Dossier: Strong mind

What to do if you suffer from panic attacks

If you’ve ever had a panic attack, you’ll know the scary symptoms of a racing heart, breathlessness and fear of death. Dr Joe Hättenschwiler, head physician at the Centre for the Treatment of Anxiety Disorders and Depression Zurich (ZADZ), talks about the causes and symptoms of panic attacks and how to manage them.

Text: Katharina Rilling; photo: iStock

Dr Hättenschwiler, when does anxiety become a problem?

Anxiety is not necessarily negative; it is a natural emotion. It is a healthy reaction to stressful or dangerous situations. Anxiety only becomes a disorder when it occurs without real danger, i.e. when it is hard to understand what brings it on. And also when it occurs too often and lasts too long. It becomes a problem if it causes someone to avoid specific situations and ultimately hinders daily life. 

How do panic attacks differ from other forms of anxiety? And what do they feel like?

Panic attacks come on very suddenly. The symptoms, including heart palpitations, difficulty breathing, feeling of tightness in the chest and throat, dizziness, shaking, dry mouth, nausea and vomiting, occur without warning. Those affected often sweat profusely and have an enormous fear of suffering a heart attack or even dying.

Some people are also terrified that the panic will drive them mad and make them lose control of their actions. Attacks can be so severe that even people who are familiar with having them believe that their life is at risk at that moment. The length of panic attacks varies considerably, but most last between 10 and 30 minutes. 

Panic attacks feel very threatening. Are they actually dangerous?

Even though panic attacks are perceived as very unpleasant and frightening by those affected, they are usually not dangerous and do not indicate a heart attack or stroke, for example.

SOS tips: what helps with panic attacks?

Breathing and muscles 
Focus on deep and calm abdominal breathing, consciously relax the muscles all over the body. 

Reality check
Remind yourself that it is not a physical threat, but a panic attack. You are experiencing acute anxiety that will pass.

Don’t run away
Many sufferers find it helps to focus on their surroundings. Anyone suffering a panic attack is recommended to go through it on the spot or find a quiet place nearby. If you run away, it is possible that you will associate this place with the panic attack and there is a risk that you will avoid that place in the future. This way, you will be increasingly restricted. 

After the attack, seek help
If panic attacks occur repeatedly and have a negative impact on your daily life, you should consult a doctor.

Further information and tips on how to manage panic attacks:

They say that the panic attacks come on suddenly without warning. So, is it possible to say what triggers a panic attack?

Panic attacks often occur out of nowhere, but in the majority of cases situations with large crowds, crowded department stores, public transport or narrow spaces such as lifts are typical triggers. But panic attacks can occur anywhere – even at home or while you’re sleeping.

Many sufferers find having a panic attack so distressing that they avoid situations they associate with previous panic attacks as much as possible. This can eventually lead to agoraphobia, i.e. the fear of situations from which it is difficult for them to escape in an emergency or where it is difficult to get help.

How do people feel after they have suffered a panic attack? 

They often feel tired, drained and empty. Many people feel ashamed, thinking that they have shown weakness and that those around them have noticed the physical changes that accompany the panic attack. In most cases, however, the attacks are perceived much more strongly by the patients than by people around them.

“Many people who suffer from panic attacks have experience and know what can help”
Dr Joe Hättenschwiler, chief consultant at the Centre for the Treatment of Anxiety Disorders and Depression Zurich

What is the best thing to do if you are out with someone who is having a panic attack?

It is important to keep calm yourself, turn to the person in question and take their complaints seriously. Talk to them and guide them into regular, deep abdominal breathing. This calm approach can quickly help ease the panic. Ask how you can help. Many people who suffer from panic attacks have experience and know what can help. If the panic attack persists, professional help should be sought. 

Can anyone suffer from panic attacks?

When it comes to anxiety, genetics play a major role. Anxiety disorders can be hereditary or may result from behaviour copied from caregivers. Triggers can also include stressful situations, such as conflict, separation or financial difficulties. Psychosocial factors can also play a role, such as violence in the family and experiences of abuse or loss. Some people simply have a very sensitive nervous system, including a hypersensitive fear centre in the brain, which makes them react to stimuli much more intensely than others. 

Personality traits, such as being a perfectionist or not being able to say no, can also cause stress, which can subsequently also promote anxiety. In addition, physical diseases such as thyroid dysfunction or hormonal changes during menopause can play a role.

“Getting enough sleep and eating a balanced diet can help prevent panic attacks”
Dr Joe Hättenschwiler

Genes cannot be reprogrammed. What can you do to prevent panic attacks? 

Stress, emotional strain and negative thinking play an important role in the development of panic attacks and thus also panic disorder. I therefore advise people who suffer from panic attacks to rethink their lifestyle. Permanent stress leads to states of tension, which promote the development of panic attacks. Sport, on the other hand, breaks down stress hormones. 

Relaxation techniques such as progressive muscle relaxation, yoga or autogenic training can also help. Getting enough sleep and eating a balanced diet can help prevent panic attacks. You should also reduce your caffeine, tobacco and alcohol intake and stay away from drugs.

If you’ve had a panic attack, do you need to be prepared for more?

Panic attacks can occur once or at long intervals. When they occur repeatedly, it is known as panic disorder. Like all anxiety disorders, it is treatable.

What are the treatment options and chances of recovery?

If diagnosed early and correctly, panic attacks and panic disorders are easily treatable with psychotherapy, for example cognitive behavioural therapy or pharmacotherapy (medication such as SSRI, SNRI). Benzodiazepines, known as anxiety relievers, help with acute panic attacks. However, they should generally only be taken for a short period of time in consultation with the doctor as they can be addictive. For long-term treatment, we prescribe anti-anxiety antidepressants.

The interviewee

Dr Joe Hättenschwiler is a psychiatrist and psychotherapist / chief consultant and director of ZADZ AG, Centre for the Treatment of Anxiety Disorders and Depression Zurich.