Are Panic Attacks Different than Anxiety?

Why do we have stress? How is stress different from anxiety?   

Our bodies have evolved over millennia to protect us from dangers. Our nervous system deploys the fight-flight or freeze responses in order to protect us. In fight-flight, we feel amped up with adrenaline and increased heart rate and blood flow to our limbs. More oxygen flows through our lungs as our body prepares us for action. You may feel the urge to run away, pace, or hide. The ability to rationalize or make good decisions lowers. Action, rather than reflection, is the order of the day. The freeze response is our body’s “play dead” response and is often tied to trauma. It can lead to tingling sensations, chest tightness, difficulty breathing, and feeling overwhelmed or incapable. According to Stephen Porges, the originator of Polyvagal theory, dangers can be real (like the saber tooth cat outside your cave) or perceived as such by our bodies (a slideshow in front of your boss). This means that in individuals prone to anxiety, bodies respond to perceived threats as though the threats are real.
   
Fight, Flight, and Freeze responses can be triggered not only by stimuli in the environment but also sensations in our bodies, thoughts or even memories.  Anxiety is fear without obvious danger. Anxiety differs from helpful stress that enables us to survive, stay safe, or get things done. Anxiety reactions can make dealing with situations more difficult and can affect relationships and our ability to live life on life’s terms.  
  
What are panic attacks? How do panic attacks differ from anxiety?  
Anxiety is taken to another level in panic attacks. Panic attacks include marked sensations like butterflies in the stomach, sweatiness, muscle tension, racing heartbeat, and breathing difficulties. Individuals may feel faint or dizzy, hot, or cold.  The sensations of the panic attack are overwhelming and the individual may feel disconnected from surroundings. Panic attacks also include worries that one is ‘losing it’ or that illness or death are imminent. Chest tightness may be perceived as evidence for a heart attack. This fear often brings individuals to emergency rooms.  

Sometimes panic attacks occur after specific triggers, like an individual with agoraphobia having a panic attack in a crowded public space. Other times, however, the panic attack comes on without a known cause. According to the Diagnostic and Statistical Manual 5 (DSM-5), some individuals will experience waking panic attacks, in which they wake from sleep in panic. Panic attacks lead to more “fear of fear” as the individual avoids contexts and environments in which panic attacks might happen. 
  
What causes panic attacks?   

According to the Cognitive Behavioral model for Panic Attacks, the normal effects of stress on the body (like increased heart rate) are misinterpreted as a serious problem. Put simply, symptoms of stress are catastrophized as indications of serious health issues or impending death.   

When the individual experiences symptoms like shortness of breath and chest tightness, worst case-scenario thoughts lead to more anxiety, which worsen symptoms and create a negative feedback loop of ever-increasing seriousness. Symptoms can lead to thoughts like: Am I having a heart attack? and Am I going to die? Am I Losing it? However, if the individual experiences the same symptoms but does not perceive the symptoms to mean something more than they are (symptoms of anxiety rather than a heart attack, for example), then the negative feedback loop will be lessened.   

The uncomfortable and overwhelming experience of a panic attack creates fear of more panic attacks. Body sensations like dizziness after standing up quickly or breathlessness during exercise are then understood to be something worse. Drinking caffeine can lead to bodily reactions that the individual associates with panic attacks. For example, increased heart rate or shakiness could lead one to associate the symptoms with a heart attack or a loss of control.   

Emotions like excitement or anger lead to bodily changes (increased heart rate or labored breathing) that could be misattributed as well.  The covid-19 pandemic has led many to worry about infection. Some symptoms of Covid-19 that are shared with panic attacks are the sensation of chest tightness as well as labored breathing. This can lead to some individuals perceiving symptoms due to the virus rather than anxiety, which leads to catastrophic What Ifs.   
  
What populations have panic attacks?  

According to the DSM-5, females are twice as likely to have panic attacks than males. Panic attack incidences tend to appear during adolescence and early adulthood, peak in adulthood, and then decline by age 65 (APA 2013).   
  
How are panic attacks treated?  

Medications and talk therapy combined are one way to treat Panic Attacks. Cognitive Behavioral Therapy (CBT) is to date the most tested therapeutic approach to panic disorders. In treatment, CBT challenges patients to test assumptions leading to more moderate viewpoints. Therapists may use exposures that mimic symptoms present in panic in order to enable clients to sit with the discomfort and learn from it. This could include spinning until dizzy as dizziness is one common symptom. As the sensations experienced are normalized, catastrophic thinking may be less likely to heighten anxiety into panic. In short, as the symptoms that lead to a panic attack are better understood, anxiety will be less likely to be interpreted as a worst-case scenario. Other treatment recommendations may include keeping a panic journal.
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While CBT is currently the most researched therapeutic approach to panic disorders, there is no significant data to suggest that it is the most effective approach. When considering your own treatment, work with a mental health professional to understand what type of treatment or therapy would best fit your needs and personality. For example, individuals who gravitate to rationalizing and reasoning may respond well to CBT. Artistic individuals may respond well to Psychodynamic Psychotherapy. Those who are interested in Mindfulness based therapies may be a good fit for ACT. ​