Panic Attacks, Panic Disorder and Agoraphobia

Panic attacks are one of the most common mental health issues. On this page, you can find out about the following topics:

What is a Panic Attack?

A panic attack is when you feel some terrible symptoms, such as:

  • you feel really, really afraid
  • your heart is racing or seems exceptionally loud
  • you might feel hot and sweaty, or break out in a cold sweat
  • you may feel dizzy or lightheaded
  • you may have trouble breathing, or feel chest pain or tightness, or feel as if you’re going to choke
  • you might feel numb or tingly in your arms or legs
  • your legs become like jelly and you feel like you’re unable to stand up
  • you might experience a strange sense of unreality, maybe as if you’ve become detached from your body
  • you have thoughts of an impending catastrophe – such as having a heart attack and dying, going insane, fainting, suffocating because you’re not able to breathe, or losing control of yourself in some terrible, permanent, and embarrassing public way (or all of these!)

The first panic attack is usually an unexpected event that happens “out of the blue”, although you may be under stress at the time or going through significant changes in your life.

What are Panic Disorder and Agoraphobia?

Panic Disorder means that you are having severe panic attacks again and again, and that you are afraid of having another one. If you are not afraid of the panic attacks, then it’s not panic disorder.

Agoraphobia means that you avoid situations where you could have another panic attack, for example situations or places where you’ve experienced panic in the past, or places from which escape might be difficult or help unavailable in the event of a panic attack. Typical examples include bridges, shopping malls, driving, air travel, elevators, undergrounds – the list goes on! Oftentimes, people avoid more and more situations until the only “safe” place left is their own home.

Are Panic Attacks Dangerous?

“No” is the short answer. Our bodies are equipped to deal with (and indeed generate) panic attacks. But that can be hard to believe when you actually experience severe panic attacks.

Panic attacks are the result of an ancient survival mechanism called the Fight, Flight or Freeze response. When our bodies were “designed”, the main danger we had to face was a big predator who saw us as a meal. And even though the world has changed a lot since, our bodies respond to danger (or perceived danger) in the same way.

When our bodies get a “danger” signal, they respond by preparing us for either fight, flight, or freeze – depending on the circumstances. If the attacker looks smaller or weaker than yourself, then fighting would make sense. If the attacker is bigger and stronger, but slower, you can choose flight and run away. And if the predator is both stronger and faster, the best response would be to freeze and keep really still, in the hope that it doesn’t see you.

The symptoms you experience during a panic attack would serve, in one way or another, to help you survive an encounter with a dangerous predator. You will have probably experienced similar sensations to those of a panic attack before, in a real emergency or in a situation you found frightening – heart pounding, adrenaline kicking in, a change in blood flow, a change in breathing – but because you attributed these changes to a real fear or danger, and because your mind was occupied with dealing with the emergency, you would not have perceived the symptoms as frightening in themselves.

Your mind wouldn’t have been searching for reasons why you were feeling this way – no need to attribute the bodily sensations to being about to die, or go crazy, or whatnot.

Why do people develop Panic Disorder and Agoraphobia?

Most of the time, when people have their first panic attack, they don’t receive much (if any) information about what it was that they experienced. You are then left to make sense of what happened on your own. Some common explanations people come up with include:

  • I was going to die (e. g. from a heart attack, stroke, or suffocating, caused by the heart “acting up”, not being able to breathe, or a chemical imbalance)
  • I was going to “go crazy” and lose my mind, and end up in a psychiatric hospital
  • I was going to faint
  • I was going to lose control of myself in a very embarrassing and public way (e. g. falling to the floor and soiling myself, screaming loudly, acting crazy)
  • All of the above!

The type of explanation(s) you come up with will depend on your previous life experiences and fears. For example, if you are a shy person, you may fear making a fool of yourself in public. If you have a friend who unexpectedly died from heart problems, you may fear having a heart attack. If you have a relative with a mental health condition like schizophrenia, you may fear going insane. Or you may come up with a different explanation altogether, but these are the most common ones.

Avoiding situations which could bring on a panic attack is a protective mechanism. Sadly, it’s a mechanism that always backfires, because it makes the situation worse in the long run.

Why do some people develop panic attacks and agoraphobia, while others don’t?

