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Section 21
When Anxiety Strikes

Question 21 | Test | Table of Contents

Your heart is beating rapidly. You can barely catch your breath and you think you are going to die. Terror grips you. You feel disoriented and all you want to do is run, but there is nowhere to run. Sweat drips from your brow and you start to imagine the most catastrophic thing that could happen to you. You ask yourself, "Is it the crowd that is making me feel this way, the plane, the elevator? Am I having a heart attack? Am I going to lose control and go crazy? Oh my God, I can't handle these feelings." These are just a few of the thoughts, feelings and symptoms experienced by someone having a panic attack.

Thousands of people suffer from anxiety or panic attacks. Some of the most common symptoms are racing heart, shortness of breath, disorientation, sweating and fear of losing control. If one is experiencing any of these symptoms, it is extremely important to have a doctor's examination to role out physical causes. However, often after extensive tests, trips to the emergency ward plus several visits to the doctor's office, some discover there is nothing physically wrong with them. The doctor might say, "there's no physical cause. It appears that you just had a panic attack." The first thought you might have is. "a panic attack? Impossible Doctor, something is terribly wrong with me. I felt I was dying. I felt I was losing my mind and going crazy."

What exactly is a panic attack? Many say that a panic attack originates from a fearful thought. The thought sends a message to the brain and the brain carries the message to the rest of the body producing scary, physical sensations. The individual tenses up and begins to experience symptoms of intense fear and anxiety. Once the person experiences these symptoms, she becomes even more frightened, which in turn, produces more symptoms.

Imagine for a moment you are skating on a pond of ice. Suddenly, the ice breaks and you fall into the freezing water. You are terrified and desperately search for the hole in the ice to find your way out. In that split second, your brain sends a message to your body, telling it to immediately do something. It is what is called the "fight or flight" syndrome. Adrenaline pours into your body making you more alert and more able to fight the traumatic episode. Now, here's the gripper. Picture yourself experiencing these same emotions -- adrenaline rush and terror -- when asked to simply do a presentation. What would it be like if you felt these dreadful feelings just riding in the back seat of someone's car? How could you handle the situation if you had these sensations when you had to attend a social event, go to a mall or drive your car alone?

It probably seems incomprehensible to think that someone could experience severe terror going to a store or doing something that is relatively easy for most people. However, those suffering from panic attacks do have difficulty doing things that others can do easily and this leads them to even more suffering and depression. The more they struggle with their fears, symptoms and what others may think, the more phobic and panicky they can become.

For many, the first panic attack is usually brought on by something traumatic in their life. Perhaps someone close to them has died and then suddenly ... wham ... they experience extremely uncomfortable feelings due to their grief. Maybe they lost their job and went into a panic over the thought of having financial difficulties or they might have been dumped by a loved one. The list goes on and on. What happens next is that the feelings experienced from the traumatic event really frightens them. They are so uncomfortable that they go into, what is called the "what- if" thinking. They may be saying to themselves, "What if I have these feelings again? What if I have them driving a car or hanging out at a club or while I'm shopping in a store?"

Once the cycle of what-if thinking starts, it begins to have a life of its own and the scary thoughts feel like they are taking over. Some become so scared that they stop doing whatever they believe is causing the anxiety.

However, the problem isn't driving alone or it's not really the elevator. The panic isn't caused from going to the store or doing a presentation. It stems from being afraid of the feelings or symptoms that have been associated with a particular situation. For example, the anxious individual might start experiencing symptoms of panic When someone asks her to come to the front of the meeting and speak. What happens next is usually this. "Oh my gosh, I can't do that. I'll just freak out up there. What if I don't say the right thing or what if I can't catch my breath? What if I go crazy and pass out?" The next thing she knows is that she feels like she is freaking out and can't catch her breath. This is because she is experiencing the physical reaction of adrenaline and fear. It wasn't the actual event that was causing the terrifying feelings; it was her thoughts that caused her body to put her in that state.

Some who suffer from panic attacks, suffer only when faced with a particular type of event. They might only have the symptoms when they have to fly or when they do a presentation. For others, it can be much more extreme. Avoidance is a major problem with people who suffer from panic attacks. It's understandable that if someone is experiencing terror doing certain things, then it would make sense to stop doing those things in order to alleviate the pain and fear. However, this is actually one of the worst things that can be done.

