Panic attacks

Indeed, just a pumpkin ghost

A panic attack is probably one of the worst experiences one can ever experience. Experiencing a panic attack is arguably one of the most dreadful psychological experiences one can have. During a panic attack, one might feel as if they are busy dying. It may even feel like a heart attack, an asthma attack, a stroke, or even a fatal disease. Some people may even feel as if they are going to lose their mind.

The good news, however, is that although this is the one psychological disorder that feels the worst, it is the least serious psychological challenge, and it is very easy to treat.

Your fear is nothing but just a pumpkin ghost.

A pumpkin ghost is a hollowed-out pumpkin with eyes, nose, and mouth, usually with a candle inside to make it look spooky. In the dark, a pumpkin ghost can be experienced as very scary, especially when it appears out of the blue. In ancient Britain, there was a superstition among the Celts that the souls of people who died the previous year on the 31^st of October (Halloween day) may arise in various forms. They therefore made a fire by lighting a candle inside a pumpkin to scare off these creatures, causing them to leave.
It was, however, just a cold pumpkin. The holes around the nose, mouth, and eyes were only created for the heat to escape.

Panic attacks can almost be compared to the idea of a pumpkin ghost.  A pumpkin ghost may initially appear to be a terrifying embodiment of a ghost. Without the holes that give it this ghostlike appearance, the fire would burn out. 

Panic feels terrible – however, just like a pumpkin ghost scaring the living hell out of you. This pumpkin ghost can easily be treated.

Hypnosis, together with information about the disorder, was found to be one of the most effective treatments for panic. Hypnosis will help you relax, find the causes of panic, and then treat these fears effectively.

What does panic disorder entail?

When you begin to feel panic or become anxious, you experience brief episodes of intense fear accompanied by multiple physical symptoms (such as palpitations, dizziness, nausea, tingling sensations, out of breath, and chest pains) which appear repeatedly and sometimes suddenly. These panic attacks which are the hallmark of panic disorders, occur when the brain’s normal mechanism in response to a threat – the so-called fight or flight response, is mistakenly activated. Most people with panic disorder also feel anxious about the possibility of getting another panic attack and avoid situations in which they believe they would get these attacks. Anxiety about another attack and avoiding what causes it can lead to a panic disorder. Some people get panic about their panic about another panic attack!

A nervous breakdown?

Some people may experience a so-called nervous breakdown. It sounds quite dramatic. To me, it sounds like when someone collapses like a building after a dynamite explosion, almost as if they deflate like a balloon. Rest assured, there is no such thing as a nervous breakdown. It’s just a panic attack.

What are the symptoms of a panic disorder?

A panic attack seems to arise out of the blue, occurring while you are engaged in some ordinary activity like driving your car or walking to work. You might be relaxed, and then suddenly get struck by a barrage of frightening and uncomfortable symptoms. These symptoms often include terror, a sense of unreality, or a fear of losing control.

Diagnostic criteria for panic attacks according to the DSM 5

A panic attack is:

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:

Which of these symptoms are you experiencing?

• palpitations, pounding heart, or accelerated heart rate;
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering;
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Paraesthesia (numbness or tingling sensations)
• Chills or hot flushes

If you are experiencing four or more of the above, you might be experiencing panic attacks.

This barrage of symptoms usually lasts several seconds but may continue for several minutes, even a few hours. People who have experienced a panic attack can attest to the extreme discomfort they felt and to the fear that they had been struck with. Often people who are having a panic attack seek help at a hospital casualty unit.

Most of the time people who have panic attacks believe they are busy:

• dying
• having a heart attack
• going crazy
• having an asthma attack
• having a stroke
• developing a serious disease

The good news is:

there are no documented cases of any of the above situations being caused by a panic attack. Even though this illusion may be created and causes distress, it’s not as bad as it seems. More about it later.

A panic attack typically catches an individual off guard and is usually overwhelming. This unpredictability is one of the reasons why panic is such a horrible experience.

