does this sound like you?

• Those experiencing panic disorder believe that their own physical and emotional well being is poor

• Studies have shown between 25% to 60% of those who see their doctor with concerns of having a heart attack are actually experiencing panic disorder

• Individuals with Panic Disorder may begin to develop fears about having another panic attack

• Avoidance behaviors begin to escalate as the severity and frequency of the attacks escalate

Panic disorder is characterized by periodic attacks of anxiety or terror, which usually last 15 to 30 mins., although residual effects can persist much longer. The frequency & severity of acute states of anxiety determine the diagnosis. During a panic attack a person feels intense fear or discomfort with at least 4 or more of the following symptoms:

• Rapid heart beat

Panic Attacks have criteria to follow in determining the attack is a true panic attack instead of a physical symptom of an illness.

At least 4 of the symptoms must match w/the symptom description list, to be designated as a "Panic Attack." Some people experience panic attacks w/out having Panic Disorder.

The number of attacks that take place w/Panic Disorder & the severity of the attacks are marked on an individual basis being different w/each case.

As the number of attacks experienced increases, the more likely it is that the individual experiencing the panic attacks will begin to develop worry & avoidance behavior regarding future attacks.

Is panic disorder serious?

Panic disorder is real & potentially disabling. The distress of the panic attack itself can rob a person of his quality of life. The anticipation of the next panic attack can be just as powerful, keeping people from driving their cars or even leaving their homes.

Frequently Asked Questions about Panic Disorder

by Jim Haggerty, M.D.
February 17, 2006

what does it feel like to have panic disorder?

This is often how people first coming to therapy describe their bewilderment at what's happening to them.......

• "It feels like I am losing my mind...."

• "I'm totally losing touch w/reality...."

• "Can you please tell me why I am getting these attacks, & please do something to make them go away......"

This is often complicated by their contact w/the medical establishment.

What causes panic disorder?

Some researchers feel that the mechanism in the brain that alerts people to potential danger in the environment misfires during a panic attack. A person having a panic attack experiences this “false alarm” & feels as if his life is truly in jeopardy.

Frequently Asked Questions about Panic Disorder

by Jim Haggerty, M.D.
February 17, 2006

Initial panic attacks may occur when people are under considerable stress, from an overload of work, for example, or from the loss of a family member or close friend. The attacks may also follow surgery, a serious accident, illness, or childbirth. Excessive consumption of caffeine or use of cocaine or other stimulant drugs or medicines, such as the stimulants used in treating asthma, can also trigger panic attacks.

What Is Panic Disorder?

Panic Attacks: This Truth Will Set You Free - By Dr Jeannette Kavanagh

Unlike far too many people on the Internet, I don’t claim to have discovered THE CURE for panic attacks and other anxiety states. I do offer you a beautifully simple insight into panic which will change your reaction to it. Immediately you’ll start you on the path to calm. The insight?

“Accept your panic symptoms and ….they’ll go. Fight them and they’ll intensify.”

Look at that word ‘INTENSify’. It’s about TENSing up. Becoming worried and even more panicky about….what?

Your feelings of panic. Once you really genuinely realize that they’re only feelings, you’ll also come to accept that feeling alone can’t harm you.

Yes, I know you don’t want them.

Yes, I know that they're frightening and uncomfortable.

But tell me this, my sweet one, “in the past, has tensing up and worrying even more about feeling panicky helped those feelings to dissipate?” Your answer? I know it’s NO.

Just so you’re very clear: tensing up and fighting your symptoms of panic help didn't help in the past. It will NOT HELP YOU today. Tensing up and worrying will not help you in the future.

One person selling his e-book on the Internet claims that that 'float with your panic' insight is his unique discovery to send panic away. The truth?

The truth is that we’ve known for decades that instead of fighting panic and tensing up, you must do the opposite. More than 3 decades ago, the Australian General Practitioner the late Dr Claire Weekes advised people that instead of fighting panic and tensing up, they should float into their panic and welcome it like an old friend.