According to Dave Carbonell, a clinical psychologist specialising in anxiety disorders, there are three main reasons:

Genetic Predisposition: some people are born likely to develop panic attacks under the right circumstances, and some people couldn’t have a panic attack if you paid them.

Childhood Circumstances and Atmosphere: adults with panic disorder have often grown up in an atmosphere that failed to teach them that the world is a safe place where they could happily pursue their own enjoyment. Maybe there was an early death in the family, severe illness, or some other serious problem such as alcoholism or mental illness. Or else the parents were themselves anxious and overprotective, or the child had to spend too much time and effort taking care of others, trying to please them, and feeling responsible for their happiness.

The Stress of Becoming an Independent Adult: most people develop panic disorder in their twenties or thirties, when they are establishing an independent life and experiencing significant life changes.

What can I do if I experience Panic Attacks, Panic Disorder or Agoraphobia?

Unfortunately, there is no quick-fix solution (unless you’ve only just started having panic attacks, in which case a quick read of the book recommendation below may well do the trick). Beware of websites which make promises along the lines of “Get Rid of your Panic and Anxiety in 7 days”. There are many of these anxiety scams on the Internet.

There are however tried-and-tested ways of addressing your fears and overcoming (or at least hugely improving) the panic problem.

The most common one is called cognitive-behavioural therapy (CBT). Usually, this involves the following steps:

  • Getting detailed information about panic attacks and finding out what the physical sensations mean
  • Learning calming techniques such as belly breathing
  • Keeping a diary of your panic attacks where you write down what you experienced, where it happened, what may have triggered it, how long it lasted etc.
  • Creating an exposure programme which starts out with the situations you feel you can handle the easiest. As you become comfortable with these, gradually you start tackling more difficult situations or places.

Another method is called Acceptance and Commitment Therapy (ACT). In a nutshell, this method teaches that getting rid of anxiety isn’t the answer. Rather, accepting the sensations from anxiety, while doing things you care about (despite how you feel) is the key to finding relief. It teaches techniques for “mindful acceptance”, a sort of Buddhist concept which denotes living in the present moment and observing and accepting anxiety, rather than getting caught up in it and fighting it.

In reality, these two approaches overlap. If you choose to work with a qualified mental health professional, you may find them using a variety of perspectives.

Self-Help

My favourite panic attacks self-help book (and I’ve read a few!) is the “Panic Attacks Workbook – A Guided Program for Beating the Panic Trick” by Dave Carbonell (also available on Amazon). Unlike many other self-help books on panic attacks, it is written by a psychologist with many years of experience in helping people overcome panic, and it is not condescending. A rare combination! It is also very easy to read, entertaining, and great value for money.

A book which has been highly recommended on our forum is “At last a life” by Paul David: “I have a found a book recently which has helped me. It’s by a man who suffered for years with anxiety and cured himself through going with the anxiety and the thoughts instead of fighting it. His website www.anxietynomore.co.uk is really good with loads of success stories on people that the book has helped and lots of reassurance about the symptoms we all fear experience associated with panic and anxiety. Also he has now released an app for the iPhone called “anxietynomore” and it includes the book and lots of other features well worth getting in my opinion.”

Another book which gets rave reviews is Claire Weekes’ “Self-Help for Your Nerves” (also available on Amazon). This is a classic, and many people don’t mind that the language in it is somewhat dated nowadays (it was first published in 1962). Many people with panic disorder or agoraphobia have said that this book has changed their lives.

Yet another book which is interesting but gets mixed reviews is “The Mindfulness & Acceptance Workbook for Anxiety” by John Forsyth and Georg Eifert. Personally I thought that it might not be the best read if you’re feeling depressed, and some reviewers have found it condescending. Other reviewers rave about it and say it really helped them when everything else had failed. It seems that people either love it or loathe it!

Working with a mental health professional

Some people find that they can overcome panic attacks using self-help alone. But

  • you may prefer some extra help and expertise from a real human being in person, or
  • you may find it hard to keep motivated, or
  • you may feel overwhelmed by the task, or
  • you may feel you’re not making any real progress, or
  • you may have other difficulties in your life in addition to panic attacks – for example living with an abusive spouse, drug or alcohol problems, severe depression, or post-traumatic stress.

