Understanding panic attacks: What triggers them and how to counter them

What exactly is a panic attack and how does it differ from other anxiety states such as phobias etc.?

A panic attack is a sudden, severe anxiety reaction that can sometimes develop into a fear of death. In addition to the feeling of fear that usually occurs, automatic and involuntary thoughts (for example, "I'm going to collapse!") are also part of it. Physical reactions also practically always occur. These are usually signs of a stress-activated autonomic nervous system such as a racing heart, a hot head, sweating, trembling, pressure on the chest, a feeling of a lump in the throat, high blood pressure, dizziness, etc. These physical symptoms are often so prominent that patients visit our emergency ward with the idea that they have a serious physical illness, such as a heart attack. It is therefore important that the doctors on the emergency ward are familiar with this clinical picture and know that it occurs frequently - much more frequently than heart attacks, for example. However, the latter are much more dangerous, so it goes without saying that physical causes should be ruled out.

By definition, panic attacks occur without a trigger. This is in contrast to phobias, i.e. focussed fears where a trigger is known. A simple example of this is arachnophobia. Both panic disorder and phobias are characterised by avoidance behaviour, which is the real problem with these illnesses: Sufferers then avoid situations that they think will provoke renewed anxiety attacks. Although this actually makes the panic attacks less frequent, the person is increasingly restricted in their everyday life and avoids social contact or public transport, for example. This "fear of fear" (so-called anticipatory anxiety) then becomes the actual problem of the illness. In extreme cases, this can go so far that people no longer leave their own home and become completely isolated.

How common are panic attacks and who is most at risk?

Panic attacks are part of the "repertoire" of possible human reactions and are an expression of a fundamentally intact but overreacting stress system, the functioning of which has evolved over millions of years and is therefore deeply rooted. In this respect, individual panic attacks are possible for everyone and occur frequently. They are not recorded statistically. We do not speak of individual attacks as a mental illness or disorder.

However, if the panic attacks are frequent and persistent, the above-mentioned avoidance behaviour occurs and there is a high level of distress, this is referred to as a panic disorder. Together with phobias and generalised anxiety disorder, it belongs to the group of anxiety disorders. It is the most frequently occurring group of illnesses in psychiatry. Approximately 10 per cent of men and 20 per cent of women fulfil the criteria for some form of anxiety disorder at some point within a year [1]. The Health Observatory OBSAN puts the frequency of panic disorder in Switzerland at 3.1 per cent, with women being affected twice as often as men. The figures were particularly high among young women aged 15 to 24 (9.9 per cent) [2].

In addition to gender, there are various other statistical risk factors, namely other mental illnesses. For example, depression is usually accompanied by anxiety symptoms, often in the form of panic attacks. These usually disappear again once the depression has subsided. Persistent stress can also manifest itself in the form of a panic disorder. In addition, personalities with a great need for control and high demands on themselves are more frequently affected.

What treatment options are available to people with panic attacks?

The treatment of isolated panic disorder is the domain of behavioural therapy, which is based on a learning psychology approach: Sufferers should "learn" that although panic attacks are extremely unpleasant, they are completely harmless and always subside spontaneously. The more often it is experienced that the fear passes and nothing of what was feared during the attack has happened, the more likely it is that the fear will recede and the attacks will become less frequent. However, this presupposes that the panic attacks are experienced and, to a certain extent, endured. As soon as they are interrupted, for example by distraction, avoidance or taking emergency medication, this learning process is interrupted. It therefore goes without saying that this therapy requires a good therapist-patient relationship.

Many other therapeutic approaches are also promising. Newer methods work with acceptance-based approaches, for example, which focus on accepting the various feelings, thoughts and body sensations during anxiety as non-judgementally as possible. In this understanding, the psychological distress is primarily caused by the inner fight against the anxiety symptoms (because they are unpleasant) and not by the anxiety itself.

The attack can be interrupted with emergency medication. However, in addition to the above-mentioned disadvantage of the lack of a learning effect, these tranquillisers are often addictive. Certain antidepressants or lavender oil preparations, on the other hand, are established and effective basic medications for reducing the frequency and intensity of attacks.

What can people do to prevent panic attacks or deal with them when they occur?