From my counselling practice, I know that you know there’s nothing to fear. At a rational level. At an emotional level, you still feel overwhelmed. For many of you, the fact that you can’t explain why you feel so terrified is often the most upsetting.

fear OF fear ITSELF

Once you accept that there's no real danger, you’ll see that your real and lingering fear is the fear of the panicky feelings. If you let those inappropriate messages of fear come and do their worst, you’d learn how to send those fears packing.

So to summarize: When your pulse races, your heart pounds, do the opposite of what you normally do. Do this:

STOP !

SMILE…

even though you mightn’t want to

B R E A T H E… D E E P L Y…

O B S E R V E…

OBSERVE YOUR fear…. FLOATING AWAY…

MIMIC MOTHER NATURE - FLOW WITH THE HURRICANE
Just as the grass and the trees sway with the wind, rather than rigidly resist it, let your fear feelings come. Then, just observe what happens as if watching a science experiment.

You might want to practice that simple approach at home a few times. You’ll soon see how well it works. I know you can make yourself feel great fear. Bring back those memories of your last panic episode. Right now. Recall every detail. Feel those fear symptoms and now…. just accept them.

That’s right. I’m not saying TRY to do anything. I’m not saying try to relax. I’m not saying try to divert yourself from your fear-filled thoughts.

I am saying – do absolutely nothing. Accept your feelings.

USE OF DIVERSION

If you normally use various tricks to divert you from the intense feelings of fear, please reconsider that tactic. It may help in the short term, but all those tactics (counting backwards, counting bricks, etc), keep you imprisoned in what Dr R Reid Wilson calls ‘the panic cycle’. They can become habits and as difficult to break as the panic cycle itself. Please visit Dr Wilson’s wonderful website for more information: anxieties.com

When you recognize your role in your own panic episodes, you’re 90% closer to the solution, to a life without panic attacks. Next time you feel the first fluttering of fear and panic follow the simple steps above.

If you’ve been experiencing anxiety and panic for a while, I have to let you know that it’s your fear of the fear-filled symptoms that feed your panic. You're a major part of your problem. But you’re also the total solution.

IT'S ALL IN THE MIND - YOUR MIND

As I point out in my self help e-kit Calming Words, if you feel terrified standing in that queue at the supermarket, or sitting in the middle of the row at the cinema, the feelings you feel are fine. They’re a perfect reaction to…danger. Where none exists.

Your mind sent the wrong message “danger, danger” to your body. Your body has then had the right reaction to that danger message – it’s sent the adrenaline surging to get you out of danger. To end with the good news: those messages can be rewritten, re-learned. That’s why I wrote Calming Words (www.calmingwords.com)!

Panic Attacks & Anxiety

By Ronald L. Hoffman, MD, CNS

Marjorie, 42, suddenly felt "spacy," with tingling in her fingers, a crushing chest pain & a sense of imminent death. She cried out to her husband, "Will, I can't breathe - I'm dying."

Seeing that in fact she was unable to take in a full breath, Will rushed her to the emergency room of a nearby hospital. It certainly looked like a heart attack, but after examining Marjorie & performing an electrocardiogram, the physician told Will, "Nothing is wrong.

The electrocardiogram is normal. This is an anxiety attack." Will & Marjorie couldn't quite accept this. She hadn't been feeling particularly anxious about anything & the physiological symptoms had been overwhelming & terrifying. Yet, the doctor was trying to tell them that Marjorie's nervous system was out of kilter.

For some reason, she had experienced a sudden neurological meltdown.

The kind of panic attack that Marjorie experienced seems to be fairly epidemic. Anxiety disorder is a modern phenomenon & it may be related to the tremendous jarring stress of modern life & perhaps to some of our common but powerful dietary stresses, such as excess sugar & excess caffeine, which are often combined, as in cola beverages.

Sugar & caffeine can't, by themselves, set off a panic attack, but what they may do is de-stabilize brain activity so that anxiety ultimately reaches meltdown proportions. I also suspect that the epidemic of panic attacks has a lot to do with our upbringing.

Some people feel themselves under enormous pressures to achieve & some parents load their children with heavy conditioning thru punishments & negative incentives, over-programming the control functions so that these people ultimately break down.

