Motivation and emotion/Book/2020/Panic

Panic:
What are the emotional components of panic and how can panic be managed?

Multimedia presentation (3 min)

Overview

Panic is the overwhelming sensation of fear which inhibits logical reasoning and thinking. Being aware of the emotional components of panic allows for the successful management of such situations. Panic's emotional components are: subjective experience, physiological response and behavioural response. These components vary greatly and effect an individuals experience of panic. The management of panic is necessary as panic effects logical reasoning and thinking, physical responses, behaviour and an influx of agitation and feelings of anxiety similar to the flight and fight response. Emotions experienced within panic can be so intense that they lead to physical responses like trembling, rapid heartbeat, dizziness and feeling faint. Sometimes, panic can be so overwhelming that it causes panic attacks. Some individuals have panic attacks so frequently that they end up with a panic disorder diagnosis. Management of panic is imperative to deal with the emotional components so that individual's are able to resume normal functioning. Panic causes severe physiological and emotional stress and the proper management of panic will lead to an improved quality of life. Psychotherapy, medication, practicing mindfulness and relaxation techniques are practical ways to combat and manage panic.

Focus questions:

• What is panic?
• What are the emotional components of panic?
• How can panic be managed?

Case study Eaton et al. (2006) study aimed to see the prevalence of DSM-III-R panic disorder in the United States of America and the correlation between other factors. They administrated a composite international diagnostics interview to 8098 participants, the age ranged from 15 to 54 years old. The results showed that 15% of participants recorded they had an occurence of a panic attack. 3% were experiencing panic attacks monthly and 1% satisfied the criteria of DSM-III-R panic disorder.

What is panic?

Panic is the sudden feeling of intense anxiety and fear which is an automatic response to danger. It causes extreme physical reactions and inhibits logical thinking and decision making. It triggers the fight or flight responseand triggers intense feelings that cause these reactions (CCI, 2006). Panic also can be triggered without a threat and can be caused by seriously stressful situations.

Symptoms

The symptoms of panic vary between individuals, they can be characterised by:

• Difficulty breathing
• Sweating
• Sense of impending doom
• Nausea
• Headache
• Chest discomfort
• Heart palpitations
• Choking
• Trembling
• Dizziness
• Hot and cold flashes
• Feeling detached of surroundings
• Numbness
• Heart pounding
• Feeling of losing control
• Thoughts of dying

(CCI, 2006)

Causes

Panic has a multitude of factors that cause the onset of panic in an individual. Genetic disposition and heredity factors have a significant impact on panic disorders and the susceptibility to panic. Pauls et, al. (1980) was able to demonstrate the correlation between the autosomal dominant trait that parents (who experienced high feelings of panic) passed down to their children made them experience frequent panic. Major life stress and traumatic events are another significant impact in the causation of panic. The candidate stressors that correlated with panic most frequently are: childhood trauma, loss of a loved one, interpersonal and health related issues, abuse and financial difficulties (Benedict, 2010). Bandelow et, al. (2002) discovered that participants who suffered a traumatic childhood (physical and sexual assault, death of a parent, separation from parents, divorce, childhood illness or alcoholic parents) had a significantly higher chance to suffer more from panic attacks and disorders. Changes in life, such as job stressors, relationship problems, transportation problems or having a baby can alter the risk of developing constant panic. Smoking and caffeine create and intensify feelings of panic. Breslau & Klein (1999) discovered that smoking and panic were closely related, smoking increased the risk for the onset of panic attacks. Daily smoking was found to significantly increase the chance of panic attacks. Charney et, al. (1985) found that caffeine increased feelings of panic, anxiety, trembling and heart palpitations.

Panic attacks

Panic can be so severe in some cases it develops into panic attacks. Panic attacks are an unexpected reaction to a random situation or specific situation that causes extreme anxiety which morphs into fear. They are brief episodes that generally last from one minute to ten (Better Health, 2020). The autonomic nervous system activates the flight or fight response when it believes it is in danger which causes physiological changes in the body. Adrenaline makes the heart beat faster and also causes accelerated breathing to allow the muscles more blood to prepare the body for a dangerous situation. These attacks are debilitating on an individual's body both physically and emotionally due to the fight or flight response being triggered. If panic attacks are left untreated there is serious complications which could effect the quality of life. Ballenger (1998) discovered that frequent and untreated panic attacks lead to the development of other illnesses as the attacks compromise the immune system. These constant attacks also cause chronic stress, the development of other phobias, avoidant behaviour of social situations, substance abuse, development of other disorders, social isolation and suicidal thoughts (Pollack & Marzol, 2000). View management of panic to see how panic attacks can be treated.

