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Dr. Sanam Hafeez PsyD

Panic Attacks: Everyday Solutions For Coping Through Them

Over 40 million adults in the U.S. suffer from anxiety and panic disorders. And as privileged as they are, celebrities are no exception when it comes to panic attacks. Whether it’s a one-time event or something they consistently struggle with, dealing with a panic attack is never easy.

Most recently, in the media and her new book, Gisele Bundchen described the debilitating panic attacks she experienced when she was younger and how they almost led her to suicide.   

Bundchen is not the only celeb who has confessed to former or current panic attacks.  Others include Lena Dunham, Caitlyn Jenner, Emma Stone, Ellie Goulding, Amanda Seyfried, and John Mayer.

We turned to Dr. Sanam Hafeez PsyD, New York City-based neuropsychologist and Teaching Faculty Member at the prestigious Columbia University Teacher’s College for some insight on what average Joe and Janes can to overcome panic attacks. 

The good news is, recovery is possible does not take an A-listers budget.

What is a panic attack?

Panic attacks typically begin suddenly, without warning. They can strike at any time — when you’re driving a car, at the mall, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently. Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides. Dr. Hafeez states that “One of the worst things about panic attacks is the intense fear that you’ll have another one.  A panic attack occurs when the body experiences a sudden surge adrenaline out of proportion to any perceived danger or threat.”

What is a panic disorder?

You may fear having panic attacks so much that you avoid certain situations where they may occur. It can become so severe as to cause agoraphobia where people become housebound.  When this occurs, it is known as panic disorder.” She adds, “the word ‘attack’ is actually a misnomer as nothing is being attacked. Panic occurs when the body goes into a state of fight or flight even when no real danger is present.

A person can be sitting at their desk typing, yet feel as if they are being chased by a lion and the body is responding with adrenaline appropriate to a dangerous situation, but not realistic for the situation the sufferer is actually in.”  Dr. Hafeez stresses to those who suffer from the panic that, “Nobody has ever died from a panic attack! A person may feel as if he/she wants to die, or death is imminent, but it simply will not happen!”   

How did Gisele Bundchen reduce her panic?

As Gisele Bundchen has mentioned, her panic attacks subsided when she made lifestyle changes such as not drinking a bottle of wine per day, stopping a pack a day smoking habit, incorporating meditation, yoga, and cutting out sugar.  After a few months, she says she stopped experiencing any panic attacks and had a new outlook on her life and her health.

What can you do to reduce and cope with panic?

Calm breathing

Dr. Hafeez says that “Taking control of breathing is the first step to controlling a panic attack. The goal is to create a slow stream of air by breathing in and out. This prevents hyperventilation and a buildup of carbon dioxide in the blood. It is helpful to practice mindful breathing outside of panic attacks. This equips people who experience panic attacks with the techniques designed to stop them. There are apps and YouTube videos people can watch to practice breathing techniques for panic. “

Progressive Muscle Relaxation

Another helpful strategy is learning to relax the body. This technique involves tensing and untensing various muscle groups. This lowers overall tension and stress levels that can contribute to panic attacks. Start with the feet and work up to your forehead. Tighten the muscle while taking a deep breath in, hold for a few seconds and then release the tension while breathing out. Move up the body, one muscle group at a time.

Mindfulness

This is the act of accepting thoughts as they come, but not letting them blow out of proportion. It is a mental framework designed to help people stay present at the moment without overanalyzing the stressful elements of life. Mindfulness incorporates many relaxation and meditation techniques.

Cognitive Behavioral Therapy

Panic attacks can originate from thoughts that spiral into deep-seated worries. Cognitive behavior therapy (CBT) is an effective, lasting treatment for controlling panic attack symptoms. CBT is a helpful option for people who experience repeated panic attacks. CBT challenges fearful thoughts. What are you afraid will happen? Is there evidence to support these fears? A practitioner trained in CBT can equip an individual with the tools to successfully control and defuse a full-blown panic attack.

Yoga

There are many uncomfortable physical symptoms of panic and anxiety, such as feelings of tension, tightness, and pain sensitivity. Yoga postures, known as asanas, help ease the physical discomfort that is caused by anxiety. Asanas work to stretch, lengthen, and balance the muscles. These postures can assist in releasing built-up muscle tension and stiffness throughout the body.