Even though people who are experiencing panic attacks may not show outward signs of discomfort, the feelings they experience are so overwhelming and terrifying that they really believe they are busy dying, going insane, or being totally humiliated. These disastrous consequences will never happen, but it feels like a reality to the person suffering a panic attack.

More about panic disorder

Panic attacks are recurring, and the person develops an intense apprehension of having another attack. As noted earlier, this fear – called anticipatory anxiety or fear of fear – can be present most of the time and seriously interferes with a person’s life even when the panic attack is not in progress. In addition, someone may develop intense irrational fears called phobias about situations where a panic attack has occurred in the past. For example, someone who has had a panic attack while driving may be afraid to get behind the wheel again, even to drive to the local supermarket.

People who develop panic-induced phobias will tend to avoid situations because they fear it will trigger a panic attack and their lives may become increasingly limited as a result. Panic may have a significant negative influence on their work since they may not be able to travel or get to work on time. Relationships may be strained or marred by conflict as panic attacks, or the fear of panic rule the affected person and those around them.

Sleep may also be disturbed because of panic attacks occurring at night, causing a person to wake up in a state of terror. Some people are even terrified to sleep because they fear the dreadful dreams they might experience. They also fear exhaustion they may experience the following day because of their lack of sleep.

People with panic disorder often persist in seeking medical treatment, undergoing multiple tests, and consulting various doctors, fearing a life-threatening disease, even after the initial doctor’s visit suggests no such condition.

It was just a pumpkin ghost all along

A panic attack, although it may feel as if you are going to die, or go crazy, is just a cold pumpkin that is cut to look like a scary ghost but is just a harmless shell.

Panic attacks catch you completely by surprise and the unpredictability of it is one of the reasons why they feel so horrible.

The good news is that a panic attack is just an over-production of adrenaline, for the fight or flight reaction. We share the same autonomic nervous system with animals. When an animal is in danger, it has only one of two reactions. He fights or runs away (the so-called fight-or-flight response). To enable it to fight or run away, the body releases adrenaline which puts more power at its disposal than usual to become stronger to fight or to run away faster. The animal’s heart rate increases to pump blood efficiently, body temperature rises for enhanced combat or quick escape, breathing accelerates in a state of readiness, and sweat is produced to cool down the body. This indeed correlates with panic symptoms, as discussed.

Once the danger is successfully avoided the animal goes to sleep to rebuild its adrenaline levels.

The process in humans is exactly the same and yet so different. We are all experiencing danger from time to time. During such times we, like animals, are producing adrenaline; our heart rate increases, breathing becomes faster to put us in a state of readiness to fight harder or to run away faster and we sweat to cool our body off.

In society, however, we cannot fight or run away. You cannot take a stick or a stone and beat the head of the Receiver of Revenue. You can also not put on your running shoes and run away from your bank manager, and as a result, adrenaline gets stuck in our body, since we are not able to use it.

At this stage, the activity of your sympathetic nervous system and the secretion of cortisol (hormones that suppress physical and emotional pain) are expected to decrease, but they are not. If your stress levels during this phase continue to increase and your body is unable to deal with it, there is a good chance that your body will release adrenaline and nor-adrenaline into your brain, and it may get trapped there which will then lead to panic attacks.

However, to our detriment, we are also different from animals in the sense that when we recall a traumatic event or remember such an event – when we picture the traumatic event in our head, or when we think that it may happen again, we are using exactly the same part of our brain that we would use when the trauma is actually happening. When we think of a traumatic event in our lives or create it in our mind, the fear that it might happen again – the brain records it as a realistic threat and your brain will release adrenaline and nor-adrenaline.

A person can’t do anything about it and the released adrenaline cannot be used. This adrenaline remains in your body and as a result, evolves into a panic attack.

The truth is that it’s just your natural fight-or-flight response. These symptoms are harmless and there is absolutely nothing wrong with you. You are medically safe, and you will not die. You will not have a heart attack or a stroke. You will not faint. You will not go crazy. It feels like death, but it is not the case.

