Alyssa’s panic attack
Alyssa is a high school senior and member of her school’s cheerleading team. She has never had a panic attack. When lifted into the air by her teammates during practice one day, she suddenly feels very dizzy and fears that she is going to crash to the ground. She yells to her teammates to put her down. When they do, Alyssa begins shaking, hyperventilating, and notices her heart is racing. She tells her coach she thinks there is something wrong with her and runs, terrified, to the nurse’s office. After about ten minutes, she feels better and returns to her team, but refuses to be lifted into the air again.
Two days later, Alyssa walks into her morning science class. She suddenly feels dizzy again, and then notices her heart racing and feels she cannot catch her breath. She worries that she is going to collapse and die in the middle of her class and runs out of the room and back to the nurse. Alyssa goes home for the rest of the day and stays home from school for the remainder of the week.
Over the weekend, she starts to worry about going back to school. While watching TV with her sister on Sunday, she begins to notice her heart is beating faster than usual. She suddenly begins to feel very dizzy and sweaty, her vision blurs, and she feels she cannot breathe. Certain she is having a heart attack, she yells for her mother. They drive to urgent care, where a doctor confirms that there is nothing physically wrong with Alyssa. When Monday comes, she is terrified to go back to school, fearing that the same thing will happen, and that she will collapse or die in the middle of her class.
What is panic disorder?
While Alyssa may not have a medical condition, Alyssa likely has something called panic disorder – a relatively common and extremely distressing anxiety disorder that can affect children, teens, and adults. Panic disorder is marked by frequently occurring panic attacks that occur in seemingly random and unexpected situations. Panic attacks are relatively short periods of significant fear in a situation where there is no real danger, coupled with a variety of intense and seemingly alarming physiological symptoms, such as a racing heart beat, shortness of breath or the feeling that one cannot breathe, hyperventilation, dizziness, sensations of choking, nausea, sweating, tingling, numbness, blurred vision, and more. In addition, during a panic attack, the person often has cognitive symptoms, or thoughts, including fears that he/she is dying, going crazy, having a heart attack, or losing control. For this reason, panic attacks often drive sufferers to the emergency room or their doctor’s office. When doctors are unable to find a medical explanation for these significant physical symptoms, panic attacks may be the cause. When panic attacks recur, they often bring with them a fear of these attacks happening again. While panic attacks can occur for a variety of reasons and in a variety of situations, the presence of both repeated and unexpected attacks, as well as the fear of these attacks happening in the future, combine to create panic disorder.
Avoidance and panic attacks
In an effort to protect oneself from a panic attack, those with panic disorder will often avoid places or situations they believe are likely to trigger an attack. Alyssa, for example, refused to be lifted in the air by her cheerleading team because that was the activity she was engaged in the first time she experienced a panic attack. Sufferers of panic disorder may avoid situations and places in which they have had a prior panic attack, or other places that seem likely to trigger an attack, such as crowded places, like stores and subways, or any place where having a panic attack would seem dangerous or embarrassing, such as while driving or in a meeting at work. However, when a person has panic disorder, their panic attacks tend to occur in seemingly out-of-the-blue situations. Alyssa avoided being lifted into the air, but then had a panic attack in her science class and while watching TV. This seemingly random pattern of attacks can be increasingly confusing and frustrating to the sufferer and can cause individuals to avoid more and more situations and places. While this avoidance may provide short-term relief from panic attacks or from worry about future panic attacks, it will likely exacerbate symptoms in the long-term, as well as increase future worry about going to these places and engaging in these situations. Additionally, avoidance does not allow the person to learn new, healthier ways to cope with these symptoms and fears.
In addition to avoidance, people who have panic disorder may engage in a number of “safety behaviors.” These are things the person does that make them feel “safer” or less likely to have a panic attack. Examples of safety behaviors include carrying around an anti-anxiety medication, drinking cold water, rolling up their sleeves, or sitting by the door in a meeting or classroom. Similar to avoidance, these behaviors do not help the person to learn to better manage or decrease their panic symptoms in the long-term.
Getting help for panic attacks
Fortunately, this type of anxiety is treatable with Cognitive-Behavioral Therapy (CBT). CBT treatment for panic disorder includes systematically addressing all three factors that combine to create this disorder: the physiological symptoms, the unhelpful thoughts, and the behaviors that may exacerbate the disorder. With the help of a CBT therapist, the client will gradually become more comfortable with the relevant physical sensations. Clients accomplish this by increasing their exposure to the symptoms so that they no longer elicit fear. They will also learn to identify and challenge their distressing thoughts and worries and learn how to respond to these thoughts in healthy and productive ways. Clients also gradually reduce and alter avoidance and safety behaviors and begin to more fully participate in their lives. If you or your child is dealing with panic disorder or recurring panic attacks that are interfering with quality of life and ability to participate in common activities, consider reaching out to a cognitive-behavioral therapist for further information and treatment.