Where the Physical Sensations of a Panic Attack Come From (Part 3)

Picking up Reut’s story

Back to Reut.

When Reut first met her therapist, Michal, they had an initial conversation. They both felt comfortable with each other and agreed to keep meeting. Reut felt she could trust Michal—personally and professionally.

At their second session, they made a kind of verbal agreement: Michal wouldn’t leave Reut as long as she needed her; she wouldn’t ask for anything Reut couldn’t give; they would speak openly about everything; and Reut committed to give herself to the process and be a full partner with Michal until she grew stronger and returned to herself.

Over the course of their meetings, Michal and Reut mapped out the difficulties Reut was experiencing and the feelings tied to each one. Reut described and defined every challenge and feeling—where else the anxiety touched her and what she feared during a panic attack: at work, with family, in her relationship, and so on. Then they brainstormed how to handle it if a panic attack did happen at work or in another uncomfortable place. Reut slowly learned that the odds of it happening weren’t high, and even if it did, there were ways to cope and resolve it.

Michal made room for every feeling Reut brought up. They analyzed why she felt that way and how she wanted to feel about it in the future.

In their shared process, Reut worked on each topic separately, first surfacing the emotions, then intensifying them, and then reducing them.

Reut and Michal set goals for the treatment and worked on small, step-by-step cognitive and emotional shifts until they reached those goals.

Let’s break down the physical sensations—and what they mean

Now we’ll analyze the physical sensations she experienced and their meaning (and I’ll note—all of this, of course, applies only after she was examined by a physician and her physical tests were indeed normal).

1. Rapid heartbeat—The moment Reut felt her heart rate rise, she immediately thought she was having a heart attack and became very frightened. But the fact is, a healthy heart can beat at 200 beats per minute for weeks without being harmed.

2. Weakness and dizziness—The dizziness and weakness made Reut feel almost faint, but she didn’t actually faint. That near-faint sensation comes from reduced blood and oxygen supply to the brain, yet it almost never ends in actual fainting.

When she felt dizzy, her immediate thought was that she was about to fall, but that wasn’t the case. The dizziness was caused by breathing too quickly and by reduced blood and oxygen flow to the brain. It’s certainly a stressful reaction, but not a harmful one. Even in very severe anxiety, it’s rare to truly lose balance.

3. Shortness of breath—Difficulty breathing also made Reut think she was having a heart attack, but it stemmed from the stress she was under, which caused the chest and abdominal muscles to contract. That response can lead to pressure and chest pain. As a result, a person may start breathing too fast, which adds even more pressure...

4. Hot flashes—All the above sensations triggered hot flashes for Reut. When someone feels a hot flash, they often conclude a panic attack is approaching, but in fact this too can come from an excess amount of oxygen or from rapid changes in blood circulation, and it does not cause anxiety. When does it become anxiety? When the person tells themselves that something dramatic is happening.

5. Feeling detached—Reut felt she wasn’t really there, as if disconnected, and again immediately thought she was losing control. In reality, this came from breathing too quickly and from reduced blood and oxygen flow to the brain. It’s a temporary sensation, and it doesn’t cause loss of control or sanity.

Why learning to breathe matters

One of the most important ways to reach a state of control over anxiety is learning to breathe correctly. Usually, people breathe very small, shallow breaths, and the lungs don’t fully empty—which contributes to feelings of difficulty breathing and tightness. Under stress, breathing speeds up, which brings on the sensations above and can lead to a panic attack.

Anat Doron is a psychotherapist and a clinician in the \"Nafshi B'She'elati\" department.

Struggling with depression, anxiety, or a low mood? Contact the \"Nafshi B'She'elati\" department at Hidabroot. For a consultation, call 073-3333331 or email [email protected]