In the situation of real danger, our attention is focused on the danger. In the absence of real danger, we then look for a danger to explain these intense sensations. We assume the danger must be inside of us (the impression of dying, passing out, going crazy, losing control, having heart attack, choking). Once these sensations happen again, be it caused by anxiety, physical activity, having sex, eating, symptoms related to an illness, they are interpreted as if they are leading to another panic attack to which we attribute dramatic consequences and we feel the need to get away or to avoid these situations as well as any related situations.
A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time 4 or more of the symptoms occurs:
- Trembling or shaking
- Shortness of breath
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensation)
- Derealization (feelings of unreality) or depersonalization (being detached from one-self)
- Fear of losing control or “going crazy”
- Fear of dying
No symptoms of panic or anxiety are dangerous. They are normal, physiological reactions. Experiencing these reactions at inappropriate times is not, in itself, a concern. These panic attacks become problematic based on how we interpret them. If these sensation are correctly interpreted as being due to anxiety, fatique, or physical exercise, they can often pass relatively unnoticed and the intensity of the symptoms and anticipate them that they take on catastrophic proportions, but remain just as harmless.
The first concern is safety, so get the person to sit down (or lie down), get the person to be focused on breathing SLOWLY (Big breathe in, hold for 4 count, release slowly for 8 counts), get some warm water to SLOWLY sip, comforting physical touch on shoulder or arm with words of reassurance in a quiet tone.
Say “You can do it no matter how you feel. I’m proud of you. Tell me what you need now. Breathe slow and low. Stay in the present. It’s not the place that’s bothering you, it’s the thought. I know what you are feeling is painful, but it’s not dangerous. You are so brave!”
The old first aid myth of Paperbag breathing is the attempt to regulate carbon dioxide intake (getting the person to breathe their own carbon dioxide). The reality is a number of things can cause a patient to breathe rapidly to the point carbon dioxide levels drop, including Panic Attack. Therefore, medical authorities no longer recommend having the patient breathe into a paper bag in the pre-hospital setting.
Therefore a better alternative is the deep measured breathing recommended.
Panic attacks are associated with increased likelihood of various comorbid mental disorders, including anxiety disorders, depressive disorders, bipolar disorders, impulse control disorders, and substance use disorders. Regardless of the frequency or once-off, it is advisable to seek professional help to help manage, if nothing else, the stressors that trigger the panic attacks. Treat panic attacks like the fire alarm of your body. If it’s ringing, it’s best to investigate whether there is a fire rather than just turn it off.
Therapy help should be sought with Psychologist to investigate the underlying cause and find strategies to deal with the panic attacks. Medication can be given by a Psychiatrist in order to manage the symptoms of panic attacks if it’s occurring too frequently or debilitating. Going to a GP for medication is not adviseable (unless it’s to get a referral to Psychologist or Psychiatrist) as psychopharmacology drugs are quite sensitive and require specialist to monitor.