Panic attacks. Causes and methods of treatment.

A panic attack is an attack of severe anxiety, fear, panic, which is accompanied by certain vegetative (bodily) reactions.

The duration of attacks can vary from several minutes to several hours, averaging 15-30 minutes.

For an anxiety attack to be identified as a panic attack, it must have at least four of the following core symptoms:

• Rapid pulse;
• Sweating;
• Feeling short of air, shortness of breath, difficulty breathing;
• Chills, tremors, internal trembling;
• Pain or discomfort in the left side of the chest;
• Nausea;
• Dizziness, lightheadedness;
• Derealization, depersonalization;
• Fear of going crazy or doing something uncontrollable;
• Fear of death;
• Feeling of numbness or tingling in the extremities;
• Insomnia;
• Confusion of thoughts;

Other (additional) symptoms may be present:

• Abdominal pain,
• Elevated temperature
• Stool disorder
• Frequent urination,
• Feeling of a lump in the throat
• Gait disturbance
• Visual or hearing impairment
• Cramps in the arms or legs,
• Motor function disorder
• High blood pressure.

Patients often talk about the spontaneity (unprovoked) of attacks. However, during the conversation it often turns out that along with spontaneous manifestations of PA, there are also situational attacks that occur in places perceived by a person as potentially dangerous. Such places and situations include:

• Using public transport;
• Staying in a large crowd of people or, conversely, in a confined space;
• And sometimes even, simply, the need to leave your own home.

This list can go on for a long time, but we will stop here.

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Panic disorder

Panic attacks are a symptom of what is called panic disorder.

Panic disorder (episodic paroxysmal anxiety) is a mental disorder that is characterized by the spontaneous occurrence of panic attacks from several manifestations per year to several times a day and restless anticipation of their occurrence.

“Panic disorder” is recognized worldwide as an independent disease. It is included in the International Classification of Diseases, 10th revision (ICD-10)

Some Russian doctors use outdated terms that are not in the ICD, but they emphasize the type of disorder of the autonomic nervous system depending on the leading symptom:

• "vegetative crisis";
• “sympathoadrenal crisis”;
• "cardioneurosis";
• “VVD (vegetative-vascular dystonia) with a crisis course”;
• “NCD” (neurocirculatory dystonia)

How does constant anxiety occur?

Margarita and her fears

Since the age of seven, Margarita cannot remember herself without constant excitement and anxiety. It all started when her father was diagnosed with schizophrenia.

“Mom was afraid that I would inherit this diagnosis,” says the girl. “We carefully hid my father’s schizophrenia from everyone except the closest relatives. I lived in constant fear for myself and for him, I dreamed of telling someone what happened to dad and how it affected me, but I never decided.”

Margarita recalls: she was most afraid of her father, his diagnosis and herself, and in her behavior she looked for signs of an incipient disease. And although it was not passed on to her, Margarita says, “many years of anxiety deprived me of strength, and a couple of years ago I fell into deep depression.”

After graduating from school with a gold medal, expelling from two universities and entering a third, Margarita decided to ask for help. A psychiatrist diagnosed her with anxiety-depressive disorder.

Moscow recluse

Lena tries to leave the apartment as little as possible, and before each work meeting, according to her, she literally breaks out in cold sweat.

“I don’t remember myself without constant fears and anxieties”

“As a child, I was teased as a coward and a crybaby, my hands always shook, and any stress knocked the ground out from under my feet. Not much has changed,” she says.

At the age of 27, Lena was diagnosed with anxious personality disorder.

“I can’t call myself a sociable person, although I always wanted there to be a lot of people around me who sincerely loved me and were safe. I tried to join companies, but it always ended badly. I tried to do everything according to the rules that seemed to exist in these groups, but sooner or later I encountered conflicts and devaluation. This unsettled me. I immediately ran away. I quit several times, although I was in good standing with my superiors,” recalls Lena.

Lena lives in Moscow, but dreams of moving somewhere where it will be quieter. She just can’t make up her mind, she admits. As soon as the real opportunity to take this step arises, Lena locks herself at home, calls two close friends and tries to quickly get rid of thoughts of leaving from her head.

Causes and development of panic attacks

Panic attacks occur when anxiety levels are extremely high.

If with phobias anxiety is increased and is looking for a way to rationalize itself, turning into a specific fear, then with panic attacks the level of anxiety is even higher and it is no longer looking for a specific object to realize. Anxiety just comes out and takes a person by surprise. This can happen anywhere: in the subway, in a bank, in a store, just on the street, etc.

As a rule, a panic attack occurs when a person’s anxiety is further “stimulated.” For example, a person finds himself in a crowded place and it seems to him that for some reason he looks “different” today and that everyone is looking at him. This can create fear in him of being judged and provoke PA.

