Anxiety and Panic Attacks
Both physical and psychological stress can produce anxiety. Often stress and the feeling of anxiety that comes with it can be quite subtle, but this is when a person becomes more vulnerable to a panic attack.
A panic attack is a sudden spell when you feel frightened, anxious or terrified in a situation when most people would not feel afraid. When the panic becomes severe, most people try to deal with it by escaping the situation in which it arose, hoping that the anxiety will subside. They may also look for help from someone who could look after them in case they collapse, have a heart attack, or go crazy. Alternatively, others prefer to retreat somewhere alone so they don’t embarrass themselves in some way in case people notice they are having a panic attack.
Panics rarely come out of the blue. Even the worst attack usually occurs during a time when the person is under emotional pressure, unwell (e.g., recovering from the flu), or when they are physically tired and exhausted, beginning to feel at the end of their tether.
The Link Between Hyperventilation and Anxiety
Within the context of the fight or flight response when the body prepares to deal with a perceived threat, the body’s natural anxiety alarm involves an increase in breathing. This over-breathing is called hyperventilation and it makes many of the symptoms of a panic attack much worse than they otherwise would be. These symptoms are important because people fear the occurrence of the anxiety reaction even more than they fear danger in a feared situation.
To understand the role of hyperventilation during a panic attack, it is important to understand the mechanism of breathing in general. Breathing ‘‘too much’’ has the effect of decreasing the levels of carbon dioxide, while breathing ‘‘too little’’ has the effect of increasing levels of carbon dioxide. The body works best when there is a balance between oxygen and carbon dioxide. When you hyperventilate (over-breathe), you end up with more oxygen than carbon dioxide in your blood. When this imbalance happens a number of changes in the body occur, such as:
- Things around you seem unreal
- Increased heart rate
- Tingling, ‘‘pins and needles’’ or numbness in hands, feet or face
- Sweating hands
- Dry mouth or throat
The sensations produced by hyperventilation and the symptoms commonly reported in panic attacks are very similar. It is also very common for people to mistake hyperventilation as a sign of a serious physical problem such as a heart attack. When they do this, their anxiety increases, they start hyperventilating even more, and their symptoms worsen or prolong .
It is important to remember that hyperventilation produces physical sensations that are distressing and frightening but they are not dangerous. Although the physical sensations are physically unpleasant, they will not harm you. When you stop hyperventilating, the sensations will go away and the panic attack will subside.
- Breathing too quickly (e.g. more than 12 times/minute). Some people do this regularly without even realizing it.
- Feeling anxious and worried for a prolonged period of time.
- Eating irregularly because this causes low blood pressure and low sugar levels which can affect breathing patterns.
- Smoking or drinking too much
- Not getting enough sleep
- Breathing too deeply (through the chest) or through the mouth on a regular basis
- Physical strain and exercise
The first step in preventing and controlling hyperventilation is to recognize how and when you over-breathe. You can do this by monitoring your rate of breathing at several different times during the day. Note that the regular sate is 10-12 breaths per minute.
The technique below is to be used as soon as you recognize the first signs of anxiety or panic. It is important to learn to recognize over-breathing because it is much harder to perform slow breathing once you are in the middle of a full-blown panic attack:
Slow Breathing For Reducing Panic
- Stop what you are doing and sit down or lean against something.
- Breathe through the nose in a smooth, light way.
- Hold your breath for 10 seconds (don’t take a deep breath)
- Breathe out through the nose and say to yourself the word “relax” in a calm soothing manner.
- Breathe in for 3 seconds and breathe out for 3 seconds.
- Repeat this 10 times (one minute).
- At the end of the 1-minute cycle (after 10 breaths), hold your breath again for 10 seconds.
- Continue with a few more another 1-minute cycles
If you do this technique as soon as you notice the first signs of over-breathing, physical symptoms should subside within a few minutes. The more you practice it, the better you will become at using it to bring your fear under control. Ultimately, your goal should be to stay calm and prevent anxiety and fear from developing into panic. To do this, try to identify the very first symptoms of hyperventilation, and the moment you start experiencing them, use the above slow breathing immediately.
Key Points About Hyperventilation:
The most significant effects of hyperventilation are not produced from too much oxygen, but from a marked drop in carbon dioxide. When you breath in deeply or rapidly, you inhale a lot of oxygen in your system, whereas when you exhale or hold your breath, your body is producing carbon dioxide. To reduce hyperventilation, you are trying to reduce oxygen intake and increase production of carbon dioxide.
The physical effects of hyperventilation fall into two categories: those on the brain (dizziness, light-headedness, confusion, blurred vision) and on the body (increased heartrate, breathlessness, numbness, cold or sweaty hands, stiff muscles).
Hyperventilation may not always come on for obvious reasons but can build up in a subtle way. A person may have been over breathing for quite some time and the body was able to compensate for the drop in carbon dioxide for a while, but eventually even a slight change in breathing (e.g. a yawn or a sigh) can trigger the symptoms. This will then seem as a sudden onset.
Most importantly: Although hyperventilation may feel terrible, it is not dangerous. Severe anxiety alone does not harm you physically.
Adapted from The Treatment of Anxiety Disorders: Clinician Guides and Patient Manuals, 2nd ed. (2012). By Gavin Andrews, Mark Creamer, Rocco Crino, Caroline Hunt, Lisa Lampe, and Andrew Page.