Cut Down on Sugar and eliminate caffeine

Although many people can’t start their day without a “cup of Joe,” Dr. Hafeez says that “for panic sufferers, caffeine can trigger panic attacks because it is a stimulant and can cause people with anxiety to have palpitating hearts and shaky hands. Sugar can cause blurry vision, difficulty thinking, and fatigue, all of which may be interpreted as signs of a panic attack, thereby increasing worry and fear. A sugar high and subsequent crash can cause shaking and tension, which can make anxiety worse. While dietary changes alone cannot cure anxiety, they can minimize symptoms, boost energy and improve the body’s ability to cope with stress.”

Stop Smoking

“If you think smoking calms you down, think again,” says Dr. Hafeez.  A study of thousands of smokers shows that they are three times more likely than non-smokers to have panic attacks and panic disorder. Tobacco smoke may induce panic attacks in susceptible individuals. “There can be other mechanisms by which smoking induces panic: the effect of nicotine for example,” says Dr. Hafeez. “Nicotine has a stimulating effect on the brain.”

Reduce or eliminate alcohol

There are clear links between alcohol and anxiety, and between alcohol and panic attacks. Alcohol can trigger panic attacks because on a physiological level drinking can cause low blood sugar, dehydration, increased heart rate, and increased levels of stress. Dr. Hafeez offers that, “A drink from time to time is not harmful, but when people use drinking to deal with anxiety and panic, they can experience severe consequences. Like other frequently abused substances such as caffeine or cocaine, the combination of alcohol abuse, hangover, and withdrawal can lead to an increased risk of panic attacks. As a consequence, this kind of abuse can result in both an alcohol addiction and more severe anxiety and panic disorders.”

Medication

There are many anti-depressants, mood stabilizers, and benzodiazepines like Valium, Ativan, Clonopin, and Xanax that can help keep panic under control when combined with therapy. Antihistamines (such as hydroxyzine) and beta-blockers (such as propranolol) can help mild cases of anxiety as well as performance anxiety, a type of social anxiety disorder. Patients need to keep in mind that benzodiazepines carry the risk of tolerance and addiction and are better suited for short-term or “as needed” usage.

Smartphone apps to assist with panic disorder

There are many great ones that exist such as Dare, Rootd, Anxiety No More, ACT Companion and Pacifica among many others.

 

The 13 Body Functions You Mess With When You Get too Stressed

Guest Post

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You’re trying to get the kids off to school, you can’t find your cell phone, and you’re sitting in traffic.

Your hypothalamus, a tiny control tower in your brain, decides to send out the order: Send in the stress hormones! These stress hormones are the same ones that trigger your body’s “fight or flight” response. Your heart races, your breath quickens, and your muscles ready for action.

This response was designed to protect your body in an emergency by preparing you to react quickly. But when the stress response keeps firing, day after day, it could put your health at serious risk.

Dr. Sanam Hafeez is a New York City Neuropsychologist who breaks down what stress can do the body.

1. Respiratory System

Stress can make you breathe harder. That’s not a problem for most people, but for those with asthma or a lung disease such as emphysema, getting the oxygen you need to breathe easier can be difficult. And some studies show that an acute stress, such as the death of a loved one — can actually trigger asthma attacks, in which the airway between the nose and the lungs constricts. In addition, stress can cause the rapid breathing or hyperventilation that can bring on a panic attack in someone prone to panic attacks. Working with a psychologist to develop relaxation and breathing strategies can help.

Gastrointestinal

2. Esophagus

When you’re stressed, you may eat much more or much less than you usually do. If you eat more or different foods, or increase your use of alcohol or tobacco, you can experience heartburn or acid reflux. Stress or exhaustion can also increase the severity of heartburn pain.

3. Stomach

When you’re stressed, your brain becomes more alert to sensations in your stomach. Your stomach can react with “butterflies” or even nausea or pain. You may vomit if the stress is severe enough. And, if the stress becomes chronic, you may develop ulcers or severe stomach pain even without ulcers.

