Don’t push the panic button

Samir Parikh

It is common for individuals to feel a sudden anxiety or worry in a particular situation. When such feelings of sudden and intense fear or discomfort rise to a peak within a few minutes, it is more likely to constitute what is called a panic attack. Panic commonly comes with physical manifestations of anxiety including heart palpitations, perspiration, trembling of hands, feeling of choking, tingling or numbing sensations, cold sweats, etc., which could vary from individual to individual. Further, such experiences of panic are also commonly accompanied with psychological symptoms including fears of losing control, going crazy or dying.

Further, the individual tends to become worried or apprehensive about having similar experiences of panic attacks in the future, and worries about the consequences of such possibilities. As a result, they tend to make all efforts to avoid situations or circumstances which they might consider as potential possibilities for the recurrence of a panic attack in the future.

Signs and symptoms

Panic, which is a manifestation of an anxiety disorder, is largely driven by a physiological process, which can be triggered in a situation which is perceived as being potentially dangerous. In a panic attack, most often the individual perceives a particular situation as threatening or dangerous, and consequently the brain sends such a message to the autonomic nervous system, thereby activating a fight or flight response. This mechanism further determines the way in which the individual reacts to the perceived potential threat or triggering situation.

Physical symptoms:

• Heart pounding
• Cold sweats or hot flushes
• Breathlessness
• Sweating
• Trembling
• Lack of control over urinary bladder
• Numbness or tingling sensations
• Headache
• Dizziness or giddiness
• Indigestion
• Nausea or vomiting
• Psychological symptoms:
• Difficulty in attention and concentration
• Forgetfulness
• Sense of a loss of control
• Fear of going crazy or dying
• Constant worrying or rumination
• Low self-esteem
•  All or none thinking or other cognitive errors

Behavioural symptoms:

• Fatigue or lack of energy
• Restlessness
• Disturbed sleep
• Irritability or anger
• Avoidance of anxiety provoking situations
• Seeking reassurance

Dealing with panic disorders

1. Professional help is irreplaceable. Panic disorder is a kind of anxiety disorder that requires adequate intervention by a mental health expert, including medications to regulate the levels of the neurotransmitter ‘serotonin’ which has been implicated in anxiety disorders. The meds usually are in combination with psychological interventions such as cognitive behavioural therapy to modify the person’s maladaptive belief systems, relaxation, etc.

2. Understand the nature of panic. One of the biggest fears associated with panic disorders relates to apprehensions about having another such attack in the future, and its anticipated consequences. It is important to understand that panic disorders in themselves cannot do any harm to the person’s physical health.

3. It is transient. Remember, the panic attack is temporary, it will come and go. Even though in those few minutes of panic you might feel as though it’s over, and that you won’t be able to survive it, it’s necessary to realise that the feeling will pass.

4. Physical activity benefits. Regular physical exercise has been found to be beneficial in alleviating anxiety, as it helps in the regulation of serotonin. Therefore, adopting healthy lifestyle choices, maintaining regular sleep and dietary habits, and regulating your routine appropriately can go a long way in helping you combat the stress in your life.

5. Seek support. It is very helpful to rely on an active social support system. Instead of alienating yourself from others, make an extra effort to socialise and find opportunities to mix with others and keep yourself engaged with social interactions.

6. Avoid stimulants. It is a myth that smoking cigarettes, or consuming caffeine (in the form of coffee, tea, cola drinks, etc.) can help you relax. Such effects are only temporary, and on the contrary they can exacerbate one’s anxiety symptoms.

7. Relax. Relaxation exercises, yoga, meditation, or any activity that you might find soothing and relaxing, including music, dance, art, etc. can help in alleviating your anxiety.

8. Share your thoughts and feelings. It is very important to express your feelings with someone. Talking about your worries not only helps in releasing the tension but also helps build your resilience towards such stressors in the future.

9. Be open to ask for help. If you are finding it difficult to deal with the panic, do not hesitate to ask for help. Such recurrence of panic attacks can be severely debilitating for a person’s personal, social as well as occupational functioning and can lead to a state of burnout and exhaustion, making the individual more vulnerable to experience depressive or anxiety features.

— The writer is Director (Department of Mental Health and Behavioural Sciences ) Fortis Memorial Research Institute, Gurgaon