Test yourself

Choose the correct answers and click "Submit":

1 What is not a symptom of panic?

	Difficulty breathing
	Sweating
	Increased heart rate
	Dizziness
	Hallucinations

2 What response creates a physiological reaction during a panic attack?

	Feedback response
	Fight or flight response
	Endocrine-system response
	Chemical response
	Mechanical response

Case study Schneiderman et, al. (2005) research aimed to examine the effect of stress and its negative impact on the body. They discovered that young or healthy individuals that suffer from acute stress that it wouldn't typically weaken the immune system. Whereas older or unhealthy individuals who suffered from constant unremitting stressors had a significantly weakened immune system. They also found biological factors that made individuals more susceptible to stress and it's negative impacts. Factors like gene disposition and constitutional factors. They identified that psychosocial interventions were extremely practical in combating stress in individuals lives leading to a stronger immune system and a healthier lifestyle.

What are the emotional components of panic?

Subjective experience

All subjective phenomena is experienced completely different by all people. It is the opposite of objective experience which were the actual events that took place. It is based on inner experience rather than fact and cognitive and emotional factors greatly influence a persons experience. Subjective experience is profound and can't be measured and it's based on individual thought. When an event happens all people involved react completely differently from each other and have completely different views on that event. Subjective experience is a major component of panic (Pollack & Marzol, 2000). How someone reacts to an occurrence greatly impacts their susceptibility of being in a state of panic. For example, a family suffers from the death of a loved one, the two siblings are both devastated. One is very shut off but seems okay for the situation she is in but the other sibling has been suffering from constant and severe panic attacks. They both experience the same event but act completely different and one sibling seems to be in more of a panicked state than the other. This example portrays the idea how people experience panic in events differently as it is a subjective experience and it is an individual reaction.

Physiological response

Intense anxiety triggers the fight or flight which is the autonomic nervous systems reaction to a dangerous stimuli. It can also perceive situations that are normally view as a regular event as a dangerous situation and triggers a physiological response preparing the body to fight against the danger or escape. The body goes through a tremendous change for the preparation for danger (Jonabram, 2013). These changes include:

Figure 4. A normal heart beat (Jana, 2016)

• Nervous and chemical effects - within the autonomic nervous system there is two subsections which control the fight or flight response called the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS). The SNS causes the fight or flight response by releasing adrenaline and noradrenaline which cause the great physical change in the body and boosts energy levels, once activated all of its parts responds at full capacity. Whereas the PNS restores the system before the physical change caused by the SNS system as a person can't function properly being in a constant fight or flight changes.
• Cardiovascular effects - the SNS increases the heart rate and its power. This increase of heart rate is necessary to improve blood flow improving the delivery of oxygen to tissues and it's waste removal. Blood is also redirected away from places it's not required to be at. This redirection is usually from the fingers, toes and skin which causes the whitening of the skin and causes the numbness and tingling sensation that people experience. It also is a safety measure the body takes, if the person was attacked and cut it reduces the amount of blood lost. All the redirected blood goes to major muscles like thighs and biceps to prepare for a response.
• Respiratory function - due to the increased blood flow there is a high demand for oxygen so breathing becomes deeper and faster. Due to the elevated breathing it causes side effects that feel like breathlessness, tightening of the chest and choking. This extreme breathing also causes another side effect which is a decrease of blood supply to the head which causes feelings of dizziness, hot flushes, blurry vision and confusion.}
• Other physical effects - sweat gland activity increases to cool the body down and also makes the skin harder to grab by making it slippery. Blurred vision is caused by the pupils widening to let in more sunlight. Cotton mouth is another side effect as there is a decrease in salivation. Constipation and nausea are also experienced due to the decrease in the digestive system. The body has a come down stage after these changes and results in tiredness, aches and shaking.

Behavioural responses

The fight or flight response greatly effects the behaviour of the individual. The SNS prepares the body to attack or escape the dangerous stimuli it is experiencing so it causes some immediate urges. An individual in this state might be aggressive as they desperately want to escape this dangerous situation. But due to social constraints sometimes escape is impossible and is released through urges like foot tapping, pacing, snapping at others and chewing on pen lids. Avoidant type behaviour is adopted so the person won't have to experience the daunting experience again. This avoidant behaviour can sometimes lead to social isolation and negatively impact upon their mental health and can possibly lead to development of other mood disorders.

