Spontaneous Panic

By Professor Kevin Gournay

Most people with anxiety states are simply more alert and aroused than the general population. The chemical processes which underlie anxiety are complex but essentially lead to the body being put into an optimum state of preparedness. One way of looking at anxiety is that the body goes into this state of preparedness without a rational external reason. For many anxiety sufferers, there is a simple cure that activates an attack. This may be the sight of a spider, the thought of going shopping or talking to a large group of people. Attacks of anxiety-like this can be managed by the exposure-based approaches which have been shown to be so effective. Therefore gradually facing one’s fears and avoided situations in graduated doses of difficulty, perhaps with some attempt to change how you think about such situations, will lead the body eventually becoming used to those situations and no longer producing the state of arousal.

However, some sufferers seem to experience surges in arousal for no apparent reason. I have come across a very large number of patients who have become physiologically very aroused and hence develop an anxiety state although there is no particular source of anxiety in their lives. Perhaps these people are more prone to produce adrenalin than some people and for some reason, their system becomes more prone to spontaneous panic attacks. The other group of people who are more prone to spontaneous panic attacks are those who repeatedly encounter anxiety linked to a particular phobia or obsession. In these cases, the repeated episodes of anxiety have a generalised effect and after a while, the body seems to just produce surges of adrenalin for no apparent reason.

What then does one do about this?

To begin with, one must look at simple factors that pre-dispose sufferers to panic attacks. Being hungry or tired can often be a factor and simply eating regularly and getting plenty of sleep is one remedy likewise, some people report that they are more prone to these apparently spontaneous panic attacks after indulging in alcohol the day before. This association has been known for some time but, it is becoming clearer that large numbers of anxiety sufferers can develop panic attacks in response to alcohol. More recently I have seen a number of patients who have developed such spontaneous panic attacks in the aftermath of taking illicit drugs such as Marijuana or Ecstasy. In the latter cases, I have seen a worrying number of young people who have developed the severest states of panic disorder after even an isolated intake of this drug.

Sometimes, spontaneous panic attacks are not really spontaneous. There is a great deal of research that shows that sometimes the arousal which occurs when one gets angry can be misinterpreted as anxiety and sometimes a panic attack may actually be a feeling of anger that presents itself a little later after the original event which caused the problem. Sometimes, there are other factors that may produce anxiety that are not so obvious. For example, one patient of mine recently developed spontaneous panic after seemingly making a good recovery from her agoraphobia. I asked her to keep a diary and eventually, we isolated the cause of these “spontaneous” panics. She had recently taken a new job and the bus journey to work which she was enjoying for the first time in many years passed a funeral parlour on a daily basis. She, therefore, glanced at the funeral parlour on the way to work and this activated a very long-standing fear of death, and cancer in particular (she had had four close family members die while she was a teenager). Thus, it became clear that this lady’s “spontaneous” panic was not really so spontaneous and she is in treatment for her long-standing fear.

However, some panics appear to be genuinely spontaneous. The first thing to do is to keep a diary and record these panics, trying to also note what may have come before them so as to isolate a cause. Secondly, keep a note of what you eat and drink. In some cases, panic may be triggered by the intake of alcohol (as mentioned prior) or lots of strong black coffee. If a diary-keeping exercise does not reveal a cause, think about ways of gradually reducing your base “level of arousal”. Although things like relaxation training and Yoga may be helpful, it is worth considering adding regular systematic exercise to your routines. There is a great deal of evidence that shows that regular exercise, a  minimum of 20 minutes, 3 times a week, can reduce states of high arousal. It is also worth looking at your pattern of breathing and seeing whether you are hyperventilating. It may be that you are breathing rather rapidly from the top of your chest and, some tell-tale signs are the presence of pins and needles, yawning and sighing, feeling tired, or having muscle cramps. The remedy for this malady is slow, but not deep, diaphragmatic breathing. The ‘No Panic’ help-line will assist you, if required, in learning some simple breathing exercises.

