Case Study Treatment For Panic Attacks –  Panic not Heart Attack?

I’m having a heart attack but it’s just Panic?

Many adolescents and adults end up in a hospital emergency department thinking they are having a heart attack only to be told it is anxiety. This can be very confusing as the physical symptoms of a panic attack are incredibly intense and terrifying with panic attack suffers frequently reporting an overwhelming sense that they are dying.

The physical symptoms of a panic attack include:

• shortness of breath
• chest pain
• dizziness
• blurred vision
• shaking
• sweating
• going pale
• an overwhelming sense of dread
• a fear of dying or having a heart attack

These same symptoms are frequently reported when someone is having a heart attack. This is very confusing and can create more anxiety when they are told to not present to hospital again and they need to see a psychologist. They ask themselves “Am I really having a panic attack?” ,or “is it panic not heart attack”?

Panic attack symptoms are not dangerous to your health. They are not a sign of your body failing or that you are about to die. Instead, the symptoms of a panic attack are actually a sign that your body’s safety system is working to protect you from something dangerous. Your body is actually working perfectly. This sounds very strange to the panic attack sufferer, how can feeling like I’m having a heart attack actually be a sign of my body and health being good?

To understand  panic attack; a story about a recent client may help to explain this.
I recently saw a young woman, Amelia who was suffering from panic attacks with an intense fear that she was having a heart attack. Prior to this Amelia was vivacious and care free. The idea of having a heart attack or being anxious about her health was completely foreign.

Unexpectedly Amelia was diagnosed with multiple sclerosis (MS) and given her young age this completely shook Amelia and her confidence in her body and health. Despite responding incredibly well to medical treatment, her MS symptoms being halted and her function returning to what was expected for a healthy young woman, Amelia remained extremely anxious about her health and began experiencing panic attacks.
Amelia presented to the hospital emergency department in the context of panic stating that she was convinced she was having a heart attack and dying. Following testing she was told conclusively that her heart was fine and that her symptoms were due to a panic attack. Amelia could not understand how her symptoms, chest pain, shortness of breath, dizziness, blurred vision could be due to anxiety rather than a real physical problem.
Amelia came to therapy highly motivated to understand what was going on and to get rid of it. She was desperate to return to being the carefree young woman she previously was and to not be so anxious about her health. I explained to Amelia that her symptoms were real and they did have a physical cause however it was actually a sign of her body trying to protect her and her bodies safety system working exceptionally well, too well in fact.
I challenged Amelia to interpret the symptoms of her panic as a sign of good physical health rather than a sign of possible death.

Fight or Flight Response

I explained to Amelia that the cause of her physical symptoms was the “fight or flight” system. This primal system is located at our brain stem level and is our body’s survival mechanism whenever danger is perceived. When this system is triggered a chain reaction occurs within our body called the HPA axis. This means that our bodies jump out of “cruise control” and into overdrive within less than a second, literally!

Instead of focusing on digesting our breakfast, with relaxed muscles, regular heart rate and breathing while we watch the Today show in our PJ’s, the HPA axis triggers our heart rate to accelerate which makes our breath shorten and increase. Instead of blood being sent to support our digestive system it is diverted away to our major muscle groups activating emergency energy supplies to make muscles jump into action ready to run away fast or fight. The secondary effect of these big changes in blood flow means that you can feel nauseous, dizzy and faint. The problem for Amelia was that this system was being triggered when it didn’t need to be, in the absence of any external danger.

We spent time exploring this chain of events – specifically for Amelia, we identified that she was engaging in body scanning. Basically Amelia would regularly “scan” her body to check for signs of it not working properly. Amelia would already be feeling anxious about her health when doing this so already her body was primed to be finding something dangerous and she would be experiencing some low level physical symptoms.

The problem here is that she would detect that her heart rate was increasing and she was starting to feel a little dizzy. Amelia would then interpret these body sensations as dangerous and the HPA axis would then be triggered and Amelia would then be spiralling into a full blown panic attack watching the Today show in her PJ’s.

We worked together to change these “catastrophic” interpretations about her body into seeing them as opportunities to see evidence that her body was working properly and her health being good. After mapping this out in session Amelia worked hard at changing her self-talk and within a fortnight her panic attacks had dramatically decreased. Amelia’s confidence in her body and her self-talk became rational and accurate and she continued to reduce her panic attacks and the vibrant young woman slowly returned

So in a nutshell if you are told its panic it’s not dangerous by a medical professional and an underlying heart problem has been medically ruled out, please feel reassured. Embrace those symptoms as a sign of your body being strong and healthy, doing what it is meant to when there is danger.

For more tips and strategies on How to Manage Panic Attacks, you may like to download our free eBook. This will help you get on your way to feeling in control of your anxiety. However, sometimes it’s hard to “go it alone”. If you find that you are still experiencing anxiety and just can’t seem to get on top of it, a psychologist can help and we strongly suggest you speak to your GP for a referral to a psychologist near you.