Test yourself

Choose the correct answers and click "Submit":

1 What physiological change is not triggered by the fight or flight response?

	Increase in cardiovascular activity
	Increase of adrenaline
	Increase in sweat
	Increase in respiratory activity
	Increase in collagen reproduction

2 Which behaviour is triggered by panic?

	Increase in social interactions
	Avoiding situations
	Increase in activities
	Decrease in hooliganism

How can panic be managed?

Psychotherapy

Psychotherapy utilises psychosocial methods to aid individuals in resolving or mitigating their behaviour and to help them overcome challenges in their life. Psychologist use cognitive behaviour therapy (CBT) to help treat individuals for mood disorders, anxiety disorders, eating disorders also with other struggles like anger, gambling and stress (Reach Out, 2020). The psychologist help the individual identify problematic thoughts and feelings (cognitive processes) which effects and controls their behaviour. CBT sessions can either be individually or in a group, with usually 5 to 10 sessions that last an hour over a space of four months. The psychologist utilises psycho-education, breathing retraining, progressive muscle relaxation, cognitive restructuring, behavioural experiments, interoceptive exposure and in vivo exposure to change cognitive process and behaviour (HANDI, 2016). CBT helps individuals suffering from panic identify their symptoms and how they affect their experience. Panic causes individuals to stress and fear over these symptoms causing a feedback loop which prolongs the fight or flight response which intensifies panic attacks and effects their frequency. Interoceptive exposure induces symptoms to help teach the individual and use it as a mastering tool, hyperventilating triggers these symptoms. Vivo exposure gradually introduces the individual to a stressful or triggering situation which helps them develop the skills to manage their behaviour in these situations (HANDI, 2016).

Pharmaceutical therapy

Figure 5. Pharmaceuticals

Pharmaceutical therapy is medication taken over a period of time prescribed to an individual by a health professional to prevent, cure and treat diseases and disorders. Some individuals experience extreme chronic panic or develop a panic disorders and need medication to alleviate and control symptoms. Byrne et, al. (2005) discovered that medication intervention was very effective with treating panic and alleviating symptoms. Medications such as selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) have also been very beneficial in the treatment of panic. When CBT and pharmaceutical therapy were combined it was found to be extremely useful in treating panic and panic disorder (Byrne et, al., 2005).

Techniques

• Practicing mindfulness - this is a form of meditation that creates a focus on the here and now. It puts the body in a state of relaxation decreasing stress and calming the mind.
• Muscle relaxation - is a form of relaxation that reduces stress and anxiety by using progressive muscle relaxation. This form of relaxation makes an individual tense up particular muscles and relax them causing muscles to relax consistently practicing this method will greatly reduce anxiety and stress.
• Breathing techniques - this technique uses controlled deep breathing methods which promote health and completely relax the body. It promotes mindfulness and awareness through breathing. There is many different types of breathing techniques like pursued lip breathing, deep breathing, tummy breathing, equal breathing and many others.

Case study on the effectiveness of CBT on panic disorder Borah Kim et al., (2010) conducted a study that focused on treating panic disorder through the use of mindfulness-based cognitive therapy (MBCT). 23 patients who had panic disorder were committed to MBCT for an 8 week treatment. Resources such as albany panic and phobia questionnaire (APPQ) and panic disorder severity scale (PDSS) were used in this study to assess the patients throughout treatment. Results showed that PDSS scores decreased throughout treatment and the APPQ improved significantly. This illustrates how MBCT can beneficially assist those with panic disorder.

Conclusion

Panic is an overwhelming sensation of anxiety and fear to a stimuli that the autonomic nervous system perceives as dangerous and life threatening. It creates many unpleasant symptoms like difficulty breathing, dizziness, sweating, heart palpitations and many other symptoms. This very intense reaction is due to the SNS increasing adrenaline and noradrenaline to trigger the fight or flight response to prepare the body to defend itself or flee from the danger. Emotional components of panic are effected by subjective experience, physiological changes and behavioural responses. Subjective experiences are how an individual experiences an event and how they are effected by this eexperience. Physiological changes occur due to the SNS and these changes are: cardiovascular system, hormones, breathing, respiratory function, sweat glands and the digestive system. The behavioural response is an avoidant type behaviour is adopted as the individual wants to eliminate the chance of another panicked state, the need to escape, increased aggression, foot tapping, pacing and snapping at others. Avoidant behaviour leads to social isolation which increases the chance of developing a mood disorder. The management of panic is necessary as developing a panic disorder becomes a debilitating affliction and needs immediate treatment. With combining CBT and pharmaceutical therapy it easily identifies the problems and give the correct treatment with combating this disorder. Also implementing techniques such as practicing mindfulness, muscle relaxation and breathing techniques lessen the severity and frequency of panic attacks.

