When people talk about anxiety attacks and panic attacks, they often use the terms interchangeably. However, although anxiety attacks and panic attacks are similar in certain ways, both terms refer to different things. This blog will look at some of the key differences between anxiety and panic attacks and identify the clinical differences, to help readers gain an accurate understanding of the two terms. In addition, the blog will also look at the different ways to treat anxiety and panic attacks.
While both share some symptoms, such as increased heart rate and shortness of breath, anxiety and panic attacks are both unique in their own way.
Generally speaking, anxiety attacks occur in anticipation of something happening. For instance, an anxiety attack may occur prior to public speaking, rather than in the act of doing so. Anxiety attacks are related to our primal instincts and the ways in which we are designed to respond to threats or danger. Symptoms can include:
Panic attacks are more sudden and can happen without prior warning. Often they will occur when someone is triggered by emotional trauma or a phobia. In addition, panic attacks can be intensely physical, with people sometimes mistaking them for heart-related conditions, such as cardiac arrest. Common physical side effects include:
Mental health specialists who treat anxiety and panic attacks do so using the Manual of Mental Health Disorders (DSM-5). In the DSM-5, panic attacks are referred to as an overarching symptom of panic disorder, although panic attacks can occur without having panic disorder. Panic disorder is characterised by regular sudden attacks of panic or fear, an intense fear of another panic attack occurring and/or misattributing panic symptoms to mean there is something seriously wrong with their health. Usually people suffering from panic will worry they are having a heart attack or they will stop breathing, but of course none of this is true. Panic symptoms are part of an internal threat system which is only active when it thinks you need protecting. It is not trying to harm you.
On the other hand, anxiety attacks are observed as being much more generalised, usually stemming from a type of anxiety disorder, as opposed to being a disorder in its own right. Anxiety attacks can tend to come on more gradually than panic attacks, and typically those who experience anxiety attacks understand that the anxiety is a result of their anxiety disorder. However, it is also possible to experience an anxiety attack without meeting the criteria of an anxiety disorder diagnosis. Some anxiety disorders whereby people may experience anxiety attacks are as follows:
There are a wide range of treatments for anxiety. Some involve professional medical advice, and others you can practice from the comfort of your own home. Below are some tips and advice as well as some information on how to receive support for yourself or a loved one.
You might not be aware, but your lifestyle choices can significantly impact your anxiety levels. For instance, although it might be clear that your anxiety stems from a specific area of your life, such as work, it is important to take a wider angle view of your anxiety. Consider other factors in your life that may be perpetuating your anxiety and how adjustment in these areas could significantly reduce your anxiety overall.
By taking a step back and analysing your lifestyle, you can pinpoint important factors that may be triggering and keeping your anxiety going. Unhelpful lifestyle habits that can perpetuate anxiety can include:
Although making lifestyle changes might not necessarily eliminate your anxiety altogether, it can significantly reduce anxiety symptoms.
There is a large evidence base that supports the use of psychotherapy to treat anxiety. Psychotherapists are trained professionals that can help the individual explore their experience, understand where it stems from, what triggers it, what is keeping it going and what changes are necessary to help them manage better. Some options include:
CBT is a world-renowned psychotherapy with a substantial amount of evidence supporting its effectiveness to treat anxiety. The UK has received international praise for making this option of therapy so widely accessible. CBT brings together two approaches, cognitive therapy and behaviour therapy. The cognitive part of CBT focuses on unhelpful thought patterns and how to adjust the way our thoughts respond to certain triggering situations. The behavioural part focuses on how unhelpful behavioural responses to triggering situations play an important role in maintaining anxiety and how adjusting these behaviours can break a vicious anxiety cycle.
The fundamental principle of CBT aims to show that it is not external events that cause our anxiety, but rather how we think, feel and behave in response to a given situation. So, for example, if you go for a job interview, it’s not the interview or the interviewer that causes you to have anxiety, but rather unhelpful thoughts about the interview or interviewer such as worries about being perceived negatively, not performing as well as you’d like or what it would mean to not get the job. In this case, CBT looks to understand why you might engage in such thought processes, what unhelpful behaviours these thoughts fuel and how to make helpful changes to both these areas.
Exposure therapy is a form of CBT and is often encompassed with CBT treatment of anxiety. Often when hearing the word exposure, many people feel afraid that this means sudden and direct exposure to their feared situation, but this is not true.
Exposure therapy takes a very gradual and graded approach, and the client will never be expected to engage in any exposure task that they do not wish to engage with. Exposure therapy involves controlled exposure to the client’s feared situations, starting with situations that trigger very low levels of anxiety. Exposure therapy will trigger some anxiety but evidence suggests that by remaining in such situations for long enough, your anxiety will automatically habituate, reducing to a very low level and reducing your overall anxiety response to this situation in the future.
There are two common exposure techniques used:
In-vivo is the most direct form of exposure therapy and focuses on gradual and graded exposure to various situations that may be triggering anxiety. The therapist will help the client learn about anxiety, the science behind it and why/how exposure therapy works. Following this, the therapist will create a list of exposure scenarios with the client and will then grade these situations from ‘most difficult’ to ‘easiest’ exposure task. They will then proceed with exposure work, starting with an exercise that is low on the list. For example, someone who has an irrational fear of dogs may decide to start with exposure to watching friendly dog videos on YouTube, as this is something that might cause them some anxiety. Once repeated exposure to this situation allows the anxiety to reduce, the client and therapist will then move to the next exposure exercise on the list.
Imaginal exposure therapy works on the same principles, helping patients engage with exposure exercises that are not possible to do in person. For example, if someone was afraid of flying in a plane, it may not be possible for them to engage in repeated in-vivo exposure, but what they can do is engage in imaginal exposure whereby they close their eyes and imagine exposure to that situation whilst being guided by their therapist.
Similarly to anxiety attacks, making changes to your lifestyle can help to reduce the onset of panic attacks. Studies have shown that a combination of exercise, healthy eating and good sleep can go a long way when dealing with panic disorder.
Not only can a lifestyle change help reduce the onset of a panic attack, but it can also help reduce the physical symptoms.
The psychotherapy treatments for panic attacks are similar in many ways to those of anxiety attacks, and therapies such as CBT and exposure are recommended to treat panic. Depending on the severity of the condition, sometimes patients will be prescribed medications including antidepressants, antianxiety drugs and benzodiazepines
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