1. Health Matter
Overcoming panic attacks
By Dr George Leow Chee Seng, Certified Stress Consultant Professional (US)
Before resorting to medication as a cure for anxiety, there are other ways to
consider in the effort to overcome this rather difficult condition.
W e all become anxious from time to time.
Examples include when we’re about to
have 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-based
All these create anxiety as the person is concerned alarm response to a dangerous or life-threatening
about 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 sometimes
instead of also considering probable positive outcomes. referred to as panic attacks.
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2. Health Matter
The term anxiety is about someone feeling department. So, she finally settled herself in the
inordinately 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 situational
interferes with the ability to function in daily life as predisposed panic attack where a person will have
the person enters a maladaptive state, characterised situational panic attack but not every time. For
by extreme physical and psychological reactions. example, when you are standing in a closed and
dark room, the panic attack does not appear all the
Panic attack time but it occurs randomly.
According to the Diagnostic and Statistic Manual
of Mental Disorder (DSM-IV-TR), a panic attack is a Medical perspective
period of intense fear or discomfort, during which In trying to understand the cause and strategy
a person experiences four or more of the following to fight panic disorder, we should discuss both
symptoms, 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 panic
attack and situationally-predisposed panic attack.
For unexpected panic attack, there is no situational
cue or trigger. The second type of panic attack
occurs where a person has a tendency to have a
panic attack in the situation but does not have one
every time.
For example, when one of my friends hears an
ambulance siren, she begins to experience the
symptoms of a panic attack. She could not work in
a hospital – especially in accident and emergency
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3. Health Matter
According to anxiety sensitivity theory, people relates bodily sensation with memories of the
with panic disorder tend to interpret cognitive last attack, causing a full-blown panic attack
and somatic manifestation of stress and anxiety in to develop even before measurable biological
a catastrophic manner. For example, they feel that changes have occurred. Over time, the individual
they cannot breathe even though others feel the begins to have panic attacks before the trigger
situation is normal. This false alarm mechanism event happens.
causes the person to hyperventilate and the person
is thrown into a panicked state. David Barlow and his colleagues proposed in a
cognitive-behavioural model that anxiety becomes
Turning to psychological perspective, we focus an unmanageable problem for an individual
on conditioned fear reactions as contributing to through the development of vicious cycle. The
the 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 them
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4. Health Matter
Stress management techniques help in the I found that clients treated with PCT show marked
treatment of a panic disorder. In this approach, the improvement, at levels comparable to improvement
client learns to systematically alternate tensing and shown by clients treated with anti-anxiety
relaxation of muscles all over the body, starting medication. I would propose that the combination
from 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 client
should be able to relax the whole body when During my training in counselling and
confronting 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 interventions
developed 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 treating
associated with panic attacks and breathing individual with panic disorders, especially those
retraining. 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!
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