Just as you frighten yourself to death when you suddenly see a pumpkin ghost or when you imagine that you have seen one – it’s just a pumpkin ghost and when you realise it’s just a pumpkin ghost, all these symptoms of anxiety will disappear within a minute or three. It will disappear just as quickly as when it started once you realised that there is no real danger.

Knowledge is power

• A panic attack cannot cause heart failure or cardiac arrest.

Rapid heartbeat and palpitations during a panic attack can be frightening sensations but they are not dangerous. Your heart is made up of very strong and dense muscle fibres and can withstand a lot more than you might think. A healthy heart can beat 200 beats per minute for days – even weeks – without sustaining any damage. Should your heart begin to race, just allow it to do so, trusting that no harm can come of it and that your heart will eventually calm down.

• A panic attack will not cause you to stop breathing or suffocate.

You may experience your chest closing down and your breathing becoming restricted. You might suddenly fear that you’re going to suffocate. When stressed, your neck and chest muscles are tightening and reducing your respiratory capacity. Be assured that there is nothing wrong with your breathing passage or lungs and that the tightening sensations will pass. Your brain has a built-in reflex mechanism that will eventually force you to breathe when your body is not getting enough oxygen. If you don’t believe this, try holding your breath for up to a minute and observe what happens. You will feel a strong reflex to breathe in. During a panic attack, you will automatically gasp and take a deep breath long before reaching the point where you could pass out due to a lack of oxygen and even if you did pass out, you would immediately start breathing normally again. To summarise, choking and sensations of constriction during panic attacks, however unpleasant, are not dangerous.

• A panic attack cannot cause you to faint.

The sensation of light-headedness with the onset of panic can evoke a fear of fainting. The blood circulation to your brain is slightly reduced during a panic attack, most likely because you are breathing more rapidly and shallow. This sensation can easily be relieved by breathing slowly, deeply, and regularly in and out since your breathing is the one thing you always have absolute control over. Just allow the feelings of light-headedness without fighting them. Your heart is pumping harder and increasing your circulation during a panic attack.  However, you are very unlikely to faint.

• A panic attack cannot cause you to lose your balance.

Sometimes you may feel quite dizzy during panic attacks. The tension you are experiencing may affect the semi-circular canal system in your inner ear, which regulates your balance. You may feel, for a few moments dizzy or as if the world around you, is spinning. Invariably this sensation will pass. It is very unlikely that you will lose your balance. If sensations of pronounced dizziness persist for longer than a few, you may want to consult a doctor to check for infection, allergies, or other disturbances that might be affecting your inner ear.

• You won’t fall over or cease to walk when you feel weak in your knees during a panic attack.

The adrenaline released during a panic attack can dilate the blood vessels in your legs, causing blood to accumulate in your leg muscles, not fully circulating. You may experience a sensation of weakness or jelly legs to which you may respond with the fear that you won’t be able to walk. This sensation is indeed just that – a sensation. Your legs are still as strong and able to carry you as ever. You may also just allow these trembling, weak sensations to pass until your legs are able to carry you wherever you want to go. 

• You won’t go crazy during a panic attack.

Reduced blood flow to your brain during a panic attack is due to arterial constriction, a normal consequence of rapid breathing. You may experience sensations of disorientation and a feeling of unreality that can be frightening. If this sensation comes on, remind yourself that it’s simply due to a slight and temporary reduction of arterial circulation in your brain and you are not going crazy at all, no matter how creepy or strange it may feel. No one ever went crazy during a panic attack, and it is completely harmless.

It may be helpful to know that people do not go crazy suddenly or spontaneously. Mental disorders involving behaviours that are labelled crazy develop very gradually over years and do not arise suddenly. No one has ever started to hallucinate or hear voices during a panic attack (except in rare instances where panic was induced by an overdose of a so-called recreational drug such as LSD or cocaine). In short, a panic attack cannot result in your going crazy, no matter how disturbing or unpleasant your symptoms feel.

• A panic attack cannot cause you to lose control of yourself.

