Anxiety, Panic Attacks and Panic Disorder

Anxiety is a normal reaction to stress and danger and it serves a very important purpose in protecting the organism to which it occurs. Certain changes take place in order to increase the efficiency, strength and stamina of the body. When required by the circumstances these changes prove invaluable.

More often than not though we become anxious for reasons that are not life threatening. This is where anxiety becomes problematic.

People will behave in such a way that will potentially earn a reward, prevent dreadful incidents from happening and/or maintain their safety. For example; when someone whom is afraid of needles and/or syringes encounters a needle or syringe, they become anxious. To manage their anxiety they may flee, try to avoid places where they may encounter needles (e.g. Dentists, Doctors and Hospitals etc.) and/or get others to check the environment for needles and syringes and seek reassurance.

This behaviour may work in the short term (it may reduce anxiety felt at the time) but it preserves the fear of needles and syringes. Others whom worry about their health are more likely to panic if they mistake sensations of anxiety for other physical problems, (e.g. the pounding heart & chest pains may be misinterpreted as a sign of impending heart attack).

Sometimes people do not even need to be in the presence of the trigger for their anxiety to feel anxious – it may be the threat of contact is enough to start the anxiety response so they may avoid people or places because they may encounter that of which they are afraid. This is called Anticipatory Anxiety.

The following are common symptoms of anxiety and panic attacks:

Pounding heart
Sweating
Trembling or shaking
Shortness of breath
Sensation of choking
Nausea or abdominal pain
Dizziness or light-headedness
Feeling unreal or disconnected from oneself
Fear of losing control
Fear of “going crazy” or dying
Numbness
Chills or hot flushes
Tingling in the fingers and/or toes
Physical symptoms that mimic a heart attack and/or chest pain

Anxiety and Panic are actually one and the same thing, the only distinction being the severity of the problem. Panic attacks occur when one is exposed to a “situational cue” for example being trapped in a lift or other enclosed space or exposed to a feared object with no avenue of escape; whereas Panic Disorder appears to the sufferer to have no identifiable trigger, often being described as “coming out of the blue”.

The incidence of irritable bowel syndrome is higher among people with anxiety and panic disorders than among that of the general population. Alcohol may be abused as a means to relieve the effects of anxiety.

Treatment

The types of intervention utilised by Cognitive & Behavioural Psychotherapists vary by which anxiety problems the patient displays.

The first steps, following a full assessment, are to construct a formulation of the problem unique to the patient. This will then be used to guide the focus of any interventions employed.

Possible interventions include Graded Exposure, Response Prevention, Verbal Reattribution, Thought Action Diffusion, self instructional training, Doubt Reduction techniques, challenging of specific thoughts and misinterpretations and Behavioural Experimentation.

Final stages of therapy include relapse prevention strategies.

Therapy may be conducted in either individual or group format, depending on the severity of the problems and the needs of the individual.

“At least half of people with depression or clinical anxiety can be cured completely with less than 16 meetings with the therapist.”

Professor Lord Richard Layard, Author: "Mental Health—Britain's Biggest Social Problem?"

Areas of the body affected by symptoms of anxiety

A cognitive model of Panic, Clark 1986

Anxiety info (PDF)