Finally, remember that panic can do you no real harm. Obviously, therefore one needs to look at how one thinks about such panics and whether there is a pattern of catastrophic thinking. Therefore, if for example, you think during a panic attack that you might die of a heart attack or stroke, this needs to be treated as an irrational thought and you should practice writing down your irrational thoughts and countering them with rational responses. Thus, as you go along, you should record the irrational thought and think about every other reasonable way of considering the situation. In the cases of someone whose thoughts are of their heart-stopping, one might respond by saying anxiety puts the body into an optimum state of preparedness, one’s heart muscle is in a very healthy condition during increased arousal. Or one may say I have had these panic attacks on numerous occasions and I have had the same thought and I am still alive!! Such simple self-help methods can often be successful however, if spontaneous panic and catastrophic thinking is a problem that will not respond to self-help strategies you should consider asking for a referral to a suitable cognitive behaviour therapist and, again, it may be worthwhile asking the No Panic helpline for advice. In some cases, medication can be useful but, although not a last resort, I would certainly not consider medication until the person showed themselves to be resistant to self-help and professional cognitive behavioural intervention. I would be very interested to hear from any of you who have developed your own strategies for dealing with spontaneous panic.

Professor Kevin Gournay is an Emeritus Professor at the Institute of Psychiatry. He has more than 35 years of experience and is the author of more than 130 articles and books. He is based in Cheshunt Hertfordshire.

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6 thoughts on “Spontaneous Panic”

  1. I have read most of your articles and have found them very insightful and helpful. My problems started with what I experienced as spontaneous panic attacks which occurred for no apparent reason, even when I was enjoying myself, and immediately escalated into full-on panic and fear of imminent death. This developed after a traumatic experience and a period of feeling very unwell for some months but once this initial period settled down, the panic condition developed. After many years of suffering these ‘spontaneous’ attacks and developing coping techniques through CBT, I am now of the opinion they were never really spontaneous in a straight forward sense. I went on to learn that they where triggered by situations, feelings, anxiety symptoms or a combination of these. This lead to an extremely quick or almost instant onset and an immediate overwhelming feeling of anxiety, instantly followed by horrible symptoms of derealisation, horrible sense of dread of death etc etc. Through a lot of work I managed to suppress the initial stage of the panic process (which still tended to happen spontaneously) but learned to tolerate these initial changes which, in a non straight forward way, led me to realise that the initial onset was down to a trigger that was being recognised subconsciously and then the anxiety was kicking in as a reaction to this. Being able to tolerate the initial trigger was very difficult with varying amounts of success and failure but I eventually proved to myself that the panic attacks were not strictly spontaneous but presented as such due to the speed of onset. Once I received help with my anxiety I began to sort it out after many many years of struggling and trying meds etc. The trouble is, is that we are all different and it’s my opinion that’s it’s how we interpret the anxiety symptoms and what we do ourselves to make sense of them that develop the complexity of the problem. After all, we need to trust our own interpretation of everything else in life and we are programmed to trust our own experience over what others tell us. Another problem is ‘believing’ advice and therapeutic approaches because it feels that the therapist has completely underestimated the very terrible nature of the anxiety condition. Advice to me felt like a person giving instructions from a safe place, like up a tower, when you are being confronted by a viscous lion – and the advice is “don’t worry, it’s tame and won’t bite you” not very convincing. Also words to describe the anxiety like ‘uncomfortable” and “problematic” adds to the sense that we are not talking about the same phenomenon. Anyway, despite all the objections that might be felt towards CBT techniques of habituation etc and ideas like ‘face the fear or feel the fear and do it anyway, in my opinion are the only effective approach I have found. They have worked for me but not in an easy way. I’ve gone on a bit but really meant to say that the usual CBT approach is a good way of tackling what appear to be spontaneous panic attacks. It’s a good tool to unpick the complex chain of events that happen in a split second. Never give up – You can beat panic. I still get the trigger feelings but they generally stay what they are – just uncomfortable feelings that no longer mean anything dangerous.

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