In these situations, you should enlist the help of a qualified mental health professional:

Finding the Right Mental Health Professional

Dental Phobia and Panic Attacks

Panic attacks make going to the dentist much harder – though some people with panic attacks actually find that the dental practice is a safe environment for them, because there are people on stand-by who can deal with panic attacks! This obviously isn’t the case when you have dental phobias in addition to panic attacks.

You can find all sorts of tips for dealing with dental fears on this website. Some which may be useful or which have been mentioned by other people with panic attacks include:

  • telling your dentist about your phobia and panic attacks and the dentist being understanding and kind
  • bringing a close friend or partner along
  • using a technique called structured time (taking frequent breaks in plain English)
  • oral sedation (anti-anxiety medication) for the night before the appointment and on the day
  • you can look into sedation options (nitrous oxide or IV sedation), if you feel that sedation would help you. Nitrous oxide can make you feel very relaxed, while IV sedation makes you both relaxed and sleepy.

In some ways, dealing with the fear of having a panic attack at the dentist’s is not that different from dealing with other dental phobias – much the same principles apply. Panic attacks are nearly always preceded by anticipatory anxiety, so getting rid of the anticipatory anxiety is the key.

The following quote comes from the Craigentinny Dental Practice’s Beat Your Dental Fear e-course, and really sums it up:

“So many phobic patients that I have helped over the years have told me about their previous visits to the dentist where they feet short of breath, had temperature swings, felt faint and even occasionally passed out altogether.  This makes these poor people feel like they are in a blind  panic  which of course did  nothing to help their mental state or reduce their anxiety.

Does any of this sound familiar? So what is actually happening to you when “the fear” starts?

What is happening is your body is kicking in to gear a protective reflex that is as old as time. We used to rely on our “fight of flight” reflex for survival. In modern times it is rarely of any help to us.  Understanding the process that your body is going through is the first step to controlling it.

When you get scared or frightened your breathing gets faster and shallower, the body produces a compound called adrenaline, this makes your heart beat faster, and   diverts blood away from the surface of the body and the brain. The net effect is that , you feel your heart pounding, you may feel dizzy or even faint.  The blood is actually directed  towards the muscles and heart ready for you to either “fight for your life or run for it.” This is often called our fight or flight reaction.

You may be familiar with that feeling as it comes on and think “oh no here we go again…” it literally is like going over the top of a rollercoaster and down the first big drop.

In the dental chair this reaction is totally counter productive but as it is an in built almost “animal” instinct  we can do little to stop it once it starts so  you are simply along for the ride. You may be able to reduce its effects but you cant stop it until it has run  its course.

So what do you do?  The trick is to avoid tipping over the top in the first instance, which means taking your time with a new dentist and slowly (and I do mean slowly) building your confidence one step at a time.

The very worst thing you can do is ask the dentist to do all of your treatment in one session to “get it over with.” You will have the fight or flight response and this will almost certainly confirm all of the  negative things that your inner voice  has been saying. Do you think this will help your dental fear on the long term or make it worse?  Yes you have got it….. it will make it worse. So please if you do nothing else follow the next piece of advice:

Work with your dentist to take small steps over a series of visits.  You can then go at  a pace that is comfortable and  hopefully avoid setting the fear rollercoaster in action. Each time you go to the dentist and have a GOOD experience the positive internal voice that tells you that this is all ok and nothing bad will happen will be reinforced.”

If you are unable to leave your home:

In the UK at least, it is certainly possible for a dentist to come and see you at home. But be aware that treatment is very limited, basically just very simple fillings, extractions and dentures. The Community Dental Service is the main provider of home visits in the UK. Your local Primary Care Trust will have a contact number for you. In most areas of the UK, you’d need a referral from your GP or Health Visitor.

You can also e-mail local dental practices/offices and ask if they offer home visits (and cater to people with dental phobias).

You can find out more on our Special Needs page.

Further Viewing and Reading

Websites

Dave Carbonell’s website – Anxietycoach.com

Anxiety No More – Self Help with Anxiety Attacks

© Parts of this text adapted from “Panic Attacks Workbook” by David Carbonell, reproduced with permission