Calm in the Chaos: Understanding + Coping with Anxiety and Panic

Anxiety and panic are often used interchangeably, although there are small differences. They are related in that they both involve the body's stress response system, but they differ in terms of intensity, duration, and the specific symptoms experienced. Anxiety refers to feelings of worry, fear, or uneasiness. Common areas of anxiety include pressures to perform at work, the fear of the unknown or the future, social situations etc… Panic attacks are intense, sudden surges of fear, that may feel uncontrollable.

Positively, there are specific therapies to address anxiety and panic. For example, Cognitive-Behavioral Therapy (CBT) is widely recognized as an evidence-based treatment for panic and anxiety disorders, meaning that numerous scientific studies have consistently demonstrated its effectiveness in alleviating symptoms. Below we review what panic attacks are, what can lead to the development of a panic attack, specific therapy interventions for panic, and coping strategies to manage.

Understanding Signs of a Panic Attack

Panic attacks are intense feelings of fear and distress that triggers severe physical reactions such as racing heart, chest pain, difficulty breathing, shakiness etc... These can feel particularly overwhelming, leaving individuals feeling helpless and out of control. During a panic attack, the body goes into a state of high alert, releasing the stress hormone adrenaline and activating the "fight-or-flight" response. A common, and difficult, component of panic attacks is the fear of having another one. This fear can create a cycle of heightened anxiety, as individuals become worried about the possibility of experiencing another panic attack, leading to increased stress and, potentially triggering a panic attack.

What Causes Panic Attacks?

Panic attacks are influenced by a wide range of factors, and everyone may have their own unique triggers. Identifying these triggers is a crucial step towards managing and overcoming anxiety attacks. Here are some common ones:

Stress and Lifestyle: High levels of stress, whether due to work, relationships, or finances, can significantly contribute to activation of our body’s stress response.

Past Trauma: Due to past trauma, it is common for individuals to be hypervigilant (heightened state of alertness) to possible threats/danger, which keeps the body in a constant state of arousal and can contribute to the onset of a panic attack. Triggers related to the trauma (situations, sounds, smells, images) may also make an individual more vulnerable to a panic attack if exposed to these triggers.

Phobias and Fears: Specific phobias, such as fear of flying or fear of public speaking, can trigger anxiety attacks in certain situations. Exposure therapy techniques for panic and anxiety, can help individuals overcome their fears and reduce the frequency/intensity of panic attacks.

Biological Factors: Imbalances in brain chemistry, genetics, and hormonal changes can contribute to the development of anxiety disorders.

Physical Sensations: For some individuals, the presence of a particular physical sensation or minor symptom, may be sign of a severe illness. The individual then ruminates on this, escalating to the point of a panic attack (ex: attributing chest pain to an impending heart attack).

By identifying the causes and triggers of anxiety attacks, individuals can gain insight into the root causes of their anxiety and develop targeted strategies for managing.

CBT for Panic and Anxiety

Cognitive-Behavioral Therapy (CBT) is a highly effective therapeutic approach for managing anxiety and panic. It focuses on identifying and challenging negative thoughts and beliefs that contribute to anxiety, ultimately leading to a shift in behavior and emotional well-being.

In CBT, individuals work closely with their therapist to understand the relationship between their thoughts, emotions, and behaviors. By becoming aware of automatic negative thoughts and particular thinking patterns, individuals can learn to reframe their thoughts by replacing them with a more realistic and balanced perspective. Let’s use an example below:

Identify the anxious thought:

“Everyone at the party will think I'm awkward and they’ll talk about me”

Challenge the anxious thought:

Ask yourself…

is there evidence to support that this is 100% true?

Is there an alternate explanation to this?

Am I making any assumptions?

Generate a more balanced thought:

“I feel anxious about the party but there is nothing to say that my thought is true. People are likely focused on themselves, not watching me.”

Behavioral response to the balanced thought (instead of the anxious one):

Instead of avoiding the party, commit to attending the party and engaging in conversation.

Exposure Therapy for Panic Attacks

Exposure therapy is another key component of CBT. It involves gradually exposing individuals to their feared situations or triggers in a controlled and supportive environment (therapy with trained clinician). This often starts with creating a fear hierarchy. This is ranking of feared situations, ranging from least anxiety-inducing to most anxiety-inducing. This hierarchy helps guide the exposure process, starting with less distressing situations and progressively moving towards more challenging ones. Through repeated exposure, individuals can learn that the feared outcome/consequences are unlikely to occur, leading to a reduction in anxiety symptoms.

Lifestyle Changes to Reduce Panic Attacks

In addition to therapeutic techniques, making positive lifestyle changes can reduce the frequency and intensity of anxiety and panic attacks. Below we review some areas where making small shifts can lead to a big impact

Regular Exercise: Engaging in regular physical activity, or increasing movement in general can reduce levels of the body’s stress hormone, cortisol. It can also release endorphins, often referred to as the “happy” or “feel good” chemical.

Nutrition: Although dietary changes will not eliminate anxiety, it can play a supportive role in managing anxiety. In addition to eating regular meals, it is recommended to avoid or limit alcohol and other substances, and caffeine, which can exacerbate anxiety symptoms.

Adequate Sleep: Good sleep is a non-negotiable! Sleep pays a critical role in our mental health and can have positive impacts including emotion regulation, alertness, and improved cognitive functioning (such as problem solving).

Stress Management: Adopting stress management techniques, such as practicing mindfulness, engaging in hobbies, and setting boundaries, can help buffer against anxiety and panic. Additionally, connecting with supports can have a positive impact on our functioning.

By understanding the causes of anxiety and panic, identifying and implementing coping strategies, and making positive lifestyle changes, individuals can experience relief from their symptoms. Remember, you are not alone in this journey. If you experience recurrent or severe anxiety or panic attacks, support is available from licensed mental health providers.