What You Should Know About What You Can Do
Introduction: What is panic? What is anxiety? And when is it a disorder? – Understanding classification
The definition of Panic Attacks is a discrete period in which there is the sudden onset of the intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control are present (DSM-4). Anxiety Disorders, which are often associated with Panic Attacks, are characterized by a severe increase in the level of stress or anxiety. This increase can be related to the presence of particular events or items (triggers) and can also exists without being prompted by any known triggers.
Contrary to the popular misconceptions about Anxiety Disorders today, Anxiety Disorder is not a purely biochemical or medical disorder. Currently there are three main schools of thought regarding the etiology of Anxiety Disorders: The Biological Theory, (includes the genetic predisposition in panic disorder and presupposes a chemical imbalance in the brain), The Psychodynamic Theory (looks at childhood issues as being the cause), and the Behavioral Theory (sees the cause as learned behavior, including our negative thought patterns). (Fox, Barker 1997)
Anxiety Disorders include the following specific disorders: Anxiety Disorder with or without Agoraphobia, Agoraphobia without History of Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due To a General Medical Condition, Substance-Induced Anxiety Disorder, and Anxiety Disorder Not Otherwise Specified. Of this list there are five major Anxiety Disorders, which are; Panic Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder, Obsessive-Compulsive Disorder, and Generalized Anxiety Disorder.
Panic Attacks and Agoraphobia, or “Avoidant Personality Disorder” are of the most prevalent, occurring in the context of several of these disorders.
Description of Categories and Types of Panic Attacks
DSM-4 (Diagnostic And Statistical Manual of Mental Disorders, fourth edition) recognizes three different types of Panic Attacks:
- Un-cued (spontaneous) Panic Attacks (relates to Panic Disorder).
- Cued (specific) Panic Attacks (relates to Social Anxiety Disorder, Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder).
- Situationally predisposed Panic Attacks (may occur on exposure to the situational cue or trigger, but do not necessarily occur immediately after the exposure).
Panic Disorder is defined as the recurrent experience of “un-cued” spontaneous panic attacks, which is often intensified by the resulting fear of the next impending attack. The fear itself of having a spontaneous panic attack often leads to Panic Disorder. The spontaneous panic attack is generally NOT prompted by a “trigger”, and is now recognized as not being associated with specific situations and places. The intensity of the attack can be extremely severe; resulting in the feeling of having a heart attack along with intense feelings that one is going to die. Criteria for Panic Attack is defined as a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes. List of symptoms are as follows:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling Dizzy, unsteady lightheaded, or faint
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
- Paresthesias (numbness or tingling sensations)
- Chills or hot flushes
Attacks that have fewer than 4 symptoms are referred to as “limited symptom attacks”.
Some Common Alternative Approaches: – Understanding Your Options
Currently, the majority of the mainstream medical and psychological establishment continues to show a preference toward treating Anxiety Disorders with medication (usually psychotropic drugs), while tending to dismiss the need of investigating where the symptoms may be originating from, such as problems in various organs or glandular systems (thyroid, adrenal etc) or vitamin/mineral deficiencies (Some studies have shown certain phobic disorders like agoraphobia to be associated with lower levels of magnesium, (Hoffman, 1999), and more recently researched possible activity of a part of the brain called the amygdala, which is believed to be rooted to the circuitry of brain function responses typical in panic disorder sufferers including OCD, PTSD, Agoraphobia and other anxiety disorders, in which case symptomology would be physiological rather than strictly environmental or emotionally based. However there are various and increasing alternative approaches commonly being used today by consumers and professionals. Some of those approaches found to be effective in treating Panic Attacks are nutritional/supplemental, breathing, physical exercise, meditative awareness/mindfulness techniques, yoga, biofeedback, psychotherapy, gentle manipulation therapies to support function of the autonomic nervous system such as Cranial Sacral therapy, etc.
Perhaps the most sound and effective nutritional approach for managing general anxiety is the practice of food combination, with raw unprocessed foods as the bulk of the diet, fats which are non-hydrogenated and medium-range saturated, and proteins which are mostly free of steroids, antibiotics and other additives, while limiting the intake of sugar, alcohol, and caffeine. One very effective way to determine the quality of foods and the effects of insulin response of carbohydrates is by using the “Glycemic Index” listing of foods as a guide, now available through many informational forums for the consumer.
One of the single most effective health promoting practices one can do is practice deep breathing exercises as part of a daily routine. Turning one’s attention to one’s breath moves them naturally toward relaxation and meditation, putting one in conscious touch with one’s vital, non physical essence. Breathing techniques can vary from just breath observation, to deep controlled yogic inhalation patterns accompanied by slow rhythmical counting. Breathing exercises can increase in productivity empowering the person with a strong grounding ability enabling them to control the onset of panic. Oxygenation of the blood is a primary and necessary function for keeping the lymphatic system healthy and toned, and is of course an enormous benefit of regular exercise in which the heart rate is kept at an elevated level for at least fifteen minutes a day.
The concept of “mindfulness” as referred to in meditative approaches involves the complete “owning” of each moment of one’s experience, good, bad, painful or terrifying. It involves cultivating our ability to pay attention in the present moment. Beginning a mindfulness meditative process is essentially nothing more than sitting quietly with the constant attempt to chase down each wandering thought as it occurs, and bring attention back to our breathing pattern. This process builds gradually with practice, and can serve as a powerful vehicle for self-understanding and healing. Researchers have documented immediate benefits from meditation in terms of lowered blood pressure, decreased heart and respiratory rate, increased blood flow and other measurable signs of the relaxation response. (Weil, 1998)
Basic forms of Cognitive Behavioral Therapy (CBT) techniques, while being very effective as a management tool of psychotherapy, don’t specifically emphasize the ongoing awareness of one’s thought patterns in the way a mindfulness technique does, which presents the opportunity to observe our direct reactions to situational triggers. Mindfulness techniques go one step beyond CBT in that they focus on the how and the why of reactions, rather than identifying the trigger and patterns alone, and then go on to establish a more reality based belief and response in order to counteract those reaction patterns.
One specific psychotherapeutic approach to the healing of anxiety disorders, which may be helpful, is referred to as the “renegotiation of trauma” (Levine, Frederick 1997) in which it is believed that residual energy is trapped within the central nervous system from the experiences of early trauma, and that resulting posttraumatic stress symptoms are a physiological response. The therapy involves allowing that trapped energy created by the “immobility response” (or paralysis of fight or flight) to be released, while avoiding the cathartic reliving of the immobility which can be re-traumatizing.
Cranial Sacral Therapy focuses on gentle manipulation of the cerebrospinal fluid, which is produced and absorbed by the body on a regular rhythmical basis, and may be considered similar in concept to the aforementioned approach of releasing trapped energy from trauma, but approached through physical touch. More commonly though Cranial Sacral therapy involves facilitating a balanced modality between the sympathetic and parasympathetic nervous system, by gently reestablishing proper motility of the adrenals, glands which produce the adrenalin involved in the fight or flight response of panic.
Biofeedback is an approach used for increasing the person’s own ability to better control their biological response to stimuli. It uses high-tech electronic equipment, monitoring skin temperature, electrical conductivity of the skin, muscle tension, heart rate and brain wave activity, by attaching wired sensors to the patient, and then by giving auditory and/or visual signals to their body, the patient learns to control what are usually subconscious responses. Biofeedback is used in relaxation therapy, is found to be effective for helping with anxiety and is most successful when combined with various other approaches.
All of these approaches are most effective when used in combination with another. No one approach can heal any anxiety disorder, as the root cause of the disorder is usually a complex mix of circumstances requiring a variety of healing aids.