4. Bowel

Stress can affect digestion, and what nutrients your intestines absorb. It can also affect how fast food moves through your body. You may find that you have either diarrhea or constipation.

Female Reproductive System

5. Menstruation

Stress may affect menstruation among adolescent girls and women in several ways. For example, high levels of stress may be associated with absent or irregular menstrual cycles, more painful periods and changes in the length of cycles.

6. Premenstrual Syndrome (PMS)

Stress may make premenstrual symptoms worse or more difficult to cope with and pre-menses symptoms may be stressful for many women. These symptoms include cramping, fluid retention and bloating, negative mood (feeling irritable and “blue”) and mood swings.

7. Menopause

As menopause approaches, hormone levels fluctuate rapidly. These changes are associated with anxiety, mood swings and feelings of distress. Thus menopause can be a stressor in and of itself. Some of the physical changes associated with menopause, especially hot flashes, can be difficult to cope with. Furthermore, emotional distress may cause the physical symptoms to be worse. For example, women who are more anxious may experience an increased number of hot flashes and/or more severe or intense hot flashes.

8. Sexual Desire

Women juggle personal, family, professional, financial and a broad range of other demands across their life span. Stress, distraction, fatigue, etc., may reduce sexual desire — especially when women are simultaneously caring for young children or other ill family members, coping with chronic medical problems, feeling depressed, experiencing relationship difficulties or abuse, dealing with work problems, etc.

9. Fat storage

You can clearly correlate stress to weight gain. Part of that link is due to poor eating during stress, but the stress hormone cortisol may also increase the amount of fat tissue your body hangs onto and enlarge the size of fat cells. Higher levels of cortisol have been linked to more deep-abdominal fat—yes, belly fat. Luckily, exercise can help control stress and help keep belly fat under control.

10. Insomnia

Stress can cause hyperarousal, a biological state in which people just don’t feel sleepy.

While major stressful events can cause insomnia that passes once the stress is over, long-term exposure to chronic stress can also disrupt sleep and contribute to sleep disorders.

What to do? Focus on sleep hygiene (making your surroundings conducive to a good night’s rest) and try yoga or another stress-busting activity during the day.

11.  Headaches

“Fight or flight” chemicals like adrenaline (epinephrine) and cortisol can cause vascular changes that leave you with a tension headache or migraine, either during the stress or in the “let-down” period afterwards. Stress also makes your muscles tense, which can make the pain of a migraine worse. Beyond treating the headache itself, focus on headache-proofing your home, diet, and lifestyle in general.

12. Memory

Too much of the stress hormone cortisol can interfere with the brain’s ability to form new memories. During acute stress, the hormone also interferes with neurotransmitters, the chemicals that brain cells use to communicate with each other. That can make it hard to think straight or retrieve memories. While it’s tough to limit stress in our hectic lives, some experts recommend trying meditation, among other solutions.

13. Blood sugar

Stress is known to raise blood sugar, and if you already have type 2 diabetes you may find that your blood sugar is higher when you are under stress. Changing what you eat, exercising more, or adjusting medication can help to keep it under control. One study of obese black women without diabetes found that those who produced more stress-related epinephrine when asked to recall stressful life events had higher fasting glucose and bigger blood sugar spikes than those with lower epinephrine, suggesting it might raise your risk for getting diabetes too.

About Dr. Sanam Hafeez PsyD is a NYC based licensed clinical neuropsychologist, teaching faculty member at the prestigious Columbia University Teacher’s College and the founder and Clinical Director of Comprehensive Consultation Psychological Services, P.C. a neuropsychological, developmental and educational center in Manhattan and Queens. 

Dr. Hafeez masterfully applies her years of experience connecting psychological implications to address some of today’s common issues such as body image, social media addiction, relationships, workplace stress, parenting and psychopathology (bipolar, schizophrenia, depression, anxiety, etc…). In addition, Dr. Hafeez works with individuals who suffer from post-traumatic stress disorder (PTSD), learning disabilities, attention and memory problems, and abuse. Dr. Hafeez often shares her credible expertise to various news outlets in New York City and frequently appears on CNN and Dr.Oz.

Connect with her via twitter @comprehendMind or www.comprehendthemind.com