Anxiety attack: causes, symptoms and treatment

An anxiety attack (also called an anxiety attack or panic attack), usually occurs without an apparent trigger. It can be due to accumulated stress, having suffered previous attacks, etc. When these attacks are recurrent and unforeseen, we speak of a panic disorder.

In this article, however, we will focus on the anxiety attack itself. We will explain what it consists of and talk about its causes, symptoms and treatments.

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Anxiety attack: what does it consist of?

In an anxiety attack, the subject feels overwhelmed, with a sensation of shortness of breath, in tension, with rapid breathing, on the verge of losing control, dizzy... (the symptoms may vary from one person to another), but the fundamental thing is that it is very difficult to control, and that once it appears, it is best to let it pass (yes, helping the person to breathe, to sit in a secluded place, etc.).

Thus, technically and according to DSM-5, an anxiety attack is a sudden appearance of fear and / or intense discomfort. This fear or discomfort reaches its maximum expression in a matter of minutes; In these minutes a series of characteristic symptoms appear, which we will see a little later. These symptoms include: palpitations, fear of dying, chills, nausea, feeling of suffocation, trembling or shaking, etc.

On the other hand, in a panic attack, the sudden appearance of symptoms can occur from a state of either anxiety or calm. In addition, the DSM makes it explicit that the panic attack, although it generally appears with fear and / or anxiety, these two are not essential requirements. It is about "fearless panic attacks."

Having more than one anxiety attack over time (that is, anxiety or panic attacks appear unforeseen and recurrent), allows the diagnosis of panic disorder (DSM-5), if other criteria.

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Causes

The causes of panic attacks can be very diverse. There are different explanatory theories in this regard.

1. Genetic models

Genetic models of anxiety propose that there is a certain predisposition to suffer an anxiety disorder in some people; what they say, more specifically, is that we inherit a vulnerability to develop an anxiety disorder in general (that is, it is not that we inherit the disorder itself).

This could occur with panic attacks (remember that the panic attack in DSM-5 ceases to constitute a specific disorder to become a specifier of other disorders).

2. Neurobiological models

Neurobiological models of anxiety propose the existence of alterations in some brain substances, such as GABA (gamma-amino-butyric acid) as the origin of some anxiety disorders.

3. Neuroendocrine models

These models suggest that stress and anxiety states involve a greater secretion of some substances., such as: thyroxine, cortisol, and catecholamines. Thus, a hypersecretion of cortisol occurs.

4. Learning models

There are also learning theories, which refer to classical and operant conditioning processes as the origin of some anxiety disorders, including anxiety attacks.

That is, due to certain traumatic experiences, we can end up developing an anxiety disorder, for example. If, for example, we suffer an anxiety attack, the fear of suffering it again can end triggering another anxiety attack, or an anxiety disorder (such as agoraphobia or panic disorder).

Symptoms

We have seen what an anxiety attack is and what are some of its possible causes, but, what are your symptoms?

The DSM-5 makes it clear that the symptoms that appear in a panic attack (which must be 4 or more), are some of the following:

• Palpitations, pounding of the heart, or racing heart rate.
• Sweating
• Shaking or shaking.
• Feeling of shortness of breath or suffocation.
• Feeling of suffocation
• Pain or discomfort in the chest.
• Nausea or abdominal discomfort.
• Feeling dizzy, unsteady, light-headed, or fainting.
• Chills or feeling hot
• Paresthesias (numbness or tingling sensation).
• Derealization (feeling of unreality) or depersonalization (separating from oneself).
• Fear of losing control or "going crazy."
• Affraid to die

Treatments

The most complete treatment (and considered of choice) to treat panic attacks is a multicomponent cognitive-behavioral treatment. Although other psychological orientations can be used (for example psychoanalysis), we will explain this model as it is the most effective and used.

This type of treatment includes various therapeutic elements, which we will briefly explain below (to apply it, but, it will always be necessary to be properly trained in the treatment in question and under clinical supervision if you do not have the experience adequate). These elements are the following.

1. Psychoeducation

Psychoeducation implies "educating the patient in his disorder and in adapting it." It consists in teaching the patient to identify the manifestations of a possible panic attack, and in explaining the basis for such manifestations. It also explains what the treatment plan will be.

2. Interoceptive exposure

It implies that the patient can experience the sensations of a panic attack (or similar sensations) in a controlled and provoked way; the patient should focus on these sensations rather than avoid them.

3. Cognitive restructuring

Cognitive restructuring, a key technique in cognitive-behavioral psychotherapy, consists of teaching the patient to identify and test his catastrophic interpretations of the bodily sensations that experiment. That is, the patient must learn to "relativize" these feelings associated with the panic attack.

4. Controlled breathing

Controlled breathing is another of the therapeutic elements to tackle an anxiety attack (or the fear of suffering it). It consists of breathing slowly and regularly with the diaphragm, through short inspirations and long exhalations.

A short pause should be made with each breath. In addition, it is important that this is done (breathing) through the nose, and not through the mouth (it is recommended that it be between 8 and 12 times per minute).

5. Applied relaxation

Finally, the last element of the cognitive-behavioral multicomponent treatment for anxiety attack is applied relaxation. This consists of progressive muscle relaxation (a specific program) and applying it in situations where the patient feels that she "may" have an anxiety attack (this is called "live practice"). This will be done hierarchically.

Treatment comments

Although in this article we have discussed the treatment of choice for treating anxiety attacks, it is clearly not the only one. You can also resort to psychopharmacology, for example (Anxiolytics and antidepressants are usually used), although complementary and / or support psychological therapy is always recommended, so that the changes produced are profound and lasting.

On the other hand, the exposure technique will be essential in these cases (that is, that the patient is exposed to situations that may generate anxiety, or that can trigger an anxiety attack, although it is not easy, because normally there is no specific trigger), together with relaxation and breathing techniques that allow the patient to gain awareness and control over their body and their sensations bodily.

Bibliographic references

• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
• Belloch, A.; Sandín, B. And Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
• Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Madrid. XXI century