Once one starts avoiding the situations that are "perceived" as causing the panic, one's world becomes smaller and smaller. If there is a problem with traveling far from home, then traveling by car, buses, and planes may be stopped altogether. If standing in a line causes terror, lines of any kind and going to malls, grocery stores or any other places where there are lines may be avoided.
Avoidance behavior of this kind can lead to the more serious type of panic disorder called Agoraphobia. Agoraphobia is a term that describes individuals who have tremendous "fear of fear" and its symptoms, so they avoid many different types of situations. Some may even become housebound. The problem can go on for many years because the person is absolutely terrified to venture out into the world. The paradox is that anyone with this disorder or who has panic attacks, needs to greet the world step by step in order to conquer their fears. Avoidance will only reinforce the fear.

Now, for the good news. Panic attacks and agoraphobia are treatable. People who have these conditions can lead normal lives and be free once again. Those who suffer from panic attacks would probably disagree. However, there are plenty of individuals who have successfully beat the problem and not only have survived, but lead wonderful, productive lives, free from panic attacks.
The leading therapy that can help is called "CognitiveBehavioral Therapy." This type of therapy deals with helping people change their thoughts in order to change their feelings and behaviors. Again, the "scary" thought is what produces the symptoms in the first place. Cognitive-Behavioral therapy teaches the art of changing what the person is telling herself so she will be less likely to experience the symptoms. The next step in the process of recovery is gradually going out and facing the fearful situations. In short, skills are taught to help these individuals cope and face their fears.

There are also times when medication is needed for those who are so frightened they can't start the process. Medical doctors will often work with them while they are in therapy. The goal is for medication to be prescribed only for the period of time while the patient learns coping skills in some type of therapy. Once the skills are learned, the patient can be weaned off the medication by her doctor. So, the goal. is not to rely on medication for long term symptom relief but rather to become self-reliant and be able to handle what life has to offer.
- Katz, D. (mar 2000). I Can't Handle These Feelings! When Anxiety Attacks Strike. Lesbian News, 25(8), 71.

Personal Reflection Exercise #7
The preceding section contained information about when anxiety attacks strike.  Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Using Relapse Prevention Interventions to Maintain Remission and Minimize Relapse Rates for Individuals With Schizophrenia: A Scoping Review

Abu Sabra, M. A., & Hamdan-Mansour, A. M. (2022). Using Relapse Prevention Interventions to Maintain Remission and Minimize Relapse Rates for Individuals With Schizophrenia: A Scoping Review. Journal of psychosocial nursing and mental health services, 60(7), 47–54.

Peer-Reviewed Journal Article References:
Erceg-Hurn, D. M., & McEvoy, P. M. (2018). Bigger is better: Full-length versions of the Social Interaction Anxiety Scale and Social Phobia Scale outperform short forms at assessing treatment outcome. Psychological Assessment, 30(11), 1512–1526.

Hourani, L., Tueller, S., Kizakevich, P., Strange, L., Lewis, G., Weimer, B., Morgan, J., Cooney, D., & Nelson, J. (2018). Effect of stress inoculation training with relaxation breathing on perceived stress and posttraumatic stress disorder in the military: A longitudinal study. International Journal of Stress Management, 25(S1), 124–136. 

Rogers, A. H., Gallagher, M. W., Garey, L., Ditre, J. W., Williams, M. W., & Zvolensky, M. J. (2020). Pain Anxiety Symptoms Scale–20: An empirical evaluation of measurement invariance across race/ethnicity, sex, and pain. Psychological Assessment, 32(9), 818–828.

Van der Giessen, D., Colonnesi, C., & Bögels, S. M. (Oct 2019). Changes in rejection and psychological control during parent–child interactions following CBT for children’s anxiety disorder. Journal of Family Psychology, 33(7), 775787.

Villabø, M. A., Narayanan, M., Compton, S. N., Kendall, P. C., & Neumer, S. (Sep 2018). Cognitive–behavioral therapy for youth anxiety: An effectiveness evaluation in community practice. Journal of Consulting and Clinical Psychology, 86(9), 751764.

What type of behavior can lead to the more serious type of panic disorder called agoraphobia? To select and enter your answer go to Test

Section 22
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