What Is Behind Your Anxiety Attack?

Out of the blue, it happened. Julie’s (not her real name) heart pounded; she sweated profusely and could not catch her breath. Just as with the previous anxiety attacks, her fear became so intense she thought she was about to die as she drove into work. When she arrived at work ten minutes later she sat in her car until the trembling had ceased. Knowing that another attack could happen unexpectedly, she hesitated to get out of her car. She couldn’t bear the embarrassment of having an attack in front of coworkers in the hospital.

Perhaps, like Julie, you also experience panic attacks. Whether they seem to be related to some event or internal thoughts, they can leave you feeling drained and vulnerable.

Panic Attacks Take a Toll

While panic attacks usually do not last long, they can leave you feeling out of control of your life. They can appear to be self-perpetuating; just the fear of having an attack can prolong the symptoms.

Having an anxiety attack can be difficult to hide from others. They can see you gasping for breath and the sweat on your brow. Having these symptoms can undermine your sense of competence; instead you feel embarrassed, ashamed or weak because your body is doing things you do not want it to do. As a result, you withdraw from your coworkers; work is a lonely place for you.

To repeatedly feel as though you are going to die can be terrifying. This kind of shock to your nervous system can leave you exhausted and even more fearful of having another panic attack. You can begin to feel a sense of dread with even those activities that once brought you pleasure. Your world begins to feel smaller and tighter as you desperately attempt to try to avoid anything that could trigger anxiety attack.

Perhaps your anxiety attacks have been so severe and debilitating that a physician has advised the use medication. These may include benzodiazepines such as ativan, klonopin, valium or xanax. While these medications may help control the anxiety symptoms, they can become addictive and withdrawal can be difficult. You may be left wondering if the medicine is worth the risk.

Why Do Anxiety Attacks Happen?

Anxiety is an indicator that your nervous system is deregulated, which means it has temporarily lost its ability to relax after something frightening has occurred.

Like animals in the wild, you naturally want to fight, flee or freeze when you encounter danger. That danger could come from outside you, like a car headed into your path or from inside you like the thought that says, “I can’t bear to be home alone.” In these examples, without you thinking about which option to take, your body may act as though the best thing you can do is to get away, fast! The body automatically sends chemicals and nerve impulses speeding through your systems to make this happen. Heart and breath rates increase; muscles tighten in preparation to move; and digestion slows.

In the ideal world, your system will get to complete the flight response. If, in the face of the threat, fleeing is not possible because it’s too dangerous or there is not enough time or space, then you will get to complete the response after the threat has gone. This can look like shaking, fluctuations in body temperature, and involuntary running movements in your arms and legs. You know the flight response is complete when you can review the incident or fear-provoking thought, and you no longer have an urge to get away from or avoid a situation.

Anxiety happens when you are faced with a threat and you want to flee from it, but something happens that prevents you from doing this.. The threat could be something that happened fairly recently or many years ago. The incomplete flight response deregulates your nervous system so that a full blown attack can be catalyzed by another threat that subconsciously reminds you of the original threat.

How to Respond When You Become Anxious

1. If you are unsure if you are experiencing an anxiety attack, have a medical doctor check you out. Serious medical problems can have symptoms similar to an anxiety attack. While a trip to an emergency room may seem unnecessary if you are given a diagnosis of “just anxiety,” it is better to not take chances if you are uncertain as to the cause of the discomfort.

.2. Remind yourself that you will not die from an anxiety attack. The anxiety can be so great that you literally feel like you are going to die, but unless there are other serious medical problems that could be triggered by anxiety; it will not kill you.

3. If you have had more than one anxiety attack, remind yourself that they are usually short in duration. Knowing that symptoms usually begin to subside after 10 minutes can help ease the fear that comes when you think that there will be no end.

4. Redirect your attention to something comforting or pleasant. The quickest way to do this is to let your eyes go where they want to go as you look around your environment. When you extend this kind of invitation to yourself, more than likely you will find at least one object or scene that is pleasant. Once your eyes have settled on something, give it your full attention. Notice the colors, shapes, textures, pleasant memories or impressions that come with what you are focusing on. By shifting your attention away from the anxiety symptoms to something calming, your system will naturally begin to relax. Notice that this approach does not require that you tell yourself to relax; this rarely works and often has the opposite effect.

