after about five or ten minutes, and then begin to subside after a further twenty minutes or so. It is unusual for an attack to last for an hour or more, but having said that, in some cases it is possible for one panic attack to roll into another with a slight trough in between. However, it is quite rare for this to happen. And we can say with some certainty that panic attacks do not go on forever. The brain is simply not disposed to maintain extreme levels of panic for long periods of time.
It is also very rare for a person to pass out as a result of a panic attack although many people harbour this fear. Fainting can happen due to low blood pressure. The idea is that if we fall to the ground then our brain is more likely to get the blood and oxygen it needs. However, panic usually increases blood pressure due to the stress hormones being released so fainting is unlikely.
Panic attacks can appear suddenly and unexpectedly with no obvious trigger or build-up. This sudden-onset feature can be disturbing for the sufferer. Another characteristic is that the person may be more inward-looking during the attack. You might think you are going mad or that something serious has gone wrong inside. This may be partly due to the absence of an obvious external trigger. The reasoning is: where there is no external cause: there must be an internal one? Panic attacks can happen months apart or they may be quite frequent. And they are often followed by periods of intense worry. This usually centers on the fear of having another attack. When panic attacks are infrequent, the sufferer may feel perfectly okay in between attacks. Whereas an anxiety sufferer will usually feel anxiety in some measure due to the high background tension levels.
People who have panic attacks can go on to develop triggers that may be linked to the first incidence. For example, if someone had their first attack in a supermarket, then going back to supermarkets may trigger further attacks. It is also possible for someone with Panic Attack Disorder to have attacks that fit both descriptions, i.e. sudden onset attacks and ones brought on by specific triggers.
Generally speaking, it is difficult to control panic attacks, once initiated they do have to run their course. If we could control or stop them then the disorder simply wouldn’t exist. There is some scope to improve things though, but having said that, there is likewise the potential to make the experience worse. The whole idea of a panic attack is to make the person panic and escape from danger. So, if we really do panic and start running around, calling for help etc, this tends to confirm the idea that danger is present. It is far better to stay calm, perhaps get up and make a drink, and then sit down again.
It is possible to recover from panic attacks and there are many therapies that have much to offer. The two main pathways are Relaxation Therapy and Cognitive Therapy. Relaxation, however, is always a progressive endeavor simply because it is impossible for the sufferer to completely relax in the moment. And, it is also true that making changes to what goes on in our heads takes time. This means in practice, that we have to dig a little to find the resources that will help. But, trust in the recovery process; determination; and a good work ethic will help take the finger off the panic button.
Generally speaking, it is difficult to control panic attacks. Once initiated they have to run their course. If we could control or stop them then the disorder simply wouldn’t exist. There is some scope to improve things, but having said that, there is likewise the potential to make the experience worse. The whole idea of a panic attack is to make the person panic and escape from the danger. So, if we really do panic and start running around, calling for help etc, this tends to confirm the idea that danger is present. It is far better to stay calm, perhaps get up and make a drink, and then sit down again.
One of the big problems with anxiety and panic is the natural tendency to resist. We try and fight or block the panic even though this is futile. Resistance can be physical where we tense up further, but resistance can also be emotional and psychological. The best thing is to accept the panic and let it do what it has to do. Many people describe panic as a bully that has to be stood up to. The problem is, this attitude only increases resistance and builds tension. Acceptance is a far better strategy.
Because panic is so inward looking, it is also a good idea to try and shift our focus to the external world when trying to deal with it. Look at things in the room; look at pictures or watch TV; listen to music or the radio; reassure yourself about the panic. Slow breathing exercises are also a good way to calm our body and mind.
It is possible to recover from panic attacks and there are many therapies that have something to offer. The two main pathways are Relaxation Therapy and Cognitive Therapy. Relaxation, however, is always a progressive endeavour simply because it is impossible for the sufferer to completely relax. And it is also true that making changes to how we manage what goes on in our heads takes time. This means in practice, that we have to dig a little to find the resources that will help. But trust in the recovery process; determination; and a good work ethic will take us a long way.