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
to a new job or concerns over a new relationship.
All these create anxiety as the person is concerned
about the future – fearing what could go wrong and
mulling possible consequences and repercussions,
instead of also considering probable positive outcomes.
Hence, it is natural that the terms ‘fear’ and ‘anxiety’
are commonly used interchangeably. However,
there is a distinction between these two terms.
Fear refers to an innate, almost biological-based
alarm response to a dangerous or life-threatening
situation. Anxiety, in contrast, is a more future-
oriented and global concern – it is sometimes
referred to as panic attacks.

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The term anxiety is about someone feeling
inordinately apprehensive, tense, and uneasy about
the prospect of something terrible happening.
Anxiety becomes a clinical concern when it
interferes with the ability to function in daily life as
the person enters a maladaptive state, characterised
by extreme physical and psychological reactions.
Panic attack
According to the Diagnostic and Statistic Manual
of Mental Disorder (DSM-IV-TR), a panic attack is a
period of intense fear or discomfort, during which
a person experiences four or more of the following
symptoms, which develop abruptly and reach a
peak within 10 minutes:
• palpitations, pounding heart or accelerated
heart rate;
• sweating;
• trembling or shaking;
• sensations of shortness of breath or smothering;
• feeling of choking;
• chest pain or discomfort;
• nausea or abdominal distress;
• 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.
department. So, she finally settled herself in the
area of public health.
The last category of panic attack is situational
predisposed panic attack where a person will have
situational panic attack but not every time. For
example, when you are standing in a closed and
dark room, the panic attack does not appear all the
time but it occurs randomly.
Medical perspective
In trying to understand the cause and strategy
to fight panic disorder, we should discuss both
biological and psychological perspective. However,
in this article, I will focus more on the psychological
perspective.
In the biological perspective, panic attack is
associated with excess of noreponephrine in the
amygdala, a structure in limbic system involved
in fear. Besides, the disorder derives from
defects in gamma-aminobutyric acid (GABA),
a neurotransmitter with inhibitory effects on
neurons.

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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According to anxiety sensitivity theory, people
with panic disorder tend to interpret cognitive
and somatic manifestation of stress and anxiety in
a catastrophic manner. For example, they feel that
they cannot breathe even though others feel the
situation is normal. This false alarm mechanism
causes the person to hyperventilate and the person
is thrown into a panicked state.
Turning to psychological perspective, we focus
on conditioned fear reactions as contributing to
the development of panic attacks. This person
relates bodily sensation with memories of the
last attack, causing a full-blown panic attack
to develop even before measurable biological
changes have occurred. Over time, the individual
begins to have panic attacks before the trigger
event happens.
David Barlow and his colleagues proposed in a
cognitive-behavioural model that anxiety becomes
an unmanageable problem for an individual
through the development of vicious cycle. The
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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Stress management techniques help in the
treatment of a panic disorder. In this approach, the
client learns to systematically alternate tensing and
relaxation of muscles all over the body, starting
from the forehead down to the feet.
After stress management techniques, the client
should be able to relax the whole body when
confronting a feared situation.
However, I like to use panic control therapy (PCT)
developed by Barlow and his colleagues. This
technique consists of cognitive restructuring,
the development of an awareness of bodily cues
associated with panic attacks and breathing
retraining.
Health Matter
I found that clients treated with PCT show marked
improvement, at levels comparable to improvement
shown by clients treated with anti-anxiety
medication. I would propose that the combination
of both anti-anxiety medication and PCT should
give a marked improvement among patients.
During my training in counselling and
psychotherapy, International Islamic University
Malaysia Professor of Psychology, Malik Badri,
explained the more comprehensive interventions
involving cognitive techniques.
He recommended in vivo exposure when treating
individual with panic disorders, especially those
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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