The emotional and physical response of anxiety is panic. It is the Fight-Flight-Freeze body response to perceived danger. The brain signals the amygdala to activate adrenaline and stress hormones that can help a person survive danger. It is an automatic response and useful when there is an actual threat of danger. (See the video for teens from Anxiety Canada to explain the fight or flight response to anxiety for teens: https://www.anxietycanada.com/articles/fight-flight-freeze-anxiety-explained-for-teens/).
What is a panic attack?
A panic attack is a “sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause” https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021. They are common and almost 1 in 4 adults will experience at least one in their life.
It “is an abrupt episode of severe anxiety with accompanying emotional and physical symptoms…[a teen might feel] feel overwhelmed by an intense fear or discomfort, a sense of impending doom, the fear of going crazy, or sensations of unreality. Accompanying the emotional symptoms may be shortness of breath, sweating, choking, chest pains, nausea, dizziness, and numbness or tingling in his extremities. During an attack, some teens may feel they're dying or can't think.” (From: Your Adolescent - Anxiety and Avoidant Disorders. American Academy of Child and Adolescent Psychology.
Symptoms of a panic attack include:
- Pounding or “racing” heart
- Shaking or Trembling
- Difficulty breathing
- A feeling of choking
- Sense of impending doom or danger
- Chest pain or discomfort
- Stomach pain or nausea
- Fear of loss of control “going crazy” or dying
- Shortness of breath or tightness in your throat
- Abdominal cramping
- Weakness or dizziness, lightheadedness, or faintness
- Tingling or numbness in the hands and fingers
- Feeling of unreality or detachment
(https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021; https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms https://www.webmd.com/anxiety-panic/guide/panic-attack-symptoms)
It is a sudden experience of intense anxiety (the physiological symptoms) with or without an apparent cause. While anxiety also produces these symptoms, in panic attacks the psychological sensations are dominant. They are sudden and abrupt in onset. They usually peak within 10 minutes and are over in 30. Panic attacks usually seem to come out of nowhere (rather than triggered by a specific fear). While not dangerous, the physical symptoms can be so concerning a person ends up in the emergency room to assess for a heart attack.
After a panic attack, a teen might avoid situations that might trigger another panic attack including daily expected routines and activities. A panic attack can occur for no apparent reason. They are a problem when panic attacks are frequent, are unexpected, and extended time is spent in fear of another attack indicating a potential Panic Disorder. Panic attacks might occur in different anxiety disorders (e.g., Social Anxiety Disorder triggered by feared social situations or occur with specific phobias and Generalized Anxiety Disorder).
A panic attack can occur when a teen has an anxiety disorder but does not always indicate that the teen has a Panic Disorder or that a teen meets diagnostic criteria for any Anxiety Disorder.
A teen can experience one or two panic attacks in a stressful time, but then not again after a stressful circumstance is over. Yet, once experienced, a teen might start to get anxiety thinking about the possibility of another panic attack (anticipatory anxiety).
What can a teen to do manage a panic attack?
Cognitive Behavioral Therapy (CBT) is a form of research supported treatment for anxiety and panic attacks. (This focuses on the interconnection between thoughts, feelings, and behaviors). Medication is sometimes warranted when the level of anxiety reaches criteria for a Panic Disorder or Anxiety Disorder and is negatively and significantly affecting the daily life and functioning of a teen. (See: https://childmind.org/article/panic-attacks-best-treatments/).
Teens can learn relaxation strategies and breathing techniques to help in the moment. Calm breathing and Progressive Muscle Relaxation are important tools to learn and practice. Mindfulness, acceptance strategies and exposures are also helpful. Teens can also work with a therapist or find resources to identify thinking patterns that increase anxiety (e.g., catastrophizing) and help them address specific thoughts that can trigger or increase feelings of panic. Both strategies are important because the more a teen focuses on the physical sensations and catastrophizes the meaning of the symptoms, the more adrenaline and stress hormones are released and this can extend the panic experience.
How can parents help?
Listen to your teen and provide opportunities to talk about fears and anxiety. Normalize anxiety about social interactions, physical appearance, and uncertainty with the future as well as acknowledge anxious feelings in high stress circumstances. Know the facts about anxiety and panic attacks to share.
Facts about anxiety: (From https://www.anxietycanada.com/articles/home-management-strategies-for-panic-disorder/).
- Fact 1: Anxiety is normal and adaptive, as it helps us prepare for danger.
- Fact 2: Anxiety can become a problem when our body tells us that there is danger when there is no real danger.
Facts about panic attacks:
- They are the fight-flight-freeze response
- This response can occur even when there is no real threat of harm or danger
- Panic attacks might feel scary and are uncomfortable, but not dangerous
- They are brief (usually 10-20 minutes)
- Other people cannot tell you are having a panic attack
- People tend to breath faster when anxious yet get in less oxygen which can make them feel dizzy or lightheaded. This can increase feelings of anxiety. Slowing down and breathing deeper through the nose and out of the mouth can help move through anxiety and relax.
Encourage learning and practicing relaxation strategies. Help teens identify and examine specific thoughts and patterns of thinking that increase feelings of panic. If panic attacks are frequent or the fear of having another panic attack is interfering with your teens ability to attend school or participate in social interactions, hobbies, or otherwise enjoyable activities please talk with your pediatrician or reach out to a therapist specializing in child and adolescence populations for support.
Additional References and Resources:
The CBT Workbook for Panic Attacks, Elena Welsh, PhD