An anxiety attack (also called an anxiety crisis or panic attack).usually occurs without an apparent trigger. It may be due to accumulated stress, having had previous attacks, etc. When these attacks are recurrent and unexpected, we speak of a panic disorder.
In this article, however, we will focus on the anxiety attack itself. We will explain what it is and talk about its causes, symptoms and treatments.
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Anxiety attack: what does it consist of?
In an anxiety attack, the subject feels overwhelmed, with sensation of lack of air, in tension, with agitated breathing, on the verge of losing control, dizzy… (the symptoms can vary from one person to another).(symptoms may vary from one person to another), but the main thing is that it is very difficult to control, and that once it appears, it is best to let it pass (of course, helping the person to breathe, to sit in a secluded place, etc.).
Thus, technically and according to the DSM-5, an anxiety attack is a sudden onset of fear and/or intense discomfort. This fear or discomfort reaches its maximum expression in a matter of minutes; in these minutes a series of characteristic symptoms appear, which we will see a little later. These symptoms include: palpitations, fear of dying, chills, nausea, choking sensation, trembling or shaking, etc.
On the other hand, in a panic attack, the sudden onset of symptoms can occur from a state of either anxiety or calm. In addition, the DSM makes it explicit that the panic attack, although it generally appears with fear and/or anxiety, these two are not essential requirements. These are “panic attacks without fear”.
The fact of having more than one anxiety attack over time (i.e., the occurrence of unexpected and recurrent anxiety or panic attacks), allows the diagnosis of panic disorder (DSM-5), if other criteria are also met.
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Causes
The causes of panic attacks can be very diverse.. There are different explanatory theories.
Genetic models
Genetic models of anxiety propose that there is a certain predisposition to suffer from an anxiety disorder in some people.What they say, more specifically, is that we inherit a vulnerability to develop an anxiety disorder in general (i.e., it is not that we inherit the disorder itself).
This could occur with panic attacks (recall that panic attack in the DSM-5 ceases to be a specific disorder and becomes a specifier of other disorders).
Neurobiological models
Neurobiological models of anxiety propose the existence of alterations in some brain substances, such as GABA (gamma-amino-butyric acid) as the origin of some anxiety disorders.
Neuroendocrine models
These models suggest that states of stress and anxiety lead to an increased secretion of some substances, such as thyroxine (thyroxine), thyroid hormone (thyroxin), and other substances.such as thyroxine, cortisol and catecholamines. Thus, a hypersecretion of cortisol is produced.
4. Models of learning
There are also learning theoriesThe first is that the anxiety disorder, which refers to classical and operant conditioning processes as the origin of some anxiety disorders, including anxiety attacks.
That is, due to certain traumatic experiences, we can end up developing an anxiety disorder, for example. If, for example, we suffer an anxiety attack, the fear of suffering it again can end up triggering another anxiety attack, or an anxiety disorder (such as agoraphobia or panic disorder).
Symptoms
We have seen what an anxiety attack is and what are some of its possible causes, but what are its symptoms? what are its symptoms?
The DSM-5 makes explicit that the symptoms that appear in a panic attack (which must be 4 or more), are some of the following:
- Palpitations, pounding of the heart or acceleration of the heart rate.
- Sweating.
- Trembling or shaking.
- Sensation of difficulty breathing or choking.
- Choking sensation.
- Chest pain or discomfort.
- Nausea or abdominal discomfort.
- Dizziness, unsteadiness, lightheadedness or fainting.
- Chills or a feeling of warmth.
- Paresthesias (numbness or tingling sensation).
- Derealization (feeling of unreality) or depersonalization (detachment from oneself).
- Fear of losing control or “going crazy”.
- Fear of dying
Treatments
The most comprehensive (and considered the treatment of choice) for treating panic attacks is a multi-component cognitive-behavioral treatment.. Although other psychological orientations can be used (e.g. psychoanalysis), we will explain this model as it is the most effective and widely used.
This type of treatment includes several therapeutic elements, which we will explain below in summary form (to apply it, however, it will always be necessary to be properly trained in the treatment in question and under clinical supervision if you do not have adequate experience). These elements are as follows.
Psychoeducation
Psychoeducation involves “educating the patient in his disorder and in his adaptation”. It consists of teaching the patient to identify the manifestations of a possible panic attack, and explaining the basis of such manifestations. The treatment plan is also explained.
2. Interoceptive exposure
It involves the patient being able to experience the sensations of a panic attack (or similar sensations) in a controlled and provoked manner; the patient should focus on these sensations rather than avoid them.
3. Cognitive restructuring
Cognitive restructuring, a key technique in cognitive-behavioral psychotherapy, consists of teaching the patient to identify and test his or her catastrophic interpretations of the bodily sensations experienced. In other words, the patient must learn to “relativize” these sensations associated with the panic attack.
4. Controlled breathing
Controlled breathing is another therapeutic element to deal with an anxiety attack (or the fear of having one). It consists of breathing slowly and regularly with the diaphragm, through brief inspirations and prolonged exhalations.
In each breath a small pause should be made. In addition, it is important that this is done (breathing) through the nose, and not through the mouth (it is advisable that it is between 8 and 12 times per minute).
5. Applied relaxation
Finally, the last element of the multicomponent cognitive-behavioral treatment for anxiety attack is applied relaxation. This consists of progressive muscle relaxation (a specific program) and applying it in situations where the patient feels that he/she “may” have an anxiety attack (this is called “live practice”). This will be done hierarchically.
Comments on the treatment
Although in this article we have discussed the treatment of choice for treating anxiety attacks, it is obviously not the only one. Psychopharmacology can also be used, e.g. (anxiolytics and antidepressants are usually used), although a complementary and/or supportive psychological therapy is always recommended, so that the changes produced are profound and lasting.
On the other hand, the exposure technique will be fundamental in these cases (i.e., that the patient is exposed to the situations that may generate anxiety, or that may trigger an anxiety attack, although it is not easy, because there is usually no specific trigger), together with relaxation and breathing techniques, which allow the patient to acquire awareness and control over his body and body sensations.