Self-esteem

An important fact is that people suffering from panic attacks generally always have low self-esteem. They are very critical of themselves. And the triggers for panic attacks are often their thoughts about how they look from the outside and what others think about them. These obsessive thoughts cause internal tension and anxiety. Fear of condemnation makes a person afraid to express himself spontaneously. He fears that someone may not like this behavior of his and cause negative emotions in this dissatisfied person, which he can somehow express.

Comfort zone and anxiety control

Very often, the comfort zone of anxious people is very narrow and cramped, and it is very easy to accidentally push them out of there. At the same time, any exit from the comfort zone causes additional anxiety and threatens the appearance of another panic attack.

With all this, being in the comfort zone, a person with this anxiety-phobic disorder does not feel completely calm. He's still worried. But being in familiar conditions, he learns not to notice his excitement.

When everything is under control, such a person has the mental resource to repress his anxiety, not to think about what causes it, being in the illusion of comfort. He fills his head with unimportant considerations that have no effect on anything.

But as soon as he leaves the usual conditions of existence, his neuropsychic energy becomes aimed at adapting to a changing environment and there is no resource left for restraining anxiety, which leads to its release in the form of panic attacks.

Upbringing

If during psychotherapy we dive into the deep layers of the psyche and look for the origins of a given mental disorder, then we will always come to childhood and the relationship that this person had with his parents.

Parents of a person with panic disorder constantly emphasized his inferiority in one way or another:

• They might not believe that he would succeed;
• They often shamed him, making him feel unworthy of something or guilty of something;
• They were constantly saying that someone was better than him;
• In general, by all means they taught him to depend on someone else’s assessment so that he would meet some non-existent standards.

The fact is that a person with PA does not allow himself to criticize the upbringing that his parents gave him and idealizes them, forgetting that they are ordinary people who, like everyone else, tend to make mistakes. This approach to one’s personality and the personality of one’s parents becomes one of the reasons for the occurrence of PA.

Agoraphobia. Panic anchors.

A special type of phobia can also be formed based on panic attacks.

If with the usual version of the formation of phobias some kind of logic of events is needed, then for the formation of phobias under the influence of panic attacks it is not needed. Since a panic attack can happen anywhere and anytime, a phobia can form for anything. And such a phobia will not be one, but there will be many of them, since each place and circumstances in which a panic attack occurred will become an anchor reminding a person of the incident in which he fell into a panic. And during the course of the illness, such anchors will accumulate more and more, due to the fact that a panic attack happens each time in new places and in new conditions. Thus, panic attacks expand their domain and over time a person begins to be afraid to leave the house, since a phobic state arises in him almost everywhere.

The result is agoraphobia

- fear of crowded places.

Who is so worried?

Why are some people so prone to worrying, like “what if it’s an illness,” while others just worry about something when it happens?

There are several reasons, for example: Genetic component Factors in upbringing or lack of upbringing

People who were raised in divorced families are 70% more likely to have generalized anxiety disorder, which is characterized by chronic anxiety, excessive worry and tension.

Overprotective parents also cause anxiety. Reverse parenting may also play a role. This happens when a child takes care of a parent because they are not feeling well.

My colleagues and I have concluded that there is likely a biological component to chronic anxiety, but there is also a significant environmental component. The child's feelings of being safe must be internalized and grown with him in order for him to feel safe for the most part.

But if you had a mom who wasn't available or consistent enough, you may develop an understanding that the world is not such a safe place. Divorce and overprotectiveness can also undermine a person's sense of internal security.

Treatment

Increased self-esteem

One of the areas of treatment for panic attacks is to work on increasing self-esteem and self-confidence. And also on the ability to be critical of the personality of your parents. The ability to criticize the upbringing that was given to him by his parents will allow a person to move forward, working on his personal characteristics and developing his own individuality, rather than freezing in place, afraid to change what the adults who are significant to him have created.

In the process of psychotherapy, a person goes through the following stages:

• Understanding that parents are not perfect, since they are ordinary people;
• Protest against the methods of education that parents used and against the parents themselves;
• Separation - mental separation from parents;
• The beginning of the formation of one's own personality;
• Acceptance and gratitude to parents for doing everything they could and as best they could to raise their child.
• Accepting yourself as you are and starting to build your life in accordance with your own preferences.

Disclaimer

It is worth noting that all the procedures described in this section are best carried out under the supervision of a psychotherapist or psychologist. Or at least visit him periodically and tell him about the work done in order to receive the necessary recommendations and make adjustments to your wellness actions.

Self-treatment

Simultaneously with working on self-esteem, it is necessary to carry out procedures that help reduce anxiety.

Helps reduce anxiety:

• Breathing exercises;
• Sports activities;
• Autogenic training;
• Relaxation exercises.

