Dr. Cynthia Stonnington is the Chair of Psychiatry and Psychology at the Mayo Clinic in Arizona:
1. ROCK CENTER: How prevalent are panic attacks?
DR. CYNTHIA STONNINGTON: So panic attacks are very common. Actually, probably one in four people might have a panic attack in their lifetime. Now that’s separate from having a panic disorder, where people have recurrent episodes of panic attacks … But anxiety, in general, is extremely common. We need anxiety just to live and to function. And so it's not surprising that anxiety disorders can occur frequently.
2. ROCK CENTER: Can you explain what happens in the brain during a panic attack?
DR. STONNINGTON: It's a primitive part of the brain. Obviously back in the day, when you might come across a tiger, you had to be alert to get yourself out of there. It’s a survival mechanism we still have and it’s still something we use to focus our attention and alert us to things we need to do. But today there might be a lot of false alarms.
3. ROCK CENTER: How much control do you have when a panic attack occurs?
DR. STONNINGTON: So when you first experience a panic attack there's nothing much you can do to stop it from coming on. It comes on. And it goes into motion. You've got your heart rate going fast. You've got all the blood rushing from your head. You're breathing fast. All those kinds of things are happening before you can even think of anything to do about it.
4. ROCK CENTER: So even though a panic attack is an event that happens in the brain, it’s not imaginary, right? The symptoms are very real, correct?
DR. STONNINGTON: It is definitely not imaginary, but if it's coming out of the blue, it’s pretty understandable why people might think they're having a heart attack or going crazy or something really pretty ominous. Because it's this rush of adrenaline, and all sorts of physical symptoms are happening at once. And it's very scary.
5. ROCK CENTER: As significant, or perhaps more significant, is what’s going on inside someone’s mind during a panic attack …
DR. STONNINGTON: We jump to conclusions. And we can create this whole worldview that is based on a sort of primitive reaction. Part of it is probably because we are wired to respond to and believe whatever our body is telling us. So, if mentally you are experiencing extreme anxiety, if you're experiencing the physical sensations of anxiety, then it must be in response to something. Because you know you're not crazy, right? So therefore it must be attached to something absolutely real.
6. ROCK CENTER: Let's talk about remedies. Panic attacks are manageable, correct? What tools do you have, as a physician?
DR. STONNINGTON: There's two approaches that we like to do -- potentially together. So, first of all, is something called cognitive behavioral therapy, and then there are effective medications.
7. ROCK CENTER: Why is cognitive behavioral therapy effective?
DR. STONNINGTON: You can really shift your view about panic attacks and your approach to it. And that makes a huge difference. It really does. Like, for example, NOT avoiding situations that provoke extreme anxiety. Very, very commonly people will associate a certain environment with causing their panic attacks. So then they start to avoid that place or that situation. And then what happens is they’re creating this vulnerable person; like they suddenly have to be hyper-vigilant. They're looking for landmines everywhere. And they're restricting their lives. And, intuitively, they may think they're doing themselves a favor, but they're actually making the anxiety level rise. So we try to get people to gradually expose themselves to those situations. And, at the end of the cognitive behavioral approach, learn to actually bring on a panic attack and then reduce it.
8. ROCK CENTER: Which medications can be helpful?
DR. STONNINGTON: The types of medicines that tend to be prescribed … as the first line … are SSRI’s -- selective serotonin reuptake inhibitors. And those are the ones that probably you've heard of: Prozac, Zoloft, Celexa, Lexapro … or now, in generic form, fluoxetine, sertraline, citalopram, and escitalopram.
9. ROCK CENTER: Isn’t half the battle just understanding what this is, right? Knowing that information is power?
DR STONNINGTON: Yes. Absolutely. But it can be a little tricky. Once you’ve had a panic attack, depending on your symptoms, you may want to rule out a heart attack or other medical conditions, and have a reasonable workup to do so. But once you understand what it feels like, what it is, and then perhaps understand some of the things that may have led up to it occurring, then the key is not to keep rushing to the emergency room to rule out a heart attack. Because that's just going to make the panic attacks more frequent.
10. ROCK CENTER: As you’ve indicated, there are established ways for people to build their confidence and manage this condition, yes?
DR. STONNINGTON: And even if a panic attack comes on, you know you’ll survive. You know you’ll be okay. Because, truly, the most debilitating thing about a panic disorder is not necessarily the actual panic attack, but a person's response to it. That’s what tends to be disabling. The key in treatment really is to get people out of that mindset: that in order to be okay they have to never have a panic attack. So they have to get comfortable with the idea that it could happen and it may happen, and that thing that they can do is manage it skillfully. And you can really extrapolate that to pretty much anything that people experience that's recurrent. More often than not, it's their response to the symptoms or the disorder that gives them the biggest amount of trouble, rather than the actual symptoms, which can be managed.
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