Panic attacks first occur unexpectedly and with no obvious reason. Researchers from Brown University say that stressful events are associated with the onset of panic attacks in the vast majority of cases.
The specific causes of panic attacks remain unknown but researchers agree that it is a combination of environmental and biological factors.
Stress is not simply a case of cause and effect. There are many factors that influence when and for how long the fight or flight response is triggered and how harmful can be the impact of stress upon us.
Such factors include:
- how we perceive an event (our thinking style, emotional coping style, beliefs, personality traits)
- duration of the stressor (stressful event), many stressors one after the other, unpredictability of the stressor, degree of control over the stressor
- self-support skills and social support
- medical conditions (e.g. mitral valve prolapsed, hyperthyroidism, hypoglycemia), diet, exercise, substance use (e.g. caffeine, drugs, alcohol…), medication withdrawal, highly sensitive nervous system
Stress and major life events
Stress is often connected with major life events and transitions in a person’s life like a divorce or job loss. Panic attacks may also be the result of a gradual and steady build up of stress over a long period. Many studies reveal that months preceding the first panic attack the person had been going through a period of stress or trauma. An accumulation of stressful events together with an emotional processing style that avoids dealing with the events and painful feelings in a healthy way will create a fruitful ground for anxiety and panic attacks.
Here are some common stresses:
- Death of a loved one
- Illness, operation, disability of a loved one
- Marriage/relationship problems: separation, divorce proceedings, arguments, fights, violent or critical partner, affairs…
- Children: having a baby, miscarriage, stillbirth, abortion, illness…
- Family: having to look after an ageing parent, over-control from parents in your life…
- Moving away from home (familiar surroundings), starting a new job/studies, moving to another home/city/country
- Your own physical health : surgery, illness, disability
- Accidents/disasters: car accident, seeing others being hurt
- Work: too much stress at work, deadlines, pressure to perform, bad atmosphere at work, boredom, long hours without breaks, many responsibilities, retirement…
- Financial worries: debts, business failure, mortgage/loans problems
- Substance use (10% of panic attacks are set off by drug use such as cannabis)
- Separation experiences: leaving home, separating with partner, moving away from family and friends
- Feeling trapped in an unhappy relationship/marriage, a stressful job, having to live in an unpleasant co-habitation with partner/ roommates/ family
- Losing control of important aspects of your life such as your job, social life
- Being controlled by a parent or a partner
Almost any of these stresses may be enough to set the scene for panic, as the pressure can be building up for months or years; often it is a combination of some issues that will bring the overload.
The warning signs of stress are there from the beginning: high levels of tension, irritability, poor sleep and concentration, feeling anxious, weak immune system, psychosomatic symptoms. Many people face successive stressful life events, so how come not all people who experience stressful events get panic attacks or anxiety related problems?
Panic attacks and Emotional processing style
How we cope with emotions plays an important role in the development of anxiety and panic attacks. Life events and stressful events will always evoke pleasant and unpleasant feelings. A lot of people tend to run away from unpleasant and painful emotions, it’s their way of handling emotions: avoidance of expressing and/or processing feelings. Signs of unprocessed emotion appear in the form of nightmares, intrusive thoughts, tension and anxiousness.
Someone who doesn’t understand, dislikes, avoids and/or suppresses unpleasant emotional experiences will be more prone to anxiety. This emotional processing style is present probably years before the first panic attack and ultimately it is this style that makes the person vulnerable to anxiety and having panic attacks.
We keep our immune system in shape with a good diet, exercise, proper sleep and rest, but what do we do for our emotional health, how do we ensure our “emotional immune system” is working properly?
A healthy emotional processing style involves giving space, valuing and expressing feelings, even painful feelings. The lack of ability to process distress and painful emotions allows tension levels to stay high for long periods of time.
Psychotherapy can be a great source of support to deal with anxiety and panic attacks by teaching breathing and relaxation techniques. What I consider the greatest gift of therapy is developing self-awareness, self acceptance and an emotionally healthy processing style, dealing with our own darkness, building a healthier ground and self-support skills so we can thrive and lead meaningful lives.