Marjorie's case was typical of panic attack in that she didn't perceive her experience as panic or anxiety. No one goes to the doctor or the hospital & says, "I suddenly felt very scared." People do feel scared, but they experience this is a result of the symptoms, not the cause.

A typical panic attack often involves strong sensations of chest pain & pressure or heart palpitations, which lead people to think they're having a heart attack.

Panic attack can take other forms:

• inability to concentrate
• spaciness
• a feeling of levitating
• tingling in the hands
• shortness of breath

A lot of patients come in & tell me, "Doctor, I can't catch my breath; I just can't take in a complete breath." I have to ask myself, is there a respiratory disease, is it asthma?

Often I do a pulmonary function test, or use a peak flow meter & find out that the person is actually breathing normally. Other patients tell me, "Doctor, I can't concentrate, I feel spacy all the time. Am I sick with something? Do I have mono?"

They may complain of gastrointestinal symptoms, such as stomach pains, cramps or diarrhea. I look for viruses, parasites, food allergies or intolerances, Candida infection, or peptic ulcers.

If someone has chest pains or palpitations, I of course do an electrocardiogram. But the tests often come up negative, without a clear cause in the affected organ, so I have to rule out these physical causes.

This leaves a diagnosis of acute anxiety.

Personal Note: I suffered from Panic Disorder or panic attacks as a symptom of Post Traumatic Stress Disorder. I believe, unlike many doctors, that the panic attack is an individual disorder as well as being symptomatic with common symptoms. My panic attacks were extremely painful, more so than what I believe is described by "pressure in the chest."

I really go the limit to find causes in the organs, because all too often doctors ascribe vague symptoms to anxiety, which is often the byproduct of a real physical problem.

On the other hand, a lot of young to middle-aged people are walking around with powerful anxiety disorders that often translate to physical sensations.

This may be a sign of the times, an indicator of the increased environmental & behavioral assault on our nervous systems. This is a distinct modern syndrome, which is real & pervasive. Even for those who haven't experienced them, the prevalence of panic attacks should remind us not to take the health of the nervous system for granted.

People often resist or deny a diagnosis of panic attack. Some people cling to their physical symptoms, convinced that they're pointing to a heart problem or something similar. They have trouble believing that it's actually the nervous system that is causing the symptoms.

They may feel that there's a stigma attached to the diagnosis of panic attack, as there often is to mental illness - that it's somehow humiliating or implies cowardice, moral failure or weakness of character.

They're afraid I'm telling them that it's all in their mind.

How Do I Know If It Is Panic Disorder?

But it's not really like mental illness or delusion - it's as if your whole body were being jolted w/electricity, w/nervous impulses gone out of control in a kind of short circuit or feedback loop. It's like an involuntary discharge of the autonomic nervous system - a strictly physiological response that isn't subject to your mental control or caused by your thinking process.

In fact, people sometimes say that they were feeling very calm before an attack, or not thinking about anything particularly stressful or emotionally jarring. Sometimes they protest that it can't be "nerves" because they weren't really under stress that day.

But it doesn't necessarily take a stressful incident to set off a panic attack. Rather, stress to the nervous system builds up gradually, over a long time & finally reaches a limit & spills over in a sudden overload. A similar thing can happen in some people with heart problems - a nerve network in the heart muscle can suddenly start to generate amplified signals, in a kind of neurological feedback loop.

This can go haywire & cause fibrillation: the heart stops beating rhythmically & just vibrates. Panic attack is a true physiological syndrome, which people should accept & take constructive steps to correct.

In fact, there are some indications that certain congenital conditions may predispose some people to having panic attacks. i.e., some people have a fairly common congenital heart condition called mitral valve prolapse.

This is a congenital anomaly in a heart valve that causes a heart murmur & sometimes causes palpitations that can trigger panic attack. These people's nervous systems may simply be wired in a more "hair-trigger" fashion, predisposing them to a whole array of physiological syndromes, including panic attacks, weird chest sensations, palpitations, irritable bowel syndrome, migraines & others.

Treating Panic Syndrome

As panic syndrome has become more frequently diagnosed, the number of specialized hospital clinics & support groups devoted to the problem has grown. They publish informational brochures & propose conventional treatment protocols that include drug therapy & counseling.