Your body goes through intense reactions during a panic attack, and you can easily imagine that you could completely lose it. You may feel that you are becoming completely paralysed, acting out uncontrollably, or running amok. There is no evidence that any of these reactions ever happened. If anything, during a panic attack your senses and awareness are heightened to enable you to fight harder, or to escape faster.

The first step in learning to cope with panic reactions is to recognise that these symptoms are not dangerous. Due to the intense bodily reactions accompanying panic attacks, it’s easy to perceive these attacks as potentially life-threatening. The physiological reactions underlying panic are natural and protective. Your body is designed to produce adrenaline to enable you to quickly mobilise to fight or flee situations that are a real threat to your survival. This reaction occurs when this natural, life-preserving response occurs without any real or apparent danger. With the above in mind, when you realise that the danger is actually just in your mind, and not in real life, you can make headway in mastering panic.

• You will not have a stroke or an asthma attack.

No one has ever had a stroke or asthma attack during a panic attack, although it may feel like that due to pressure you may experience in your throat and head.

• Nothing can be that serious and nothing can go wrong.

While you may feel like you have an incurable disease, rest assured that you don’t. Even though it feels like it and your medical tests prove the opposite, keep in mind that your doctor is not uninformed.  You are simply producing too much adrenaline and nor-adrenaline and that is making you feel terrible.

Overcome this pumpkin ghost forever

You can use the following tips to help you conquer this pumpkin ghost forever. Psychotherapy will assist you further in this process.

You can simply take the following steps and all anxiety will subside completely within a minute or three. You will find that you will begin to follow these steps automatically without even thinking about it until you realise that it is not even happening at all anymore.

• Keep in mind that although the feelings and symptoms you experience during panic might feel very frightening, those symptoms are not at all dangerous or harmful. It’s just your body’s natural secretion of adrenaline and nor-adrenaline that causes the so-called fight or flight response that isn’t finding expression as with animals or during ancient times.
• Understand that your experience is only an exaggeration of your normal bodily reactions to stress, the so-called fight or flight
• The more you fight your panic, the more adrenaline and nor-adrenaline you will secrete and the more anxious you will become. You just need to keep in mind that the more you fight your fear of this pumpkin ghost, the more power you are giving this ghost. This ghost is, however, powerless and will burn itself out. You may even think: Oh, what a childish ghost. It scares me because it is attention– It is desperate to remind me of the souls who died, though it is just a pumpkin that wants to scare me for the sake of a useless myth. This ghost will lose its’ power over you when you realise that it’s just your body’s natural fight-or-flight response.
• You can have the opposite reaction than fighting. When this happens, panic will automatically pass. Allow your body to react without fighting it, experiencing symptoms like palpitations, chest pains, and dizziness; patiently wait, and the panic will subside within a few minutes.  The key is letting time pass and not exacerbating it with additional fear. 
• Practice deep breathing – by breathing deeply, as if you are breathing into your stomach and abdomen. You always have full control over your breathing.
• Relax your body more and more with every breath that you exhale. Relax and assess your body for tension, consciously releasing tension from any areas that feel tense.

• Ask yourself:

–  What is the worst thing that can happen if my fear comes true?

–  If it happens, how bad can it really be?

–  What are the chances that it will happen, since most things we fear, never happen?

Most things we fear never happen anyway. Think about the past and how many times you worried about things.  How many of these things actually happened?  If they did happen, were they as bad as you expected them to be?  You are still here, alive and kicking.

The truth is that the things we fear hardly ever happen, and we make ourselves unnecessarily miserable and anxious.

And realise:

Every panic attack passes. It can’t and never will go on forever. It’s going to take a few minutes to disappear completely. Nothing funny will happen to you. It is, once again, just a cold pumpkin and a scary illusion.

Co-existing conditions

It is generally recommended that patients be carefully evaluated for other conditions that may be present along with panic disorder. These may influence

the choice of treatment. Some conditions are frequently found to coexist with panic disorders.