Health MatterOvercoming panic attacksBy Dr George Leow Chee Seng, Certified Stress Consultant Professional (US)Before resorting to medication as a cure for anxiety, there are other ways toconsider in the effort to overcome this rather difficult condition.W e all become anxious from time to time. Examples include when we’re about tohave a meeting with an important person, changing Hence, it is natural that the terms ‘fear’ and ‘anxiety’ are commonly used interchangeably. However, there is a distinction between these two terms.to a new job or concerns over a new relationship. Fear refers to an innate, almost biological-basedAll these create anxiety as the person is concerned alarm response to a dangerous or life-threateningabout the future – fearing what could go wrong and situation. Anxiety, in contrast, is a more future-mulling possible consequences and repercussions, oriented and global concern – it is sometimesinstead of also considering probable positive outcomes. referred to as panic attacks.30 NOV/DEC 2009 • OH!
Health MatterThe term anxiety is about someone feeling department. So, she finally settled herself in theinordinately apprehensive, tense, and uneasy about area of public health.the prospect of something terrible happening.Anxiety becomes a clinical concern when it The last category of panic attack is situationalinterferes with the ability to function in daily life as predisposed panic attack where a person will havethe person enters a maladaptive state, characterised situational panic attack but not every time. Forby extreme physical and psychological reactions. example, when you are standing in a closed and dark room, the panic attack does not appear all thePanic attack time but it occurs randomly.According to the Diagnostic and Statistic Manualof Mental Disorder (DSM-IV-TR), a panic attack is a Medical perspectiveperiod of intense fear or discomfort, during which In trying to understand the cause and strategya person experiences four or more of the following to fight panic disorder, we should discuss bothsymptoms, which develop abruptly and reach a biological and psychological perspective. However,peak within 10 minutes: in this article, I will focus more on the psychological perspective.• palpitations, pounding heart or accelerated heart rate; In the biological perspective, panic attack is• sweating; associated with excess of noreponephrine in the• trembling or shaking; amygdala, a structure in limbic system involved• sensations of shortness of breath or smothering; in fear. Besides, the disorder derives from• feeling of choking; defects in gamma-aminobutyric acid (GABA),• chest pain or discomfort; a neurotransmitter with inhibitory effects on• nausea or abdominal distress; neurons.• feeling dizzy, unsteady, light-headed. or faint;• derealisation (feelings of unreality) or depersonalisation (being detached from oneself );• fear of losing control or going crazy;• fear of dying;• paresthesias (numbness or tingling sensations); and• chills or hot flushes.There are three categories of panic attack –unexpected panic attack, situationally-bound panicattack and situationally-predisposed panic attack.For unexpected panic attack, there is no situationalcue or trigger. The second type of panic attackoccurs where a person has a tendency to have apanic attack in the situation but does not have oneevery time.For example, when one of my friends hears anambulance siren, she begins to experience thesymptoms of a panic attack. She could not work ina hospital – especially in accident and emergency NOV/DEC 2009 • OH! 31
Health MatterAccording to anxiety sensitivity theory, people relates bodily sensation with memories of thewith panic disorder tend to interpret cognitive last attack, causing a full-blown panic attackand somatic manifestation of stress and anxiety in to develop even before measurable biologicala catastrophic manner. For example, they feel that changes have occurred. Over time, the individualthey cannot breathe even though others feel the begins to have panic attacks before the triggersituation is normal. This false alarm mechanism event happens.causes the person to hyperventilate and the personis thrown into a panicked state. David Barlow and his colleagues proposed in a cognitive-behavioural model that anxiety becomesTurning to psychological perspective, we focus an unmanageable problem for an individualon conditioned fear reactions as contributing to through the development of vicious cycle. Thethe development of panic attacks. This person diagram shows the cycle of panic attacks. Unpleasant Feels what sensations is happening Draws the and Faulty Highly Anxiety is individual’s can do cognition and negative and unpredictable attention like nothing misperception feelings phobia and a magnet except of cues uncontrollable thinking about them32 NOV/DEC 2009 • OH!
Health MatterStress management techniques help in the I found that clients treated with PCT show markedtreatment of a panic disorder. In this approach, the improvement, at levels comparable to improvementclient learns to systematically alternate tensing and shown by clients treated with anti-anxietyrelaxation of muscles all over the body, starting medication. I would propose that the combinationfrom the forehead down to the feet. of both anti-anxiety medication and PCT should give a marked improvement among patients.After stress management techniques, the clientshould be able to relax the whole body when During my training in counselling andconfronting a feared situation. psychotherapy, International Islamic University Malaysia Professor of Psychology, Malik Badri,However, I like to use panic control therapy (PCT) explained the more comprehensive interventionsdeveloped by Barlow and his colleagues. This involving cognitive techniques.technique consists of cognitive restructuring,the development of an awareness of bodily cues He recommended in vivo exposure when treatingassociated with panic attacks and breathing individual with panic disorders, especially thoseretraining. with agoraphobia (which loosely means being afraid of open spaces). He taught the use of graduated exposure, a procedure in which clients expose themselves to increasingly greater anxiety- provoking situations. For example, Mr X finds visiting large shopping malls to be emotionally overwhelming. I would recommend that his exposure to such stressful environments to begin with a small shop in which he feels safe and relatively anxiety free. Step- by-step, Mr X would progress to environments that are higher on the list of anxiety-provoking settings. I have just completed attending training in counter- conditioning. This technique is used to treat hyperventilation, a common symptom in panic attacks. In this approach, the client hyperventilates intentionally and begins slow breathing, a response that is incompatible with hyperventilation. In this training, the client can begin the slow breathing at the first signs of hyperventilation. Hence, the clients learn that it is possible to exert voluntary control over hyperventilation. If the recommended psychological approach is not able to control the anxiety of a person, the use of medication can help alleviate symptoms, with the most commonly prescribed being anti-anxiety and antidepressant medication. OH! NOV/DEC 2009 • OH! 33