Anxiety disorders are the most commonly diagnosed mental disorders. They fall into several categories: panic disorder, social anxiety disorder, generalized anxiety disorder, and specific phobias.((Dialogues in Clinical Neuroscience: Treatment of Anxiety Disorders))
Panic disorder is commonly associated with a feeling of anxiety that hits you out of nowhere. These are often referred to as panic attacks. This article will teach you how to handle anxiety associated with panic disorder and panic attacks.
What Are the Warning Signs of a Panic Attack?
Panic disorder is characterized by sudden and unexpected panic attacks. Panic attacks may feel like they hit you out of nowhere. However, there are common warning signs, and learning to identify them is the first step in learning how to handle anxiety.
Here are the common symptoms associated with a panic attack:
- Difficulty breathing or tightness in the chest
- Heart palpitations or rapid heart beat
- Sweating, shaking, or trembling limbs
- Feeling dizzy, nauseous, or faint
- Perceived loss of control or becoming detached from the body
- Fear of death
What Causes Anxiety?
Anxiety can have many root causes, and knowing them can help learn how to handle anxiety in a more comprehensive way.
The Fight-or-Flight Response
While an anxiety attack may feel debilitating, it is actually the body’s natural response to danger. The fight-or-flight response is activated rapidly by the amygdala, which is the brain’s threat detection center. This response happens suddenly and without warning to help you respond quickly to danger.((Harvard Health Publishing: Generalized Anxiety Disorder))
However, the system may become overactive when you have a history of trauma, an abundance of stress, or excessive fears about the future. Your brain may become hypersensitive to potential threats and detect danger everywhere. As a result, seemingly harmless objects, places, or people may trigger sudden and intense panic.
Psychological studies have also determined that fear and anxiety may be conditioned. For example, pairing a neutral stimulus with a negative experience may lead to the neutral stimulus becoming associated with fear.((Dialogues in Clinical Neuroscience: The Biology of Fear- and Anxiety-Related Behaviors))
Stated in simpler terms: a non-threatening situation, person, or object may become threatening after it is paired with anxiety.
For example, if you experience a panic attack while driving, you may start to associate driving with panic. As a result, driving may become a negative experience and general source of panic attacks.
Medical Conditions, Genetics, Stress, or Trauma
Anxiety may be the result of health conditions that mimic panic, such as heart arrhythmia or hyperthyroidism.((Pharmacy and Therapeutics: Current Diagnosis and Treatment of Anxiety Disorders)) This speaks to the importance of meeting with a medical doctor at the onset of anxiety to rule out medical causes.
Genetics may also play a role in the development of anxiety. If you have a first-degree relative diagnosed with anxiety, you are 40% more likely to develop anxiety. Anxiety may also be the result of chemical imbalances in hormones such as serotonin, cortisol, or gamma-aminobutyric acid.((Stat Pearls: Panic Disorder))
Additionally, stress may play a major role in the development of anxiety disorders. You may be at an increased risk of developing an anxiety disorder if you have been exposed to catastrophic or ongoing stress.((Pharmacy and Therapeutics: Current Diagnosis and Treatment of Anxiety Disorders))
Lastly, anxiety is more common in individuals who have experienced Adverse Childhood Experiences (ACEs). ACEs include abuse, family challenges, and neglect. You can learn more about ACEs and find your personal ACE score on the Centers for Disease Control website.((CDC: About the CDC- Kaiser ACE Study))
What Triggers Anxiety?
It may be frustrating to note that 53% of panic attacks occur in situations that are not threatening. The attack seems to hit out of nowhere. Alternately, the most common triggers for anxiety attacks in stressful situations are: work, driving, and shared public spaces.((Neuroscience Biobehavioral Review: Etiology, Triggers and Neurochemical Circuits Associated with Unexpected, Expected and Laboratory-Induced Panic Attacks ))
The crux of a panic disorder is that panic attacks lead to intense fears or avoidance of recurrent panic attacks. You may work yourself into a panic simply attempting to avoid experiencing panic. This can create a frustrating cycle if you don’t know how to handle anxiety and move away from panic when the first symptoms appear.
How to Handle Anxiety With Self-Help Techniques
Now that you have learned to identify the symptoms and causes of anxiety, you can begin to develop techniques to combat it.
Practice Diaphragmatic Breathing
One of the most common symptoms of anxiety is difficulty breathing. Shallow breathing can limit airflow and increase feelings of stress and anxiety.((Harvard Health Publishing: Relaxation Techniques: Breath Control Helps Quell Errant Stress Response)) Diaphragmatic breathing (also known as deep belly breathing) taps into the full capacity of the lungs while restoring a state of calm.
To practice diaphragmatic breathing:
Begin by placing one hand on the belly and the other on the chest. Attempt to send the breath into the lowest part of the lungs. You should feel your belly expanding on the inhale and contracting on the exhale.
