What is a panic attack?

September 11, 2020

 Image courtesy of Stylist magazine and Unsplash

With the increase in people sharing their experiences with panic attacks, some might still be confused as to what one actually is. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a panic attack is characterised by four or more of the following symptoms:

  •        Palpitations, pounding heart, or accelerated heart rate

  •        Sweating

  •        Trembling or shaking

  •        Sensations of shortness of breath or smothering

  •        A feeling of choking

  •        Chest pain or discomfort

  •        Nausea or abdominal distress

  •        Feeling dizzy, unsteady, lightheaded, or faint

  •        Feelings of unreality (derealization) or being detached from oneself (depersonalization)

  •        Fear of losing control or going crazy

  •        Fear of dying

  •        Numbness or tingling sensations (paresthesias)

  •        Chills or hot flushes

It is thus not surprising that many think they are experiencing a medical emergency such as a heart attack when they have a panic attack for the first time.

 

What happens to our body during a panic attack

The ‘fight or flight’ response, is a physiological reaction to a perceived threat to our survival. The reaction begins in the amygdala, which triggers a neural response in the hypothalamus, followed by the activation of the pituitary gland and secretion of the hormone ACTH. ACTH’s principal effects are the increased production and release of cortisol, which, in turn increases blood pressure, blood sugar, and suppresses the immune system. The adrenal gland is activated almost simultaneously and releases adrenaline which binds to liver cells which produce glucose. The reactions are triggered in order to create a boost of energy meant to help us ‘fight’ or ‘flee’ an impending danger.

During panic attacks, however, the intense fear response due to the aroused sympathetic activity can be manifested in the absence of life-threatening danger.

 

So, what do I do if I have a panic attack?

Breathe! When you have a panic attack you start to hyperventilate: your breathing becomes much faster, which leads to a deficit in carbon dioxide. While CO2 is in your bloodstream before you fully exhale, it gets converted into carbon acid which has a crucial role in regulating your body’s pH. When you hyperventilate, blood vessels constrict, inhibiting the transfer of nutrients from the bloodstream into your brain. However, if the breath is stopped or inhibited, CO2 rises and blood vessel diameter increases in order to maximise transfer of glucose and oxygen out of the bloodstream and into the tissues - which is why so many breathing exercise have you hold your breath for a count before exhaling.

You also need to breathe through your belly and not just your chest. If you place your hands on you abdomen you should feel it rise with the inhale and deflate with the exhale. It may feel strange at first, but if you keep practicing it will soon become automatic.

 

Some breathing exercises

Here are some simple breathing exercises to try out, but you don’t need to suffer from panic attacks in order to benefit from their relaxing effect. Try either breathing in and out through your nose or breathing in through the nose and out through the mouth.

  • 4-2-4: breathe in for 4 seconds, hold your breath for 2 seconds, exhale for 4 – I like this one as if you do it 6 times it lasts a minute;

  • 5-2-5: in for 5, hold for 2, out for 5;

  • 4-7-8: in for 4, hold for 7, out for 8 – this one is a bit harder but I know people who swear by it;

  • 7-11: in for 7, out for 11 – some people don’t like holding their breath so this one is a great alternative.

This is by no means an extensive list, and no one exercise is better than the other.

 

It is important to practice your breathing when you are not experiencing heightened anxiety so that when they are needed they become second nature. My favourite way is to do some measured breathing in bed before I fall asleep as it helps relax me. You could also do these exercises in the shower, waiting in line for your coffee, before eating ... the possibilities are endless. The key is to make it work for you without adding unnecessary stress to your day.

 

Another tip is to listen to pink noise (e.g. wave sounds, rain …) or white noise while doing these exercises as it will help you relax and focus on the breath. There are plenty of YouTube videos out there, but my preferred way of accessing these is through the Calm app.

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