Panic disorder sucks

Listen to my “Just Therapist Things” episode on Panic Disorder or read it here!

Hi all and welcome to Just Therapist Things! Today I will be talking about panic disorder and specifically, why it sucks. I am not going to go too much into the science or DSM criteria in this episode, because I want to focus more on the real life experience of having panic disorder. 

Firstly, let's make a distinction between panic disorder and panic attacks. Panic attacks are part of panic disorder, but if you have a panic attack it does not mean you have panic disorder. 

Panic attacks are one off, occasional experiences of panic, while panic disorder encompasses recurrent panic attacks plus the fear of panic attacks. 

Also, it is important to differentiate anxiety attacks vs panic attacks. Anxiety attacks are usually the result of built up stressors and come on gradually, while panic attacks are often unexpected and come on rapidly. However, the symptoms can be similar. 

So to reiterate in basic terms, anxiety attacks are gradual, panic attacks are out of the blue, and panic disorder is recurrent panic attacks. 

A panic attack is an extreme fight or flight response. Your brain perceives a threat and your body and mind respond in a way to survive the threat. Please listen to my “Physical Symptoms of Anxiety” episode for a more in depth description and exploration of anxiety symptoms that occur during fight or flight. The purpose of a panic attack is to alert your mind and body that it is time to get the heck out of there, or fight, or hide, because there is a big scary monster coming for you. 

The fight or flight response is a very helpful survival skill until, of course, it is not helpful. 

Some panic attacks occur when there is no real threat, it’s just your mind making shit up, and if those occur often, you may have panic disorder. 

A huge part of diagnosing panic disorder is that, in between panic attacks, the person has an intense fear that they will have another panic attack. This can be accompanied by a change in behavior such as avoidance of situations that may cause panic. 

I have dealt with anxiety my whole life, even though I didn’t know I did until this experience, but I began struggling with panic disorder and generalized anxiety in college. 

It is pretty wild to think that I knew very little about anxiety until about 6 years ago, when my severe anxiety began. I knew kind of the basics of anxiety, but my knowledge mainly revolved around test anxiety and such. At one point I honestly thought anxiety was a diagnosis that people said they had to get more time on tests. I was sooo wrong. 

My anxiety first presented as intense physical symptoms including dizziness, numbness in hands, heart palpitations, blurry vision, and chest pain. I had all of these symptoms for months before I found out that it was anxiety and, more specifically panic attacks. When I was not feeling these symptoms I would worry that I would have these symptoms, and worry that I would have them at a really bad time like when I was driving or in the shower or something. During those months before I got the diagnosis, I thought I was dying and went to countless doctors and received countless tests but nothing helped. It was getting so bad that I became depressed and did not feel like myself at all. Mom’s know best always and because there seemed to be no medical reason for these symptoms, my mom suggested I see a therapist. I was desperate and would try anything, and so I went to my first therapy appointment. It really does blow my mind that my first therapy appointment ever was 6 years ago and now I am a full blown therapist because of this experiences. Life is crazy. 

So fast forward, after these months of hell, this therapist informed me that my symptoms were anxiety. She even had me go on my phone and google “anxiety symptoms” during session because I did not believe that anxiety could cause all these insane physical symptoms. 

I finally believed her, and the treatment started. I learned to manage anxiety and was doing better. About a year in, the panic disorder reared it’s head again and the coping skills and the tools that I was using wasn’t enough. I was avoiding the gym, and certain areas of my university’s campus because I was worried I would have a panic attack there. I was also hyperaware of every sensation in my body, and the thought spirals were out of control. I started on Prozac 20mg and have been taking it ever since. I have had minor moments of panic and anxiety, but I can honestly say I have not had my version of a full blown panic attack for 5 years. It’s pretty amazing. I still have some fear of having a panic attack, but it is easier to manage. Even talking about it makes me get a lump in my throat and tightness in my chest. It was a truly awful time. 

Thanks to this experience though I am now a therapist, and I love helping people through anxiety and panic disorder. I honestly use some similar tools and sayings that this first therapist used with me. 

