Panic Attacks

Shirley Babior, LCSW

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My first panic attack came out of nowhere and hit me at work one day. I went outside the building for some fresh air. I felt better so I went back in. But the next day, I had three attacks at work. The third day I didn't want to go back.

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Panic attacks along with other anxiety disorders are the most common of all mental health problems and can arise in a number of ways. Research on the central nervous systems indicates the presence of an underlying biological vulnerability in anxious people. With stress, these people become afraid, avoid a situation or emotion perceived as threatening, have catastrophic thoughts, and may eventually develop pronounced avoidance behavior and physical symptoms as well as associated depression.

Stress in the workplace can begin or aggravate a panic disorder. Even if stressors outside of work are involved, an employee's confidence and performance can decrease on the job because he or she fears being embarrassed by an attack at work. Time on the job may also be lost due to worry over having an attack. Individuals suffering panic attacks often go to great lengths to hide their symptoms because they fear ridicule. Symptoms may include:

heart palpitations
dizziness
tingling in the hands or feet
chest pain or discomfort
feelings of unreality or disorientation
sweating
faintness
trembling
shortness of breath
stomach distress

When a cycle begins: physical symptoms are followed by fear, which gives rise to more pronounced physical symptoms and so on. Eventually, the employee may want to flee the work place and go to an emergency room or a safer location. If a supervisor notices a decline in the performance of a good employee (for example, the employee starts avoiding certain tasks or staying at home) try the following:

identify the presence of any panic symptoms
offer help in a non-judgmental way to bring the real problem out into the open
ask the employee to get a physical to rule out underlying medical causes

Regardless of the outcome of the medical examination, a panic disorder is still a possibility. Fortunately, panic attacks are highly treatable. Reassurance, possibly with the aid of self-help books or tapes, is very useful and may be all some employees need. These publications are readily available at many bookstores. For more severe problems, understanding the situation and encouraging the employee to seek counseling can result in productivity being resumed and can avoid a stress claim for disability. State-of-the-art treatments used by therapists usually include cognitive/ behavioral coping techniques, often integrated with medication for optimal outcome. Panic sufferers usually tense their bodies and breathe in a way that increases symptoms. Helpful coping strategies include:

muscle relaxation exercises
breathing retraining
visualization
gradual exposure to all avoided situations
appropriate labeling of emotions.

Any strong emotion can trigger a panic attack. People are encouraged to observe their fearful thoughts and replace them with more rational ones. For example, "I'm going to faint" could be changed to "I've never fainted before and there is no evidence I'm going to now." The affected employee may need to take it slow and collaborate with the supervisors in the work environment so there is a gradual increase in the work load.

Panic disorder may involve fear of being in an enclosed place, where the individual feels trapped and unable to get help. For example, an employee may avoid taking the elevator or suddenly refuse to fly. Again, counseling is very effective in combating these phobias. A good employee experiencing a panic disorder need not be fired or suspended if the company realizes what is happening, and that solutions exist. It makes sense to leave these employees in the workplace and help them find relief.

For more information on locating specialists in the treatment of panic disorder, write to the Anxiety Disorders Association of American, 600 Executive Blvd., Rockville, MD. or contact local professional societies for names of psychologists, socialworkers and psychiatrist.

5/21/98

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Shirley Babior, LCSW is a psychotherapist and co-director of the Center of Anxiety and Stress Treatment in San Diego. She is co-author of the self-help book Overcoming Panic Attacks: Strategies to free yourself from the Anxiety Trap.

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