Understanding and Treating Panic Attacks

As a psychologist working in Melbourne, I regularly get enquires from clients seeking treatment for panic attacks. Like everything else I do in therapy, my approach to treating panic disorder is highly personalised. What therapy looks like for one client will be very different to how it is with another. That being said, here are some of the main principles of treatment I try and apply with my clients.

Understanding the Goals of Treatment

People who come to see me about panic attacks usually want to never have another panic attack in their life. This is understandable – panic attacks are unpleasant – but stopping panic attacks is rarely a good goal for treatment. For starters, they are already terrified of potential future panic attacks.  Basing their treatment progress on stopping all panic attacks will just add to this stress. This is particularly unhelpful because stress about panic often contributes to panic attacks. If you get a detailed history of what someone was thinking before a panic attack, often the thought “oh my god, it’s happening again,” is what tipped them from anxiety into full blown panic.

Instead, a better goal of treatment is to help the client be less concerned about future panic attacks. “Maybe I will have a panic attack, but I’ll be ok, I’ll just find a place to sit down and wait it out.” A client who genuinely believes this rarely still has panic disorder. They might have the occasional panic attack, but this doesn’t stop them living their life, and if this belief is maintained, the panic attacks tend to go away entirely.

Of course, genuinely believing this is easier said than done. Panic attacks are incredibly unpleasant, and people understandably are desperate to avoid them. However, helping someone address a few common misconceptions about panic attack can help them get there.

Your Panic Isn’t Trying to Kill You

Almost everyone with panic disorder sometimes worries their panic attacks are actually heart attacks or some other health issue. This fear is understandable, the intense physical discomfort of a panic attack makes it seem like something is wrong with our bodies. This is why consulting a doctor before treatment begins is important. Some clients may even need to consult a specialist to fully rule out physical causes of their panic attacks. Even if these tests don’t find anything they aren’t a waste of time. If a client has the smallest suspicion that their next panic attack might be fatal, treatment will be much harder.

Your Panic Isn’t Trying to Humiliate You

People with panic disorder often imagine having panic attacks at the most inconvenient or dangerous times. What if I had a panic attack on a crowded train? Or when my baby needs me? Or while driving? They imagine humiliating themselves in front of hundreds of people, seriously hurting themselves, or hurting someone else.

On the surface these fears seem reasonable, but panic attacks with disastrous effects are surprisingly rare. When people do faint, it’s almost always as soon as they found a safe place to sit down, or pull over, or when they know someone is looking after their child. While at the time of a panic attack they can feel like they’ve lost all control, usually when looking back on the situation they did a good job of looking after themselves and the people they were responsible for.

This makes evolutionary sense. Humanity wouldn’t have survived long if we collapsed while an animal was chasing us, or while swimming across a river. Our sympathetic nervous system evolved to protect us, not to make us lose control in the most dangerous places possible.

To be clear, I’m not saying go out and drive on a freeway if you’re currently worried about panic attacks. But the belief that panic will strike at the worst possible moments leaving you incapacitated is probably inaccurate.

Riding The Wave

One good thing about panic attacks is they rarely last long. After adrenaline has been in our blood for around 15 minutes it starts to break down, and our parasympathetic nervous system returns us to a more normal arousal level. Unfortunately, people with panic disorder often don’t know this, as they equate the end of the panic attack with something they did, rather than the limits of adrenaline. “I was feeling awful in the shopping centre, but luckily I got back to my car so I could calm down.” While perhaps sitting down in the shopping centre instead would have been more unpleasant, it’s likely their panic attack would have passed almost as quickly.

This is why the concept of riding the wave can be a nice metaphor for dealing with a panic attack. To make a panic attack go away, we generally don’t have to do anything. All we need to do is wait it out, and our arousal will eventually fall back to normal levels. Breathing exercises can make this happen faster, but the most important thing is to just let time pass. Feeling a panic attack advance and recede without doing anything can be a liberating experience for someone with panic disorder.  The thought, “what if this lasts forever,” makes panic attacks particularly unpleasant, and learning they go away quickly can make future panic attacks more manageable.

Doing it On Your Own is Tough

Some of the principles of treating a panic attack seem straightforward, tempting some to treat panic disorder without therapy. There are even self-help books available on how to treat your panic disorder. While for some people this might be useful, research shows therapy remains one of the most effective ways for treating panic disorder. Everyone’s own fears and insecurities regarding panic will be different, and these concerns are best addressed when they can be explored without pressure over the course of therapy. What’s more, as with most mental health issues, what works for one person will be completely ineffective to another. A good therapist will be sensitive to these differences and tailor an approach to treatment that is right for you.

For more information about how to see me for panic disorder, please visit my appointments page.