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November 2011

Carol Boulware, Ph.D

Feeling panic once or twice in our lives is not unusual. But, when it happens more frequently and with intensity, it may indicate that you have a serious anxiety problem that may need treatment. Panic Disorder, or panic attacks, can begin in the teenage years, early in adulthood or during periods of major stress in one’s life.

Panic attacks usually come without warning and without an apparent cause. The unpredictability of panic attacks often adds to the stress of dealing with them. The sufferer dreads a repeat of the unpleasant experience, and he or she may develop a fear of having another attack, in addition to the initial disorder.

The basis of panic attacks is fearful thoughts, often barely conscious to the sufferer, such as “No one will ever love me,” or “If I lose my job my life will be over.” These type of thoughts can be difficult for people to identify as fearful thoughts, since they seem perfectly logical to them. However, most people strongly want to avoid fearful feelings. Ironically, avoidance of the fearful thoughts exacerbates the panic attacks, creating even more fear in the individual.

Symptoms of Panic Disorder

When we are threatened with physical danger, the body’s natural defense system, called “Fight or Flight Response” gets activated, causing adrenaline to be released into the bloodstream. However, the same fear response is triggered during a panic attack, even though no physical danger is present.

A panic attack seems to come “out of the blue,” but it is actually a physical reaction to extreme anxiety (conscious or unconscious), and is triggered, in the moment, by fearful thoughts that the sufferer is avoiding feeling. The acute body sensations that accompany a panic attack are usually misinterpreted by the person as dangerous, catastrophic or life-threatening.

A panic attack is a cycle of intense anxiety that starts with a sudden perception of danger or a threat, even though there is no physical evidence of it. This frightening thought is immediately followed by a surge of adrenalin, which causes physical sensations, such as accelerated heart rate, rapid or difficult breathing, dizziness, shaking, hot or cold flashes, nausea and a choking or smothering sensation, that escalate the frightening experience, especially when they come without warning.
There are secondary, emotional symptoms of fear and dread, where the sufferer believes their distorted interpretation of the panic experience, or recognize the irrationality of their fears (that no danger is actually present), but feel helpless to do anything about them.

People having panic attacks regularly show up in Emergency Rooms, thinking they are dying or having a heart attack, since there is usually no obvious reason for their physical symptoms.

There is a mental, or psychological, aspect of panic attacks, where sufferers describe having a “sense of unreality,” feeling out of control, or having thoughts such as, “I’m going to die” or “I will go insane.” Some who experienced an attack while driving their car, believed they will faint while driving in traffic. These erroneous thoughts are fueled by a lack of awareness of the nature of panic attacks and not understanding of what is happening to them; and they contribute to a sense of dread of repeating the panic experience in the future.

The mistaken belief that the sufferer is out of control, may do something irrational or dangerous, or harm themself or others adds to intensity of the anxiety and unpleasantness of the experience. However, none of these things will actually happen – outside of the sufferer’s imagination. For example, in the case of fear of fainting, only a sudden drop in blood pressure will cause a person to faint; anxiety causes one’s blood pressure to rise, which makes it nearly impossible for them to faint.

Possible Causes

Some possible causes of panic attacks are: physical illness, major stress, hormonal imbalances and underlying emotional or psychological factors, such as, serious relationship problems, worry about finances, legal problems, trauma, PTSD – Post Traumatic Stress Disorder, and physical or emotional abuse.

Research shows that panic attacks are often connected to major life transitions, such as marriage, divorce, a first child, school graduation, a new job, etc. But, the cause of a panic attack can be biological, behavioral or psychological.
Physical causes may include hormonal imbalance, a brain or inner-ear dysfunctions prescription-medication side effects or a physical illness. Panic attacks can also be triggered by major stress and underlying emotional or psychological factors, such as serious relationship problems, worry about finances, legal problems, past trauma (PTSD – Post Traumatic Stress Disorder), physical or emotional abuse, or a combination of these factors.

Managing and Treating Panic Disorder

The physical effects of panic attacks can be temporarily managed to lessen their impact on the sufferer. Awareness of the physical symptoms of a panic attack is the first step. Sufferers can be helped by drinking a large glass of water, or by using a slow, deep-breathing technique to calm their heart rate, induce relaxation and increase their oxygen intake to neutralize the adrenalin their bloodstream.

To help panic attack sufferers regain a sense of safety in their lives, I use a highly effectively technique called EMDR, or Eye Movement Desensitization and Reprocessing (described below). By integrating EMDR with the standard treatment for Panic Disorder, I am able to partner with clients to quickly identify and treat the underlying cause of their attacks. Once the cause is discovered, we work together to process the “memories and clear away their negative impact.
The first step is to educate clients about the nature of panic attacks and the physiology of human fear-response. This enables them to see that their fearful thoughts about their panic attacks are false, and know that their physical reaction to the adrenaline in their bloodstream will soon pass.

Once the client’s confidence in their present-time safety is achieved, they can use techniques to manage their bodily sensations when future panic episodes arise. Symptom-management skills, such as self-calming, are reinforced by the EMDR technique.

The next step is to work towards eliminating the trigger of the panic response. This involves processing through unresolved anxiety, past trauma, or other cause for the panic attacks. This process is well worth the time and effort because the outcome means regaining a life of confidence and normal activity.

How EMDR Works

EMDR is a safe procedure used by EMDR-certified therapists that involves using eye movement patterns to release emotional pain that has been “stuck or frozen” in the deeper centers of the brain, beyond the present control of the conscious mind, therefore you cannot will yourself or think yourself, through conscious rational thought out of a panic attack, following a trauma or highly stressful experience. Numerous studies have shown that EMDR is highly effective in the treatment of trauma, depression, anxiety disorders, phobias and addictions.

Research has shown that EMDR works on the deeper centers of the brain, the amygdala, where fearful emotions get stuck and are not processed. It has been shown that EMDR can reprocess these fearful emotions so that they are no longer stuck and no longer have the same level of intensity when they are stimulated. They become more like everyday thoughts and memories that are integrated and assimilated.

EMDR helps the individual develop a larger window of tolerance (for their fearful thoughts) so that they can work through their fear without being overwhelmed by it.

Although still being studied, EMDR is believed to synchronize the two hemispheres of the brain, stimulating a process similar to REM sleep, and integrates sensory and cognitive “information” in the brain and nervous system to promote balance and natural healing.
Dr. Carol Boulware is a Psychotherapist and a Certified EMDR Therapist practicing in Santa Monica and Redondo Beach and is a member of the Independent Psychotherapy Network. Visit Dr. Boulware’s website at

Copyright 2011 by Carol Boulware, Ph.D.

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