Medicines

Also, if a psychiatrist or neurologist prescribes medications, then you should not neglect them, just as you should not get carried away.

Medicines should be treated as an auxiliary tool that facilitates psychotherapy and the dosage of which should be constantly reduced as psychotherapeutic treatment progresses.

Psychotherapy

Psychotherapeutic treatment can be carried out in various directions:

• Cognitive behavioral therapy. It will help you develop the habit of not being afraid of panic attacks.
• Body-oriented therapy. Will teach you to understand the body signals that precede panic attacks, as well as manage bodily reactions to reduce symptoms.
• Hypnotherapy. It will help create new internal attitudes that promote mental immunity, helping to predict and prevent panic attacks.

In addition to all of the above, a psychotherapist will help you understand the causes of PA. During psychotherapeutic sessions, it will become clear what underlies this disorder and what events or series of events led to it.

Complex treatment

In order for the treatment of panic attacks to be successful, a certain number of vectors must converge:

• A doctor prescribing medications must respect psychotherapeutic methods of treatment and understand that medications do not fully treat a mental disorder, but only relieve certain bodily symptoms and adjust the chemical and hormonal background of the body. As soon as a person stops taking them, his body stops producing the chemical elements necessary to maintain health. Therefore, in the long term, medications lead to addiction.
• The psychotherapist should also not sabotage drug treatment, but should enter into collaboration with the doctor to discuss the results of drug-psychotherapeutic treatment, as well as determine and adjust the dosage of medications.
• The third condition is the cooperation of the patient himself with the specialists treating him. He should try to be honest with them and follow all their instructions. In other words, the patient must feel responsible for what happens to him and not shift it to the people treating him.

Treatment results

If client-doctor-psychotherapist cooperation is established, then a decrease in the number of panic attacks will gradually be observed, as a result of which they will stop completely.

As treatment progresses, the dosage of medications should be reduced until they are completely discontinued. All this should happen against the background of psychotherapeutic treatment.

As general anxiety decreases, both phobias and panic attacks will go away, that is, complete physical and mental recovery will occur.

Author: Dmitry Malin - clinical psychologist

How much is too much worry?

It depends on how much this irrational worry affects you, how much you suffer, and how much it limits you. If this is causing disruption in your life or is enough of a problem or nuisance to make you feel sad, then the good news is that you can seek help from a therapist. Most often, patients come to me with the following requests:

• how to deal with fears within yourself and stop stressing yourself out • how to calm down and stop stressing yourself out in relationships • how to calm down and stop stressing yourself out about your health • how to become psychologically strong and invulnerable • how to stop being jealous and stressing yourself up and trust a man • how to learn make decisions and stop doubting

Based on these requests, I prepared answers from 9 independent steps before contacting a psychotherapist.

“Parents still don’t believe it”

Alexandra, 27 years old, Kemerovo:

I have been living with panic attacks for 10 years. When it all just started, I sat in the apartment for about a year without leaving. Friends brought food and took out trash.

Sometimes there are no panic attacks for six months, sometimes they happen several times a day. The attacks last up to 10 minutes: arrhythmia, weak legs, shaking hands, dilated pupils, difficulty holding your head straight. I fall into a stupor and slowly understand. I haven’t found any pattern, no reasons: I’m overwhelmed with both acquaintances and strangers, both at home and at work. A panic attack is like being in front of a predator and having to fight or run. It’s impossible to control yourself at these moments. You just have to endure it.

A panic attack is like being in front of a predator and having to fight or run.

I saw a neurologist, a psychotherapist, lived in Israel for seven years, was treated there and am still being treated here. I am ashamed to live with this: you are both disabled and not disabled. The strong pills that I took in Israel are impossible to get in Russia without outpatient treatment. They told me: to get it, you have to stay in a mental hospital. I don’t consider myself mentally ill, so I don’t see the point in being hospitalized.

I lead an active lifestyle, I’ve been living with my boyfriend for two months. He hasn't noticed my attacks yet. I choose non-social activities and change jobs frequently.

My parents still don't believe that panic attacks are real. They say that I just invent problems for myself. Friends are understanding. I don't expect support. What to support? Well, we felt sorry for you, once, twice. You won't constantly bother with your problems. I cope on my own as best I can. You can live with this.

Which specialist should I contact first?

The most severe depressive episode “turned off” Margarita for three months.

“And I went to a psychiatrist,” says the girl. “We selected a successful combination of drugs, and now I feel human. The doctor suggested that I see a psychotherapist. The first attempt was unsuccessful, but on the second I managed to find a specialist with whom I feel comfortable.”

Elena went the same way. Both girls claim that the combination of drug treatment and psychotherapy helped them reduce anxiety, understand themselves better, and also be less afraid of contacts with other people.