The first line of treatment may be the use of a tranquilizer just to reduce the immediate overactive nervous response so that more long-term therapy can begin. Antidepressants may be used if the physician believes that the anxiety may have its root in depression.

Unfortunately, some of the drugs used to treat anxiety have an addictive component & this is one of the risks of conventional treatment. If judiciously used, these medications can be very helpful, but all too frequently doctors have over-prescribed them to the point of inducing dependency or true addiction.

personal note: I do believe I was addicted to demerol. While I continued to have severe panic attacks over a year's time, no doctor was able to diagnose me with panic attacks until I saw a specialist two years from my first panic attack. All doctors that I saw, including a specialist for gastrointestinal problems, who used endoscopy on me three times, were not able to say I was having panic attacks instead of a physical problem. kathleen

Since drug therapy is generally only a stopgap, we have to look at cognitive & behavior strategies & especially nutritional strategies. I do recommend some kind of behavioral practice, whether it's yoga, t'ai chi, meditation, or Dr. Herbert Benson's "relaxation response."

In my own practice, I've found nutritional therapy an important aspect of treatment. This includes limiting the intake of sugar, alcohol, caffeine & sometimes drugs & also providing the necessary vitamins & nutrients that may be undersupplied in the diet.

To treat panic syndrome, I first get my patients to cut out coffee, tea & cola drinks & start a stress reduction program. I do a glucose tolerance test to check blood sugar levels & how they vary in response to eating.

I sometimes measure blood levels of adrenaline. Sometimes there is a tremendous outpouring of adrenaline, precisely where blood sugar levels bottom out & this is when patients have the symptoms of panic attack.

It's normal for the body to release stimulating hormones like adrenaline when blood sugar is low - this prevents fainting & a dangerous drop in blood pressure.

Panic syndrome is especially common in people who have used cocaine or other stimulants. The jarring nature of the cocaine high seems to de-stabilize the nervous system & set the stage for neurological reverberations that continue even after withdrawal from the drug.

But even milder stimulants can throw off the neurological balance in some individuals, especially with long-term use. The relationship isn't one of simple cause & effect - you don't have a cup of coffee & become enraged or go into panic. But these stimulants can put the nervous system into a constant keyed-up state of alert.

You can feel fine & enjoy being alert & active, but over weeks or months of steady use you can suddenly reach a threshold where continued use or an outside stimulus can make it all spill over & shift you into having psychological or neurological symptoms.

And you wouldn't necessarily connect the symptoms with coffee because you've been drinking it for months or years.

Alan, one of my patients who taught in a university sociology department told me he had got into a habit of drinking tea from a thermos throughout the long hours of his workday, which involved a long commute by car, teaching several classes, planning budgets, going to meetings & advising students on special projects.

One fall semester, he found himself getting into frequent hysterical rages over next to nothing - at other drivers on the highway & his wife, students & colleagues. Afterward, he'd be left shaking, hyped-up & easily set off again by another petty annoyance or frustration.

He was very disturbed by this but thought it was due to his long hours & stresses at work.

At about the same time, he started having chronic stomach pains. Fearing an ulcer, he stopped drinking tea & cut out all caffeine from his diet. He was amazed to discover that his mood changed completely - no more rages, no more constant impatience, no more hysterical responses.

After a month or two of cold turkey, he found he could permit himself 2 to 3 cups of coffee or tea a day w/out serious side effects. But everyone's individual response is different. Some find that even a single cup a day winds them up too tight.

Nutrition therapy can also play an important role in treating panic disorder. Thiamine (vitamin B1) & magnesium are especially useful.

Vitamin B1 (Thiamine)

Dr. Derek Lonsdale, a colleague of mine, has advanced the theory that certain people w/neurological symptoms may have unrecognized borderline vitamin B1 deficiencies. Lonsdale worked especially w/children who had autonomic nervous system dysfunction - not specifically panic syndrome, but a syndrome of drastic swings between lethargy & hyperexcitability & found that thiamine often helped stabilize them.

