The Upside of a Panic Attack: The Worst Is Over Before You Know It

Research suggests the physiological changes that occur in the hour before the onslaught of anxiety may deserve a much closer look

There are plenty of misperceptions about panic attacks. People often tell the anxiety ridden to 'take a deep breath,' for instance, when they may actually already be taking too much oxygen in by hyperventilating. Indeed, what experts suggest instead is to breathe in a slow, shallow, and regular manner, so that a constant, very small stream of air comes in through the nose. Paper bags are optional too, as cupped hands do the trick just as well.

New research aims to debunk another myth: Panic attacks occur completely out of the blue. Though those who panic don't realize it, their attacks are in fact foreshadowed by minute physiological signals, according to a study led by Southern Methodist University's Alicia Meuret in the journal Biological Psychiatry. "The hour before panic onset was marked by subtle but significant waves of changes in patient's breathing and cardiac activity, not just the moment of onset of the attack or even during the attack," she says. "Our analysis provided us with a whole different pattern."

That pattern goes like this: Physiological instabilities occur in repeated bouts or waves and are often initiated by heart rate accelerations, followed by changes in breathing and carbon dioxide levels. Ultimately, breathing becomes much shallower, causing a spike in carbon dioxide levels that lead to symptoms that could no longer escape the attention of those who panic. More precisely, they experience terrifying sensations, such as dizziness, air hunger, and shortness of breath.

Meuret's team monitored this series of respiratory and autonomic activity using ambulatory devices attached to the waists of 43 participants diagnosed with panic disorder. They measured body movements using three accelerometers attached to the upper left leg, lower arm, and chest; skin temperature with a sensor on the little finger; and vocalization from a sensor on the lower larynx. For their part, patients were simply told to go about their lives normally, to push a panic button if they felt an attack coming on, and to recount the symptoms they experienced in a journal. The authors collected over 2,000 hours of data from the trial, during which 13 full-blown panic episodes occurred.

After the observation period, however, the researchers could still not determine why sufferers are unable to perceive panic attacks earlier. But some clues did emerge from the physiological patterns they observed. During recurring bouts, the body may be silently fighting off physiological instabilities that "return to a baseline but then restart," Meuret says. As a result, only one wave of disruption, the one that could no longer be pacified in secret, is felt. A gradual crescendo of anxiety never occurs, and the panic attack appears to have come out of nowhere.

UCLA anxiety expert Emanuel Maidenberg says this research may inspire new coping methods. He says since autonomic arousal symptoms precede awareness, the therapeutic practice of identifying and reexamining fears may potentially be initiated earlier, so patients could pursue threatening activities head-on. David Barlow, a psychiatry professor at Boston University, agrees that if patients could be made more sensitive, more proactive solutions may be possible. "Perhaps we should avoid communicating to the patient that they should short circuit these sensations but rather foster a non-threatening attitude of acceptance," he says. "This might in itself modulate the subsequent intense emotional experience that is a panic attack."

What may be even more reassuring is that the researchers did not find any indications that physical changes during panic attacks were all that extreme. Meuret says that the fluctuations in heart rate and breathing were significant, but they never spiked to damaging levels. She adds that the sensations of shortness of breath were unlikely caused by a lack of oxygen as well.

So would telling the anxious that 'the worst is over' when they panic help? Yes, says Meuret. "Based on our findings, this would indeed be very true."

Image: Bhernandez/Flickr.