See also

• Anticipation (Book chapter, 2013)
• Autonomic nervous system (Book chapter, 2018)
• Caffeine (Book chapter, 2015)
• Cognitive behaviour therapy (Book chapter, 2020)
• Terror (Book chapter, 2016)

References

American Journal of Psychiatry. (1994). Panic and panic disorder in the United States. American Journal Of Psychiatry, 151(3), 413-420. https://doi.org/10.1176/ajp.151.3.413

Aronson, T., & Logue, C. (1987). On the longitudinal course of panic disorder: developmental history and predictors of phobic complications. Comprehensive Psychiatry, 28(4), 344-355. https://doi.org/10.1016/0010-440x(87)90071-x

Ballenger, J. (1998). Comorbidity of panic and depression. International Clinical Psychopharmacology, 13, S13-S18. https://doi.org/10.1097/00004850-199804004-00003 Bandelow, B., Späth, C., Tichauer, G., Broocks, A., Hajak, G., & Rüther, E. (2002). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Comprehensive Psychiatry, 43(4), 269-278. https://doi.org/10.1053/comp.2002.33492

Better Health Channel. (2020). Panic attack. Betterhealth.vic.gov.au. Retrieved 17 October 2020, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/panic-attack#:~:text=A%20panic%20attack%20is%20a,related%20to%20any%20external%20threat.

Breslau, N., & Klein, D. (1999). Smoking and Panic Attacks. Archives Of General Psychiatry, 56(12), 1141. https://doi.org/10.1001/archpsyc.56.12.1141

Centre for Clinical Interventions. (2020). What is Panic?. Cci.health.wa.gov.au. Retrieved 17 October 2020, from https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Panic/Panic---Information-Sheets/Panic-Information-Sheet---01---What-is-Panic.pdf.

Charney, D., Heninger, G., & Jatlow, P. (1985). Increased Anxiogenic Effects of Caffeine in Panic Disorders. Archives Of General Psychiatry, 42(3), 233.https://doi.org/10.1001/archpsyc.1985.01790260027003

Hopper, J., Judd, F., Derrick, P., Macaskill, G., Burrows, G., & Rao, D. (1990). A family study of panic disorder: Reanalysis using a regressive logistic model that incorporates asibship environment. Genetic Epidemiology, 7(2), 151-161. https://doi.org/10.1002/gepi.1370070205

Jonabram. (2013). Jonabram.web.unc.edu. Retrieved 18 October 2020, from http://jonabram.web.unc.edu/files/2013/04/physiology-of-anxiety.pdf.

Klauke, B., Deckert, J., Reif, A., Pauli, P., & Domschke, K. (2010). Life events in panic disorder-an update on “candidate stressors”. Depression And Anxiety, 27(8), 716-730.https://doi.org/10.1002/da.20667

Mayo Clinic. (2020). Panic attacks and panic disorder - Symptoms and causes. Mayo Clinic. Retrieved 17 October 2020, from https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021.

NIMH. (2020). NIMH » Panic Disorder: When Fear Overwhelms. Nimh.nih.gov. Retrieved 17 October 2020, from https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml.

Pollack, M., & Marzol, P. (2000). Panic: Course, Complications and Treatment of Panic Disorder. Journal Of Psychopharmacology, 14(2_suppl1), S25-S30.https://doi.org/10.1177/02698811000142s104

Schneiderman, N., Ironson, G., & Siegel, S. (2005). Stress and Health: Psychological, Behavioral, and Biological Determinants. Annual Review Of Clinical Psychology, 1(1), 607-628.https://doi.org/10.1146/annurev.clinpsy.1.102803.144141

Ursani, A. (2020). Do I have panic disorder if I have panic attacks? | Expert help for your emotional health. Getcerebral.com. Retrieved 17 October 2020, from https://getcerebral.com/do-i-have-panic-disorder-if-i-have-panic-attacks.

External links

• Panic disorder (ncbi.nlm.nih.gov)
• Panic attacks (lifeline.org.au)