Interestingly, it's been shown that vitamin B1 is necessary for the metabolism of sugar. People who consume a lot of sugar & refined carbohydrates not only may deplete their vitamin B1 by using large amounts to metabolize sugar but at the same time may not be getting enough vitamin B1 because refined foods are notoriously low in this nutrient.

In fact, the origin in Asia of the classic vitamin B1 deficiency disease, beriberi, was the polishing of rice - stripping the husk off brown rice to make it into white rice. It's the husk that contains the vitamin. So if your diet contains a lot of white flour, sugar & processed foods you may not get enough vitamin B1.

Magnesium is depleted by production of the hormonal neurotransmitters called catecholamines, which stimulate the body into the kind of heightened readiness for activity we call the fight-or-flight response. When there's a perceived stress or danger, the brain releases these hormones, which very quickly speed up the heart rate, increase the blood pressure & put the body in a state of readiness for physical action.

This may have been useful for our ancestors, who needed to fight off a saber-toothed tiger, but it's not so helpful to have our heart rate soaring when someone cuts in front of us in high-speed traffic on the freeway.

Cortisol, another stress hormone, also depletes magnesium. Some studies have shown that certain phobic disorders like agoraphobia are associated with lower levels of magnesium & other kinds of nervous system instability may also be involved.

One clear symptom of magnesium deficiency is hyperreflexia - a kind of heightened startle reflex marked by sensitivity to noise & exaggerated reflex responses. In fact, one of the symptoms of magnesium overdose is the suppression of normal reflexes.

So the idea is to keep the body supplied with the ideal levels of magnesium - though deficiencies are the real concern. In our high-stress post-industrial environment, daily stresses & shocks may literally leach away the magnesium we need to maintain our neurological equilibrium.

Sleep may be disturbed because of panic attacks that occur at night, causing the person to awaken in a state of terror. The experience is so harrowing that some people who have nocturnal panic attacks become afraid to go to sleep & suffer from exhaustion. Also, even if there are no nocturnal panic attacks, sleep may be disturbed because of chronic, panic-related anxiety.

A panic attack isn't dangerous, but it can be terrifying, because it feels 'crazy' and 'out of control.' Panic disorder is frightening because of the panic attacks associated with it, and because it often leads to other complications such as phobias, depression, substance abuse, medical complications, even suicide. Its effects can range from mild worry or social impairment to a total inability to face the outside world.

Phobias developed thru panic disorder don't come from fears of actual objects or events, but rather from fear of having another attack. This causes people to avoid certain objects or situations because they fear that these things will trigger another attack.

Please remember that only a licensed therapist can diagnose a panic disorder. There are certain signs you may already be aware of.

One study found that people sometimes see 10 or more doctors before being properly diagnosed, & that only 1 out of 4 people w/the disorder receive the treatment they need. That's why it's important to know what the symptoms are & to make sure you get the right help.

If you suffer from repeated (4 or more) panic attacks & especially if you've had a panic attack & are in continued fear of having another, these are signs that you should consider finding a mental health professional who specializes in panic or anxiety disorders.

Panic attacks haunt sufferers

Those who suffer from disorder find it's not easy to control minutes of terror

By Evan Henerson
Los Angeles Daily News  Last Updated: May 14, 2000

"Panic" - the word sounds like what actually happens: an accelerated heart beat, sweating, shortness of breath.

For someone w/panic disorder, an attack is worse than anything we can dream up because it's precisely that person's imagination that goes haywire.

When she has an attack, Liz, a former executive secretary, said she develops a feeling of hyper self-awareness. A sneeze or cough isn't just something she can brush aside & ignore. It's something she builds upon & becomes obsessed with.

"I could go from this one little pain to the funeral," Liz said, who asked that her last name not be used. "The worrier part of you escalates all these feelings that cause your anxiety level."

Michelle Craske, a psychologist at the University of California at Los Angeles, characterizes hypersensitivity as a fear of one's own body - a prevalent theory in panic disorder research. A person can feel a twinge, Craske said & think cancer.

True panic sufferers often become convinced that they're going crazy or that they're about to die. Attacks happen often, usually w/out warning & typically peak within 10 minutes.

For panic sufferers, it's 10 minutes of terror. It's the fact that you can't predict it that differentiates panic attacks from stage fright or other anxieties.