If you notice your chest rises more than your stomach, attempt this lying down. If you still have difficulties, try breathing into a paper bag. Alternatively, you can slowly inhale through the nose and fully exhale through the mouth.((FRAN K M. DATTILIO , Ph.D. : Crisis Intervention Techniques for Panic Disorder))
Diaphragmatic breathing takes practice. It’s ok if it doesn’t work on the first attempt. It is also important to practice when you feel calm.
Develop a Mindfulness Practice
Mindfulness simply means present-moment awareness. Mindfulness practices have been shown to decrease symptoms of depression and anxiety. Mindfulness practices have also been linked with increased quality of life.((Trends in Psychiatry and Psychotherapy: Mindfulness in Mood and Anxiety Disorders: A Review of the Literature))
Utilizing the five senses can be helpful if you are new to a mindfulness practice. One technique that focuses on the five senses is called grounding. It is a simple and quick method for returning to the present moment and regaining a sense of calm.
Try this grounding activity:
- Notice 5 things you can see
- Notice 4 things you can touch
- Notice 3 things you can hear
- Notice 2 things you can smell
- Notice 1 thing you can taste
Repeat this activity as often as you like when learning how to handle anxiety. Think of grounding like a grown-up game of I-spy with the added benefit of increased calm.
Avoid Stimulants and Smoking
As you have learned, people with panic disorder are hyper-sensitive to bodily sensations that mimic panic. Stimulants may trigger the fight-or-flight response. Sources of stimulants include coffee, cold medicines, and some over-the-counter medications.((Harvard Health Publishing: Combination Therapy for Panic Disorder))
Additionally, people with panic disorder are hyper-sensitive to breathing abnormalities. Smoking can restrict oxygen in the brain, which increases heart rate and may result in panic.((Harvard Health Publishing: Combination Therapy for Panic Disorder))
Learn More About Anxiety
Bibliotherapy is often practiced along with therapeutic support. Bibliotherapy simply means reading self-help books as a complementary treatment.
The following list is an introduction to several helpful resources:
- Don’t Panic (Third Edition): Taking Control of Panic Attacks by Reid Wilson, Ph.D.
- Coping with Panic: A Drug-Free Approach to Dealing with Anxiety Attacks by George A. Clum
- The Relaxation and Stress Reduction Workbook (Fifth Edition) by Martha Davis, Ph.D., Elizabeth R. Eshelman, MSW. & Matthew McKay, Ph.D.
Learn How to Handle Anxiety With the Help of an Expert
Only a licensed therapist, physician, or medical doctor has the authority to diagnose and treat a panic disorder. It may be helpful to visit an expert if you notice major changes in your behavior, thoughts, or mood as a result of anxiety.
Cognitive-Behavioral Therapy (CBT) is commonly cited as the most effective treatment for anxiety. CBT can only be utilized by a trained professional and can be very helpful as you’re learning how to handle anxiety.
There are three components to CBT: Relaxation, Cognitive Restructuring, and Exposure Therapy.
1. Relaxation Techniques
Therapists may work with you to develop relaxation strategies. This may include working with your breath to create a sensation of relaxation. You will learn how to handle anxiety with coping skills, which you can utilize outside of therapy.
2. Cognitive Restructuring
Within CBT, you can expect to explore triggers for panic, including thoughts, events, or bodily cues. A technique called cognitive restructuring helps to replace negative thinking around panic with more realistic and positive thoughts.((American Psychological Association: Answers to Your Questions About Panic Disorder))
3. Exposure Therapy (ET)
There are two forms of ET that are commonly practiced as you’re learning how to handle anxiety:
The first form of ET involves environmental exposure to panic-inducing situations. This is called in-vivo exposure.((BMC Psychiatry: Interoceptive Hypersensitivity and Interoceptive Exposure in Patients with Panic Disorder: Specificity and Effectiveness))
The second form of ET involves exposure to physical symptoms of panic. This is called interoceptive exposure.((BMC Psychiatry: Interoceptive Hypersensitivity and Interoceptive Exposure in Patients with Panic Disorder: Specificity and Effectiveness ))
Working Through Therapy Anxiety
It is common to feel nervous about visiting a therapist. In fact, some people may experience increased panic symptoms at the mention of therapy. It may be helpful to practice self-help techniques before you attend your first session.
Many therapists are offering services online as a result of the Covid-19 pandemic. Studies have shown internet-based CBT is as effective as in-person CBT.((Cureus: The Effectiveness of Internet Based Cognitive Behavioral Therapy)) Online alternatives may also be helpful for people with limited mobility due to panic disorder with agoraphobia (fear of crowds, leaving the home, or entering a scenario where escape is difficult).
It is important to educate yourself on the warning signs, triggers, and causes of a panic disorder or panic attack. Anxiety can be frustrating to live with day in and day out, but it is possible to learn how to handle anxiety and live a calmer, more focused life.
You do not have to suffer in silence or live a limited life. There is a solution for your suffering whether you choose to start with self-help techniques or seek therapy. The most important thing is to simply get started on your path to healing.