Did that panic attack really come from out of the blue? Nope.

Monday, September 19, 2011

They can seem like they come with no forewarning, for no reason, but there's a back story to every panic attack. It might involve caffeine or alcohol or other drugs, or a period of heightened stress, or a genetic predisposition to panic. We know these things. Now we also know that panic attacks are presaged by measurable physiological activity. According to a new Atlantic article:

Though those who panic don't realize it, their attacks are in fact foreshadowed by minute physiological signals, according to a study led by Southern Methodist University's Alicia Meuret in the journal Biological Psychiatry. "The hour before panic onset was marked by subtle but significant waves of changes in patient's breathing and cardiac activity, not just the moment of onset of the attack or even during the attack," she says. "Our analysis provided us with a whole different pattern."

That pattern goes like this: Physiological instabilities occur in repeated bouts or waves and are often initiated by heart rate accelerations, followed by changes in breathing and carbon dioxide levels. Ultimately, breathing becomes much shallower, causing a spike in carbon dioxide levels that lead to symptoms that could no longer escape the attention of those who panic.
More precisely, they experience terrifying sensations, such as dizziness, air hunger, and shortness of breath.

...the researchers could still not determine why sufferers are unable to perceive panic attacks earlier. But some clues did emerge from the physiological patterns they observed. During recurring bouts, the body may be silently fighting off physiological instabilities that "return to a baseline but then restart," Meuret says. As a result, only one wave of disruption, the one that could no longer be pacified in secret, is felt. A gradual crescendo of anxiety never occurs, and the panic attack appears to have come out of nowhere.

UCLA anxiety expert Emanuel Maidenberg says this research may inspire new coping methods. He says since autonomic arousal symptoms precede awareness, the therapeutic practice of identifying and reexamining fears may potentially be initiated earlier, so patients could pursue threatening activities head-on.
The more we pay attention, it seems, the earlier we may be able to get started heading off panic at the pass. Perhaps even more important: While the physiological changes leading up to panic may continue during the attack, they're no more dangerous than what's come before:

...the researchers did not find any indications that physical changes during panic attacks were all that extreme. Meuret says that the fluctuations in heart rate and breathing were significant, but they never spiked to damaging levels....

So would telling the anxious that 'the worst is over' when they panic help? Yes, says Meuret. "Based on our findings, this would indeed be very true."
So, you know, yay panic!