Researchers say the condition is probably genetic, passed directly from parent to child & may be the result of a chemical imbalance.

"It's not some imaginary thing that people talk themselves into. It's a pathological disorder," said John Murphy, a Beverly Hills psychiatrist who, w/his partner Dennis Munjack, conducts clinical trials in which panic sufferers experiment w/new medications.

"As best we understand it, it's a chemical imbalance. But we don't know if it's in the brain, the blood stream or the respiratory tract."

After living with & studying her condition for 7 years, Liz knows all the theories & medical terminology. She recognizes a panic attack when one is in progress. Still it can feel like ants are crawling up her face.

"My son had (the condition) & that really made me sad," she said. "This is something you don't want to be passing on. This affects my husband, my children. It's scary."

According to Pasadena psychiatrist & neurologist Stuart Shipko, 1 out of 75 people worldwide suffers from panic disorder. Sufferers are 12 times more likely to go to hospital emergency rooms & visit doctors 700% more than the general population.

In 1999, panic even became pop-culturally trendy. We watched fictional mob bosses played by Robert De Niro (in the film "Analyze This") & James Gandolfini (star of the HBO series "The Sopranos") visit analysts for treatment of panic attacks. Celebrities such as actress Kim Basinger & talk-show-host/singer Donny Osmond disclosed that they suffered from panic& anxiety disorders.

Shipko, who runs the Panic Disorders Institute & Web site, said the condition is hardly a new phenomenon. He doesn't believe doctors have treatment under control.

"The amount of real help for panic disorder in this country in no way meets the demand for it," said Shipko.

Shipko's Web site includes his theories on the link between panic, bile flow & gastroesophageal reflux. He has also written about extreme fluctuation in the heart rates of panic patients over a 24-hour period.

The site also includes a bulletin board where panic sufferers can ask questions & exchange information. Shipko, who answers many of the questions personally, said he has learned much from his "citizen scientists."

"I lead a group of grass-roots patients who were smarter than their doctors," he said.

Self-education helped Lori, who now helps operate Shipko's Web site from her home in Laramie, Wyo. A panic sufferer since childhood, Lori underwent years of therapy. When her youngest son started to show symptoms of the condition, Lori began conducting research. Now she's a health educator who is working on a book about anxiety disorders in children.

"Between the two of us, we give out a lot of information," Lori said. "Our site isn't meant to take the place of a doctor, but it can help you understand what questions to ask your doctor. We reach a lot of people."

To keep her panic under control, Liz - who is Murphy's patient - uses a combination of diversionary techniques and medication. But those two approaches to panic disorder treatment - biological and cognitive behavioral therapy - don't always coincide.

Patients who visit Craske at UCLA's Anxiety Disorders Behavioral Program, for example, will learn all about anxiety. During the 12 to 16 sessions in the program, patients learn to gain control of their breathing and are made to confront the symptoms they experience when suffering a panic attack.

Agoraphobics are exposed to the situations they fear - elevators, driving or being alone - so they learn to be less afraid. Drugs aren't part of the program, although Craske might prescribe medication in her clinical practice.

Shipko said that by the time they contact the Panic Disorders Institute, patients are looking for a concrete medical diagnosis - conclusive proof that they're not crazy. And they want the panic attacks stopped immediately, even if means starting on medication.

"Stopping the attacks is critical," Shipko said. "If you stop the attacks, a large portion of the people will have no phobias or depression and they're largely able to go on with their lives as normal."

Doctors often prescribe anti-depressants, benzodiazepines (such as Klonopin & Xanax) and monoamine oxidase inhibitors (MAOIs) such as phenalzine. Selective serotonin reuptake inhibitors (SSRIs) such as Zoloft and Paxil are also now used to treat panic. All of the medications have associated risks and side effects and are potentially addictive.

Although he believes the basic panic attack can't be stopped by any means except thru medication, Shipko said drugs aren't necessarily required for treatment of other related symptoms.

"It's not all black and white, that either you can control this and pull yourself up by your bootstraps or that this is a neurological disease that must be medicated," Shipko said. "It's not either/or, it's both."

What Can I Do About Panic Disorder?

