Many people, at some point in their lives, will experience a sudden, dramatic rise in heart rate, along with rapid shallow breathing, dilated pupils, and cold, clammy hands. Convinced they are having a heart attack, they rush to the emergency room, where, after a series of tests, they are informed there is nothing physically wrong with them. It is “only” a panic attack. Advised not to worry, they are then referred to a psychiatrist, because “a little Xanax should make it all go away.” When they ask what a panic attack is and why they might have had one, they are usually told that it is something that “just happens,” and that it is not related to any specific cause.
But is it truly that simple? Do panic attacks really “just happen” without cause, or are there underlying triggers that precipitate such events? Are they inevitable, or can they be prevented? If so, how?
In my view, panic attacks do not happen for no reason, but are based in ongoing anxiety. The anxiety, however, rather than being conscious and continuous, as with general anxiety disorder, is unconscious and discontinuous. That is, like a covered pot in which the boiling water cannot be seen by the naked eye, with panic attacks, the seething anxiety is unavailable to the conscious mind. And a panic attack is like the lid blowing off the pot, revealing the boiling emotions underneath.
Although medication might be helpful in the short run, over the long haul, decreasing the frequency and severity of panic attacks requires a thorough exploration of the underlying anxiety, along with the reasons that anxiety is not being experienced consciously. When the hidden feelings emerge into the light of day, where they can become the focus of clinical attention, they can be further explored and understood. Over time, as they become integrated into a more complete and complex experiential world, they will not boil below the surface, and the lid will no longer blow off the emotional pot.