An anxiety attack (also called anxiety crisis or panic attack), usually occurs without an apparent trigger. It may be due to accumulated stress, having suffered previous attacks, etc. When these attacks are recurring and unforeseen, we talk about a panic disorder.
In this article, but, we will focus on the anxiety attack itself. We will explain what it is and talk about its causes, symptoms, and treatments.
Anxiety attack: what does it consist of?
In an anxiety attack, the subject feels overwhelmed, feeling short of breath, in tension, with agitated breathing, about to lose control, dizzy … (symptoms may vary from one person to another), but what fundamental is that it is very difficult to control and that once it appears, it is best to let it happen (yes, helping the person to breathe, to sit in a secluded place, etc.).
Thus, technically and according to the DSM-5, an anxiety attack is a sudden onset of fear and / or intense discomfort. This fear or discomfort reaches its maximum expression in a matter of minutes; In these minutes a series of characteristic symptoms appear, which we will see a little later. These symptoms include palpitations, fear of dying, chills, nausea, choking sensation, tremor or shaking, etc.
On the other hand, in the panic attack, the sudden onset of symptoms can occur from a state of anxiety or calm. In addition, the DSM makes it clear that the panic attack, although it usually appears with fear and / or anxiety, these two are not essential requirements. It is the “fearless panic attacks.”
Having more than one anxiety attack over time (that is, unforeseen and recurring anxiety or panic attacks), allows the diagnosis of panic disorder (DSM-5), if other criteria are also met.
The causes of panic attacks can be very diverse. There are different explanatory theories about it.
The genetic models of anxiety propose that there is a certain predisposition to suffer from an anxiety disorder in some people; What they say, more specifically, is that we inherit a vulnerability to develop an anxiety disorder in general (that is, it is not that we inherit the disorder itself).
This could happen with panic attacks (remember that the panic attack on the DSM-5 ceases to be a specific disorder to become a specifier of other disorders).
Neurobiological models of anxiety propose the existence of alterations in some brain substances, such as GABA (gamma-amino-butyric acid) as the origin of some anxiety disorders.
3. Neuroendocrine models
These models suggest that stress and anxiety states suppose a greater secretion of some substances, such as thyroxine, cortisol, and catecholamines. Thus, the hypersecretion of cortisol occurs.
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There are also learning theories, which refer to classical and operant conditioning processes as the origin of some anxiety disorders, including anxiety attacks.
That is, due to certain traumatic experiences, we may end up developing an anxiety disorder, for example. If, for example, we suffer an anxiety attack, the fear of suffering it again may end up triggering another anxiety attack, or an anxiety disorder (such as agoraphobia or panic disorder).
We have seen what an anxiety attack is and what are some of its possible causes, but what are its symptoms?
The DSM-5 explicitly states that the symptoms that appear in a panic attack (which must be 4 or more), are some of the following:
- Palpitations, heart-pounding or heart rate acceleration.
- Trembling or shaking
- A sensation of difficulty breathing or suffocation.
- Choking sensation
- Chest pain or discomfort.
- Nausea or abdominal discomfort.
- Feeling dizzy, unsteady, lightheaded or faint.
- Chills or feeling hot.
- Paresthesia (numbness or tingling sensation).
- Derealization (feeling of unreality) or depersonalization (separating oneself).
- Fear of losing control or “going crazy.”
- Afraid to die
The most complete (and considered of choice) treatment to treat panic attacks is a multi-component cognitive-behavioral treatment. Although other psychological orientations can be used (eg psychoanalysis), we will explain to this model because it is the most effective and used.
This type of treatment includes various therapeutic elements, which we will explain below in a summary way (to apply it, but, it will always be necessary to be properly trained in the treatment in question and under clinical supervision if you do not have the appropriate experience). These elements are as follows.
Psychoeducation involves “educating the patient in his disorder and in its adaptation”. It consists of teaching the patient to identify the manifestations of a possible panic attack, and to explain the basis of such manifestations. It also explains what the treatment plan will be.
2. Interoceptive exposure
It implies that the patient can experience the sensations of a panic attack (or similar sensations) in a controlled and provoked way; The patient should focus on these sensations instead of avoiding them.
3. Cognitive restructuring
Cognitive restructuring, a key technique in cognitive-behavioral psychotherapy, is to teach the patient to identify. And test their catastrophic interpretations of the bodily sensations they experience. That is, the patient must learn to “relativize” these sensations associated with a panic attack.
4. Controlled breathing
Controlled breathing is another therapeutic element to address an anxiety attack (or fear of suffering from it). It consists of breathing slowly and regularly with the diaphragm, through brief inspirations and prolonged exhalations.
In each breath, a small pause should be made. In addition, it is important that this is done (breathing) through the nose, and not through the mouth (it is advised to be between 8 and 12 times per minute).
5. Relaxation applied
Finally, the last element of the multicomponent cognitive-behavioral treatment for anxiety attack is relaxation applied. This consists of a progressive muscular relaxation (a specific program) and in applying it in situations where the patient feels that he “can” suffer an anxiety attack (this is called “live practice”). This will be done hierarchically.
Although in this article we have talked about the treatment of choice to treat anxiety attacks. It is obviously not the only one. Psychopharmacology can also be used, for example (anxiolytics and antidepressants are usually used). Although complementary and/or supportive psychological therapy is always recommended so that the changes produced are profound and lasting.
On the other hand, the exposure technique will be fundamental in these cases (that is, that the patient is exposed to situations that can generate anxiety, or that can trigger an anxiety attack, although it is not easy, because normally there is no specific trigger), together with relaxation and breathing techniques, which allow the patient to acquire awareness and control over his body and his body sensations.