The British singer Adele, fresh from divorce, said she was assaulted by strong feelings of guilt. She suffers from panic attacks and, to fight back, she dived into daily fitness practices (“I lost 45 pounds in the gym to fight panic attacks,” said by Oprah Winfrey). Often the terms panic and anxiety attacks they are used interchangeably. In fact it is about two situations with obvious differences, also because “anxiety is an absolutely normal emotion, which we all experience more or less in particular moments of our life, and which has an important adaptive function. Not all so-called anxiety crises are therefore something ‘pathological’ or something to worry about “, explains Dr. Gabriele Melli, Director of the IPSICO Institute of Florence and National Secretary of CBT-Italy, Italian Society of Cognitive Behavioral Psychotherapy.
“The case of a panic attack is different, which is not simply a moment of intense anxiety, but a phenomenon perceived as uncontrollable, ‘devastating’. A set of very intense emotional states and extreme and unusual physical sensations (crazy heart, tremors, fainting, foggy head, etc.) that alarm the person, especially when they arise for the first time. In fact, many not knowing that they are facing a panic attack require emergency medical interventions, convinced that they have a heart attack or a stroke in progress, or that they are going crazy and losing control. The panic attack is a terrible experience, sometimes very traumatic, so much so that those who experience it even once live with the terror that it will reappear at the least opportune moment. The so-called agoraphobia almost always follows: the tendency to avoid all those situations from which it would not be easy to get away quickly, if the attack were to arise, or in which it would be difficult to get help. Crowded (such as stadiums, concerts, markets, shopping centers, etc.), confined (e.g., trains, planes, ships, buses, etc.) or dispersed (such as large squares, woods, mountains, and so on) can become difficult to attend, especially if alone. In some cases, even being at home without company can be a problem. In short, panic, or rather the fear of experiencing it, turns into an increasingly narrow cage, significantly impacting the quality of life and independence of the person.”.
Is the panic attack the most striking expression of an accumulation of tension and discomfort?
“Not necessarily. It is true that an accumulation of stress and nervous tension can be, and often is, the trigger of the first panic attack, but sometimes organic aspects can come into play, such as hyperthyroidism, low blood pressure, digestive difficulties and hiatal hernias – just to name a few – or environmental ones, such as sultry heat, artificial lighting, poor oxygenation in closed places and so on. These factors are responsible for the sudden altered physical sensations, already mentioned above, of which the person becomes very frightened. The fright, in turn, amplifies the sensations and creates others that are closely related to the emotion of anxiety, triggering a vicious circle that leads to the actual panic attack. In predisposed people, therefore, attacks can be triggered in an unexpected and apparently unjustifiable way by specific stressors, but then they themselves become a great stress, due to the fear of their occurrence and the limitations described above “.
How widespread is this phenomenon?
“If anxiety, even strong, is a universal and normal phenomenon, the real panic disorder, the one that requires clinical attention and that implies the presence of repeated attacks and the fear that these will occur, it affects at least 2-3% of the population. A figure that is constantly increasing, perhaps because those who suffer from it are not ashamed as in the past to talk about it both with professionals and with friends and relatives. Or even publicly, as Adele did. These openings by public figures are welcome, because there is nothing worse than having a problem like this, well known and also treatable in the vast majority of cases, and keeping it secret, without asking for help ”.
Are there any warning signs that can lead to a panic attack?
“By definition, a panic attack is unexpected and unpredictable, so it doesn’t mean there are any such signs. Indeed, what often happens is that those who have suffered from it, even just once, monitor every bodily sensation and tend to interpret it as an imminent attack, becoming excessively alarmed even by harmless somatic alterations, such as a simple dizziness. It is therefore not useful to worry about the warning signs, rather it is necessary to come to consider panic attacks as something unwelcome but not dangerous, to accept should they show up, just waiting for them to pass, like a bad headache “.
What psychotherapeutic approaches can be indicated? What other strategies can they be combined with?
“Psychotherapy is undoubtedly the main strategy for dealing with panic disorder and the resulting agoraphobia. The approach that has proved most effective, in numerous scientific studies, is the cognitive-behavioral one, which can give results in a relatively short time and which focuses the work primarily on the problem presented. The good news is that you don’t need years of analysis and endless research on the alleged causes of the phenomenon, but above all useful and functional strategies to deal with the problem and free yourself from the trap of anxiety. Undoubtedly, intense physical activity (which instead is usually avoided by those suffering from panic attacks), as well as relaxation techniques such as autogenic training or Jacobson, and above all mindfulness meditation. Just as it is counterproductive to avoid all those situations, including rest, in which the attack is feared, because these are all elements that in the long term maintain and worsen the problem “.