What Causes Panic Disorder: Mind, Body, or Both?

Body: There may be a genetic predisposition to anxiety disorders; some sufferers report that a family member has or had a panic disorder or some other emotional disorder such as depression. Studies w/twins have confirmed the possibility of 'genetic inheritance' of the disorder.

Panic Disorder could also be due to a biological malfunction, although a specific biological marker has yet to be identified.

All ethnic groups are vulnerable to panic disorder.

Mind: Stressful life events can trigger panic disorders. One association that has been noted is that of a recent loss or separation. Some researchers liken the 'life stressor' to a thermostat; that is, when stresses lower your resistance, the underlying physical predisposition kicks in & triggers an attack.

Both: Physical & psychological causes of panic disorder work together. Although initially attacks may come out of the blue, eventually the sufferer may actually help bring them on by responding to physical symptoms of an attack.

i.e., if a person w/panic disorder experiences a racing heartbeat caused by drinking coffee, exercising or taking a certain medication, they might interpret this as a symptom of an attack & because of their anxiety, actually bring on the attack.

On the other hand, coffee, exercise & certain medications sometimes do cause panic attacks. One of the most frustrating things for the panic sufferer is never knowing how to isolate the different triggers of an attack.

That's why the right therapy for panic disorder focuses on all aspects:

• physical
• psychological
• physiological 

of the disorder.

Although the exact cause is still not clear, researchers have found that Panic Disorder usually appears during the late teen years or early adulthood, & there seems to be a connection w/major life transitions that are potentially stressful:

• Relationship problems, divorce or abuse

Description of Categories & Types of Panic Attacks

DSM-4 (Diagnostic And Statistical Manual of Mental Disorders, fourth edition) recognizes 3 different types of Panic Attacks:

1. Un-cued (spontaneous) Panic Attacks (relates to Panic Disorder).
2. Cued (specific) Panic Attacks (relates to Social Anxiety Disorder, Obsessive-Compulsive Disorder & Posttraumatic Stress Disorder).
3. Situationally predisposed Panic Attacks (may occur on exposure to the situational cue or trigger, but don't necessarily occur immediately after the exposure).

Panic Disorder is defined as the recurrent experience of "un-cued" spontaneous panic attacks, which is often intensified by the resulting fear of the next impending attack.

The fear itself of having a spontaneous panic attack often leads to Panic Disorder. The spontaneous panic attack is generally NOT prompted by a "trigger" & is now recognized as not being associated w/specific situations & places.

The intensity of the attack can be extremely severe; resulting in the feeling of having a heart attack along w/intense feelings that one is going to die. Criteria for Panic Attack is defined as a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes. List of symptoms are as follows:

1. Palpitations, pounding heart or accelerated heart rate

2. Sweating

3. Trembling or shaking

4. Sensations of shortness of breath or smothering

5. Feeling of choking

6. Chest pain or discomfort

7. Nausea or abdominal distress

8. Feeling Dizzy, unsteady lightheaded or faint

9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)

10. Fear of losing control or going crazy

11. Fear of dying

12. Paresthesias (numbness or tingling sensations)

13. Chills or hot flushes

Attacks that have fewer than 4 symptoms are referred to as "limited symptom attacks".

Some Common Alternative Approaches: - Understanding Your Options

Currently, the majority of the mainstream medical and psychological establishment continues to show a preference toward treating Anxiety Disorders with medication (usually psychotropic drugs), while tending to dismiss the need of investigating where the symptoms may be originating from:

• such as problems in various organs or glandular systems (thyroid, adrenal etc)

• vitamin/mineral deficiencies (Some studies have shown certain phobic disorders like agoraphobia to be associated w/lower levels of magnesium, (Hoffman, 1999)

• more recently researched possible activity of a part of the brain called the amygdala, which is believed to be rooted to the circuitry of brain function responses typical in panic disorder sufferers including OCD, PTSD, Agoraphobia and other anxiety disorders

in which case symptomology would be physiological rather than strictly environmental or emotionally based.

However there are various and increasing alternative approaches commonly being used today by consumers and professionals.

