Reflections on Panic Attacks
Panic attacks and bouts of intense anxiety/fear are debilitating and frightening experiences. These intense symptoms are felt to appear “out of the blue” by their unforeseen triggers and sudden, dangerous onset. Panic attacks are characterized by sudden or unexpected bouts of extreme fear/anxiety paralleled with shortness of breath, constricted breathing, catastrophic thinking, accelerated heart rate, sweating, trembling, and/or fear of loss of control or death. Although there is research to suggest panic attacks are more prevalent among Caucasian persons, these symptoms are not selective in their aim to overwhelm and disrupt any person’s psyche (Asnaani et al., 2009).
Most psychotherapies that address panic attacks focus on modifying expectations about danger and reducing the immediate anticipation of a panic attack, disrupting the vicious cycle of fearing fear. Such treatment benefits are achieved via methods like breathing retraining, mindfulness exercises, and directed attention to bodily sensations with the aim of relaxation (Roth, 2010). No matter the type of treatment, one might reduce the severity of their panic attacks or bouts of fear/anxiety by concentrating on the triggers. More specifically, one route of care is to reflect on the subconscious meaning of the panic attack and/or trigger that causes feelings of suffocation, doom, and being utterly overwhelmed (Busch et al., 2012). Interpretations about panic attacks and a developed capacity for reflective functioning are frequently used in various forms of psychotherapy, and they correlate with improvements in panic symptoms, interpersonal distress and the misinterpretation of bodily signals (Milrod et al., 2007; Barber et al., 2020; Keefe et al., 2019). For example, if one endures a panic attack after an argument with a loved one it may be of use to reflect afterwards about the reasons for the panic attack. For some persons, the idea that their own raw emotions (e.g., anger, rage, disappointment) might bleed into another person (i.e., loved one) and cause destruction of their mental state or the relationship itself triggers old wounds of abandonment, trauma or rejection. In this form, panic attacks may serve two purposes: 1) to alert the person what wounds are bruised and/or 2) punishing a person for engaging with their raw emotions by causing intense fear/anxiety about their capacity to destroy. Research shows that emotional and meaningful engagement in a psychotherapy alliance that prioritizes the processing of raw emotions correlates with greater psychosocial functioning and decreased panic attack symptoms (Keefe et al., 2019).
If you would like to receive help with your panic attack symptoms, and the complicated life that can develop around intense fear/anxiety, please considering consulting with the clinicians at Town Center Psychology. You are not alone!
Asnaani, A., Gutner, C. A., Hinton, D. E., & Hofmann, S. G. (2009). Panic disorder, panic attacks and panic attack symptoms across race-ethnic groups: Results of the collaborative psychiatric epidemiology studies. CNS Neuroscience & Therapeutics, 15(3), 249-254. http://dx.doi.org.portal.lib.fit.edu/10.1111/j.1755-5949.2009.00092.x
Barber, J. P., Milrod, B., Gallop, R., Solomonov, N., Rudden, M. G., McCarthy, K. S., & Chambless, D. L. (2020). Processes of therapeutic change: Results from the cornell-penn study of psychotherapies for panic disorder. Journal of Counseling Psychology, 67(2), 222-231. http://dx.doi.org.portal.lib.fit.edu/10.1037/cou0000417
Busch, F. N., Milrod, B. L., Singer, M. G., & Aronson, A. C. (2012). Manual of panic focused psychodynamic psychotherapy – extended range. Routledge
Keefe, J. R., Solomonov, N., Derubeis, R. J., Phillips, A. C., Busch, F. N., Barber, J. P., Chambless, D. L., & Milrod, B. L. (2019). Focus is key: Panic-focused interpretations are associated with symptomatic improvement in panic-focused psychodynamic psychotherapy. Psychotherapy Research, 29(8), 1033-1044. http://dx.doi.org.portal.lib.fit.edu/10.1080/10503307.2018.1464682
Keefe, J. R., Huque, Z. M., DeRubeis, R. J., Barber, J. P., Milrod, B. L., & Chambless, D. L. (2019). In-session emotional expression predicts symptomatic and panic-specific reflective functioning improvements in panic-focused psychodynamic psychotherapy. Psychotherapy, 56(4), 514-525. http://dx.doi.org.portal.lib.fit.edu/10.1037/pst0000215
Milrod, B., Leon, A. C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., Aronson, A., Singer, M., Turchin, W., Klass, E. T., Graf, E., Teres, J. J., & Shear, M. K. (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. The American Journal of Psychiatry, 164(2), 265-272. http://dx.doi.org.portal.lib.fit.edu/10.1176/appi.ajp.164.2.265
Roth, W. T. (2010). Diversity of effective treatments of panic attacks: What do they have in common? Depression and Anxiety, 27(1), 5-11. http://dx.doi.org.portal.lib.fit.edu/10.1002/da.20601