Social media was huge for me during the tough time, to help me find accounts and other people who knew what I was going through. I owe so much to Taylor Barone of “Health_Anxiety” instagram for sharing her story through panic attacks and health anxiety. I still have some quotes that she has shared saved on my computer and I look at them when I need to. Here are some quotes that have helped me through a lot.

First is, “It is easy to give up when you start to feel bad again. Remember that you got through this before and you can get through it again. It always passes.”

Another is “I don’t think people realize how much strength it takes to pull your own self out of a panic attack. So, if you've done that today or any day. I’m proud of you.”

And lastly, “Though I feel anxious, this too shall pass.”

Anxiety really is a constant battle in your mind. It takes a lot of effort and determination to get through. It’s kind of like having a job, it takes effort, consistency, time, and patience to deal with anxiety daily and work through panic. 

So what do we do about panic disorder and panic attacks?

First off, seek help from a professional. Especially if you think you may have panic disorder. You cannot treat this on your own. If you have once in a while panic attacks, I would still recommend seeking therapy to figure out where those are coming from, however I will provide just basic tips to get through a panic attack on your own. 

When you seek out professional treatment, cognitive behavioral therapy is the best treatment for panic disorder. The therapist should also refer you for a psychiatric evaluation to see if medication would benefit you. Medication plus therapy is truly the most successful treatment for many mental health disorders but specifically for panic disorder. 

So when you are in treatment with a professional and doing cognitive behavioral therapy, there will be a lot of metacognition, or thinking about your thinking. Identifying your thought patterns is the first step to challenging, reframing, and stopping distorted thinking. 

In cognitive behavioral therapy there is a huge emphasis on thoughts, and how powerful our thoughts are, as they can affect our feelings and behaviors. Therapists and clients work as a team, to fight these powerful thoughts and make it so that the client feels they have more control over these thoughts. 

Identifying your thought patterns are done with interventions like cognitive triangle work which is exploring how thoughts affect feelings and behaviors, exploring automatic negative thoughts and cognitive distortions, or creating a thought record. 

Interoceptive exposures are also used for panic disorder, but only in a very controlled and well managed setting. Interoceptive exposures are simulating the physical sensations of a panic attack with the goal of showing your brain that the feared sensation is not so scary and that it is more under your control than you think. 

An example of an interoceptive exposure is to run laps to get your heart rate up to stimulate heart palpitations, or spin in a chair to simulate dizziness. 

I have done all of these interventions with clients and have seen great success. 

What I just mentioned are more comprehensive treatment options, but there are also some acute, and kind of odd  ways to snap out of a panic attack.

These methods do not treat the thought patterns, but they really just shock your body out of the fight or flight stage, and helps to ground you and turn your focus to the present. 

-Ice cube: holding ice cube, holding ice pack on chest

-Similarly with eating sour candy, something spicy

-Go in the shower 

-Put on music or start singing

These are all methods that stimulate your 5 senses and are in some ways extreme sensations that will shock your nervous system.They seem strange but really work.  Again, these are short term, in the moment, solutions that should ideally be monitored by a mental health professional.

Another large part of managing panic disorder is to have coping skills and mindfulness techniques on hand at all times. It is necessary to use these skills even when you are not anxious, because preventative work is key.

Mindfulness and coping skills can include meditation, deep breathing, engaging your five senses, exercise, drawing, journaling, and more.

The key to deep breathing is to breathe out for longer than you breathe in. If you breathe in for 3 counts, breathe out for at least 4. If you breathe in for 4 counts, breathe out for at least 5. This act sends calming messages to your brain. You also want to breathe in through your nose and out through your mouth. Doing this increases your oxygen intake and encourages fuller breaths. 

Another useful way to nose breathe is to plug one nostril while you breathe in and switch over to plug the other as you breathe out. 

Engaging your 5 senses connects you with the environment around you, connects you to your body, and is very grounding. 

Panic disorder and panic attacks really suck. If you have experienced them, I feel for you.

 I encourage you to seek out professional help, engage in coping skills, and follow social media accounts that are useful. And remember “this shall pass.”