5. Work with a therapist who understands how to help your nervous system to become regulated again. While the therapist may inquire about times in your past when you felt overwhelmed or if you notice patterns when the anxiety attacks occur, you do not have to know the underlying causes of the anxiety. Focusing on a minor event, which results in you becoming mildly anxious can be used as a starting point for completing a flight response that is stuck in your nervous system.

But Wait…

I wake up feeling anxious almost every morning. I have done this for many years. Can working with a therapist help or should I just take medications?

Chronic anxiety can be challenging because it may seem as though you are anxious about nearly everything. Counseling that helps you to complete the flight response can be very effective. Whether medications are also needed may be influenced by how well you tolerate the anxiety symptoms and to what extent they interfere with daily functioning including your ability to sleep, concentrate and eat. Ideally, you will be able to make the decision in consultation with a counselor and psychiatrist who both understand how trauma affects the nervous system.

I think my childhood was pretty normal. I’m 20 years old and I don’t remember anything really bad happening so I’m not sure where the anxiety is coming from.

What triggered you to become anxious can be tucked away in your memory. It’s not uncommon to not remember some scary events that, if we had been bigger, stronger or more independent, we would have liked to run from.

In addition, what your mind says is “no big deal” could really have been quite overwhelming. Even fender benders can elicit a flight response; if you had known the car was coming your way you would have turned the wheel to move the car out of the way. Instead, the flight response is still stuck in your body and appears as anxiety whenever you get in the car.

Your anxiety could also be linked to a situation that on the surface seems like it was a good thing. For example, while you may be pleased that you received a scholarship to attend college, the move away from home could trigger anxiety about leaving familiar surroundings. Wondering about whether you will be able to succeed with the course work and make new friends can lead you to question some basic attitudes about your self that you used to take for granted.

What Happened to Julie?

By the time Julie came to see me she was having anxiety attacks several times a week. She told me that they usually happened when she was driving to work. As we looked more closely at the pattern of the attacks, she realized that they occurred on the days that her husband was going to be gone for a couple of nights on business.

In our sessions together, I invited Julie to remember a time when she felt very close to someone then to notice how that experience felt in her body as she talked about it. Julie’s face visibly relaxed and she noticed that her breathing slowed and deepened. Muscles in her legs relaxed, too. This approach helped to remind Julie’s nervous system that it does have the capacity to calm her. Julie was pleasantly surprised because she had come to think of herself as one jumble of nerves that had to keep moving.

Working with small segments of her story, I first invited her to notice how she felt when she just thought of the possibility that her husband might be leaving for a trip. Immediately, her chest and legs tightened. She continued to track what wanted to happen in her body. As she and I watched her feet began to make small movements, which Julie said reminded her of running. She wanted to run to the safety of her aunt’s house, and, in her mind, she let herself do this. After several minutes she felt exhausted. Even though she had not left the chair her nervous system had gone through a work out, releasing a lot of pent-up energy.

Over time as more energy was released, Julie began to grasp a new meaning of her anxious response. When her husband left, it reminded her of the time that her father suddenly left her mother when she was a young girl. At that time, she had nowhere to go to escape her mother’s grief and subsequent depression. The impulse to flee became locked in her nervous system; years later it showed up as anxiety attacks that came when her husband went away.

Near the end of our work, Julie’s anxiety attacks had subsided to just one or two a month. Driving to work was no longer a struggle and she no longer feared being with her coworkers. One coworker even noticed that she seemed to smile more and that patients seemed to relax more in Julie’s company. When Julie noticed that an attack was coming, she tried to stop what she was doing and become very curious about what was around her. She gave particular attention to what drew in her attention, whether it was an interesting pattern of light and shadows or the scents or sounds around her. By redirecting her attention away from the anxiety symptoms she was able to tolerate them better and to actually decrease the amount of time it took for her to come out of them.

Summary

Anxiety can show up when you are not able to get away from a threatening experience that may have happened recently or long ago.

The symptoms of an anxiety attack can be very similar to those caused by serious health problems. If you are not 100% sure that what you are experiencing is from anxiety, consult a physician.

Remind yourself that if you are having an anxiety attack that you will not die.

Remind yourself that the anxiety attack will most likely subside after 10 minutes.

During the attack, redirect your attention toward something that is pleasant, whether it is a memory or something you notice in your environment.

Next Step?

If you would like additional support reducing or eliminating the frequency or intensity of the anxiety attacks, consider working with a therapist who understands how nervous systems respond to and move through threatening experiences. Working with just changing how one thinks about the anxiety rarely is very effective.