What happens in the body during an attack
A panic attack is caused by a sudden surge of adrenaline. The body prepares to flee or fight: the heart speeds up to pump more blood to the muscles, breathing quickens, pupils dilate, blood is redistributed from the skin and fingers to large muscles. Hence the whole range of sensations - heartbeat, lack of air, numbness of the fingers, trembling, chills. The only problem is that there is no real threat, and a powerful defensive reaction works in vain.
- Palpitations, palpitations, heaviness or tightness in the chest
- Feeling short of air, lump in throat, desire to take a deep breath
- Dizziness, unsteadiness, feeling of impending fainting
- Numbness and tingling in the fingers and around the mouth
- Trembling, sweating, hot and cold waves, nausea
- Feeling of unreality, fear of death or loss of control
Understanding the mechanism has direct practical value. A rapid heartbeat during an attack is not a sign of a diseased heart, but a normal response of a healthy heart to the release of adrenaline. Numbness of the fingers and tingling around the mouth are not the beginning of a stroke, but a consequence of rapid breathing. Dizziness is not a sign of fainting: during a panic attack, blood pressure usually rises, not falls, so actual fainting is extremely rare. Every time a person finds a correct explanation for a bodily sensation, the attack loses part of its power.
Why the first attack must be seen by a doctor
The diagnosis of panic attack is made by exclusion. Similar attacks give rise to several completely physical states, and they cannot be missed. Therefore, the correct order is this: first, a basic examination, and only then work with a psychotherapist. The reverse order is dangerous, and endless walking in a circle of examinations, on the contrary, itself maintains anxiety.
- Заболевания сердца: нарушения ритма, ишемическая болезнь. Минимум — ЭКГ, при необходимости суточное мониторирование и ЭхоКГ.
- Щитовидная железа: тиреотоксикоз даёт сердцебиение, дрожь, потливость и тревогу. Проверяется анализом на ТТГ.
- Низкий уровень сахара крови, особенно у людей с диабетом на терапии.
- Анемия: слабость, сердцебиение, головокружение. Общий анализ крови.
- Действие веществ: избыток кофеина и энергетиков, некоторые препараты, отмена алкоголя или снотворных.
- Редкие причины, такие как феохромоцитома, — их ищут прицельно, если картина нетипична.
How to stop a seizure right now
The goal during an attack is not to “defeat” it by force of will, but to stop trying to disperse it. Panic intensifies from the struggle: the more actively a person tries to immediately stop the heartbeat, the more adrenaline is released. Therefore, the steps below are not aimed at suppressing symptoms, but at waiting for the natural end of the attack with the least loss. It is better to master them in advance, in a calm state: at the moment of an attack, it is almost impossible to remember an unfamiliar technique.
- Сказать себе то, что уже известно: это паническая атака, она достигнет пика за несколько минут и закончится. Это не остановит приступ мгновенно, но не даст страху разгоняться.
- Замедлить дыхание: вдох через нос на счёт четыре, пауза на счёт один-два, выдох через слегка сжатые губы на счёт шесть. Ключ именно в удлинённом выдохе — глубокие частые вдохи ухудшают состояние.
- Сесть или опереться, ослабить воротник, поставить стопы на пол и почувствовать опору.
- Перевести внимание вовне: назвать пять предметов, которые видно, четыре звука, которые слышно, три вещи, которых можно коснуться.
- Умыть лицо прохладной водой, взять в руки холодный предмет, сделать несколько глотков воды.
- Не убегать of ситуации, если это возможно: дождавшись окончания приступа на месте, человек получает важный опыт — «я справился, и ничего не случилось».
The advice to breathe into a paper bag is not recommended today: it does not help everyone, and if the cause of the attack is unrecognized, it can be dangerous. Extended exhalation and slower breathing work just as well and do not pose any risk.
How single attacks turn into a disorder
It is not the attack itself that is dangerous, but the vicious circle that builds around it. After the first attack, anxiety of anticipation appears - constant listening to the body: “is it starting again.” Any ordinary sensation - a rapid pulse after going up stairs, dizziness during a sharp climb - is interpreted as the beginning of an attack, and this triggers a real attack. Next comes avoidance.
- A person stops traveling in the subway, in an elevator, in a minibus, or flying by plane.
- Avoids places where “you can’t get out quickly”: queues, cinemas, long trips
- Does not leave the house alone, asks someone to accompany him
- He always carries his medicine with him and never leaves his side.
- Refuses coffee, sports, baths - anything that speeds up the heartbeat
Each avoidance brings immediate relief and thereby strengthens the problem itself: the brain receives confirmation that the danger was real and was avoided. This is how agoraphobia is formed, in which the circle of available places narrows month after month. That is why treatment is not based on avoidance, but on a gradual return to those situations that a person is afraid of.
Treatment: what works
Panic disorder is one of those conditions where treatment is truly effective: with properly selected therapy, in most patients, attacks either disappear completely or become rare and cease to affect life. The main thing is not to replace treatment with endless repeated examinations and not to build all tactics around remedies that only work at the time of an attack.
- Cognitive behavioral therapy is the method with the greatest evidence base. A person learns to recognize catastrophic thoughts, test them in practice and stop reacting to bodily sensations as a threat
- Exposure is a gradual, step-by-step return to avoided situations: first a short trip, then a longer one, first with an accompaniment, then alone
- Breathing training and working with muscle tension as auxiliary tools
- Antidepressants of the group of selective serotonin reuptake inhibitors are the basic drug therapy for panic disorder. The action develops in 2–4 weeks, the course is usually long, prescribed by a doctor
- Tranquilizers are used briefly and to a limited extent: they quickly relieve an attack, but when taken regularly, they form an addiction and prevent you from developing the skill to cope independently.
- Routine: sleep 7–8 hours, limit caffeine and energy drinks, avoid alcohol “to calm down,” regular aerobic exercise
A combination of psychotherapy and medications is often more effective than either one alone, especially for frequent attacks and severe avoidance. For a significant proportion of people, after a course of therapy, attacks stop completely, while for others they become rare and cease to control their lives.
What helps in everyday life
Between therapy sessions, the person does most of the work himself, and quite simple things help here. Their general purpose is to reduce the background level of excitation of the nervous system: against a calm background, attacks occur less frequently and are more easily tolerated, even if they have not yet completely gone away.
- Keep a short diary of attacks: when, where, what preceded, how long it lasted. After a couple of weeks, patterns become visible
- Do not cancel physical activity for fear of heart palpitations - moderate aerobic activity reduces anxiety levels
- Watch your sleep: lack of sleep is one of the most reliable provocateurs of attacks
- Eat regularly: long breaks in food and a drop in sugar increase alarming symptoms
- Limit coffee, strong tea and energy drinks, especially in the afternoon
- Warn loved ones what exactly to do during an attack: be nearby, speak calmly, do not panic and do not call an ambulance at every episode if the diagnosis has already been established.
It’s worth thinking about work in advance. Many people hide attacks from their colleagues, for fear of looking weak, and spend enormous energy trying to “keep face” - this in itself maintains anxiety. As a rule, it is enough for one person nearby to know what is happening and what to do: do not call an ambulance every time an episode occurs, let them go out for a few minutes, do not ask questions during an attack. In the same way, you shouldn’t quit and refuse to travel in the first months of treatment: the more situations a person avoids, the narrower his life becomes and the more difficult it is to get it back.