Some of those approaches found to be effective in treating Panic Attacks are:

• nutritional / supplemental

• breathing

• physical exercise

• meditative awareness / mindfulness techniques

• yoga

• biofeedback

• psychotherapy

• gentle manipulation therapies to support function of the autonomic nervous system such as Cranial Sacral therapy, etc.

Perhaps the most sound and effective nutritional approach for managing general anxiety is the practice of food combination:

• with raw unprocessed foods as the bulk of the diet

• fats which are non-hydrogenated and medium-range saturated

• proteins which are mostly free of steroids, antibiotics and other additives

• limiting the intake of sugar, alcohol and caffeine

One very effective way to determine the quality of foods and the effects of insulin response of carbohydrates is by using the "Glycemic Index" listing of foods as a guide, now available through many informational forums for the consumer.

One of the single most effective health promoting practices one can do is practice deep breathing exercises as part of a daily routine. Turning one's attention to one's breath moves them naturally toward relaxation and meditation, putting one in conscious touch with one's vital, non physical essence.

Breathing techniques can vary from just breath observation, to deep controlled yogic inhalation patterns accompanied by slow rhythmical counting. Breathing exercises can increase in productivity empowering the person with a strong grounding ability enabling them to control the onset of panic.

Oxygenation of the blood is a primary and necessary function for keeping the lymphatic system healthy and toned and is of course an enormous benefit of regular exercise in which the heart rate is kept at an elevated level for at least 15 minutes a day.

The concept of "mindfulness" as referred to in meditative approaches involves the complete "owning" of each moment of one's experience, good, bad, painful or terrifying.

It involves cultivating our ability to pay attention in the present moment. Beginning a mindfulness meditative process is essentially nothing more than sitting quietly with the constant attempt to chase down each wandering thought as it occurs and bring attention back to our breathing pattern.

This process builds gradually with practice and can serve as a powerful vehicle for self-understanding and healing. Researchers have documented immediate benefits from meditation in terms of lowered blood pressure, decreased heart and respiratory rate, increased blood flow and other measurable signs of the relaxation response. (Weil, 1998)

Basic forms of Cognitive Behavioral Therapy (CBT) techniques, while being very effective as a management tool of psychotherapy, don't specifically emphasize the ongoing awareness of one's thought patterns in the way a mindfulness technique does, which presents the opportunity to observe our direct reactions to situational triggers.

Mindfulness techniques go one step beyond CBT in that they focus on the how and the why of reactions, rather than identifying the trigger and patterns alone and then go on to establish a more reality based belief and response in order to counteract those reaction patterns.

One specific psychotherapeutic approach to the healing of anxiety disorders, which may be helpful, is referred to as the "renegotiation of trauma" (Levine, Frederick 1997) in which it's believed that residual energy is trapped within the central nervous system from the experiences of early trauma and that resulting post traumatic stress symptoms are a physiological response.

The therapy involves allowing that trapped energy created by the "immobility response" (or paralysis of fight or flight) to be released, while avoiding the cathartic reliving of the immobility which can be re-traumatizing.

Cranial Sacral Therapy focuses on gentle manipulation of the cerebro-spinal fluid, which is produced and absorbed by the body on a regular rhythmical basis and may be considered similar in concept to the aforementioned approach of releasing trapped energy from trauma, but approached through physical touch.

More commonly though Cranial Sacral therapy involves facilitating a balanced modality between the sympathetic and parasympathetic nervous system, by gently reestablishing proper motility of the adrenals, glands which produce the adrenalin involved in the fight or flight response of panic.

Biofeedback is an approach used for increasing the person's own ability to better control their biological response to stimuli. It uses high-tech electronic equipment, monitoring skin temperature, electrical conductivity of the skin, muscle tension, heart rate and brain wave activity, by attaching wired sensors to the patient and then by giving auditory and/or visual signals to their body, the patient learns to control what are usually subconscious responses.

Biofeedback is used in relaxation therapy, is found to be effective for helping with anxiety and is most successful when combined with various other approaches.

All of these approaches are most effective when used in combination with another. No one approach can heal any anxiety disorder, as the root cause of the disorder is usually a complex mix of circumstances requiring a variety of healing aids.