The Benefits of Counseling and Psychotherapy For Anxiety Attacks

Though Anxiety Attacks are not officially recognized by the latest edition of the Diagnostic and Statistical Manual of Disorders (DSM 5), Anxiety Attacks are a genuine experience for many people who deal with diagnosed or undiagnosed anxiety.

Anxiety Attacks are typically an experience of intense fear that may feel more incapacitating than typical feelings of apprehension about the future. The experience of worry, restlessness, and nervousness could peak into an anxiety attack when the mind starts treating a stressor as ‘life-or-death’ even though it might not be, e.g. fearing an exam to the point that you feel unable to breathe or think clearly.

Anxiety attacks are distinct from panic attacks. Panic attacks can feel more intense than anxiety attacks and are experienced as a surge of physical sensations that may feel life-threatening. Typically, panic attacks can resemble a heart attack, sudden breathing difficulties and even choking sensations.

They may be shorter in duration than anxiety attacks but their impact can be felt for a longer time. Additionally, panic attacks can feel sudden, like they come out of nowhere, and may or may not have a trigger. In contrast, the triggers for anxiety attacks are usually clearer (Leonard, 2023). 

Typical Signs of Anxiety Attacks: 

• Surge of intense worry, the person may feel unable to stop thinking about worst-case scenarios. In some cases, people may temporarily feel unable to speak.
• May seem highly disconnected from the present moment and have difficulty processing information. It isn’t simply ‘distracted’ such as when people are lost in their phone, instead it may seem like the person is overwhelmed by fear 
• Tension in the body, muscle tightness, jaw tightness, restlessness. People can also experience cramps, headaches and other pronounced aches and pains. 
• Difficulty breathing, chest pains, gastrointestinal distress
• People may also experience trembling, sweating, dry mouth and may feel extremely fatigued in the aftermath of the anxiety attack. 

Anxiety attacks can occasionally occur as a response to temporary stressful events, e.g. during exam season. However, when there is prolonged exposure to stress people can develop other anxiety conditions such as Generalized Anxiety Disorder, which includes feelings of: 

• constant worry, thinking of worst-case scenarios 
• insomnia (difficulty falling asleep or difficulty staying asleep), 
• concentration difficulties, typically due to racing thoughts, multiple thoughts (“overthinking”)
• physical symptoms such as muscle tightness, digestive difficulties, breathing issues 

Anxiety disorders are a sign that the sympathetic nervous system (SNS; stress response system) is in overdrive and very sensitive to triggers, like an ambulance siren blaring to signal a life-threatening emergency even when there isn’t one. During an anxiety attack, the SNS system begins to sound this siren with greater intensity. 

Treatment of Anxiety Attacks Through Psychotherapy: 

The experience of psychotherapy can expose people to skills and experiences to help with anxiety attacks. For instance, during therapy, I sometimes invite folks to look around the room and identify something in the room that helps them feel less agitated. I also encourage them to notice themselves breathing, but without forcing a deep breath. It might seem like such a simple thing-” look around the room and take a breath”- but the fact is that it can work. Here’s one explanation:  

The part of our brain that is responding to danger (“sympathetic nervous system”) is sending a signal to the rest of the body to

• Fight - Express anger or aggression 
• Flight - Escape or avoid 
• Freeze - Stop or collapse
• Fawn - submit to authority, attempt to please or appease

When the body receives these fear-based signals, it is unable to focus on things like logic and language. 

As a psychotherapist, I use my presence, my voice, and my understanding of anxiety to  “manually install” a calm behavior such as looking around the room slowly and taking a breath. As such, I invite folks to consciously awaken the part of their brain that would help them rest during our session and connect with me. So rather than feeling overwhelmed by the fear-based thoughts and sensations that may evoke fear/anxiety/anxiety attacks, people learn how to reach a better position to engage the language and logic centers of the brain, which would also help them engage in a therapeutic relationship with me, receiving information and offering me information as needed. 

Managing Anxiety Attacks Through Psychotherapy

With the support of a talk-based psychotherapist, people can understand anxiety attacks and learn three types of strategies to manage them: 

1. Things to do ‘in-the-moment’ when an anxiety attack occurs; learn how to ‘manually install’ Parasympathetic Nervous System (PNS) activity. Examples: 
   • Belly breathing: Notice your inhales and exhales as they enter and exit your belly. 
   • Orienting and Grounding in Space: Look around the environment where you are and recognize “I am here, the ground is below me, and the sky is above.” 
   • Use your senses to notice what you see, smell, hear, taste, touch. E.g. the open window, I smell the rain, I hear children laughing, I taste nothing, I can touch the soft sofa that I am sitting on. 
2. Understanding and altering our response to internal and external situations that trigger anxiety attacks. Examples: 
   • When thoughts about your to-do list worry you, return your attention to the present moment and focus on the task at hand. Disrupt the habit of responding to thoughts about to-do lists with more list-making and problem-solving by focusing on the present moment 
3. Lifestyle changes that can help you strengthen your Parasympathetic Nervous System (PNS; “rest-and-digest” system) on a regular basis
   • Discuss habits to make a regular part of your life so that you can strengthen your PNS. For instance, as a therapist I have invited folks to practice belly breathing 5 times a day, ideally paired with something they already do, such as meals and watching TV. Since our stress and thoughts about stress are much more frequent than our rest, our SNS is stronger than our PNS. Just like learning to swim in the shallow swimming pool can help us eventually swim in the open ocean, regular lifestyle habits can help us strengthen our PNS and protect us against the impact of frequent SNS activity. 
   • I also explore ways to improve people’s sleep, meals, and rest habits so that their naturally-occurring PNS responses can be strengthened. Prioritizing good quality sleep so you wake up refreshed, setting aside time to eat a nutritious meal without multitasking, and making time to connect with hobbies and/or friends and family - these are some ways people can prevent anxiety attacks through lifestyle changes. 
     

Benefits of Psychotherapy for Anxiety Attacks: 

Typically, evidence-based psychotherapy is designed to build a collaborative working alliance between therapist and client in a manner that allows: 

• Greater self-awareness 
  • Recognize your internal environment of thoughts and feelings, or your external environment of people, expectations of others, etc. 
• Non-judgemental acceptance of feelings and thoughts, e.g. “I am feeling worried. This is neither good nor bad, it is what it is”, instead of denying or resisting them, e.g. “I should not be scared. Why am I scared? This is so illogical”. 
• Investigating the experience the way a journalist would, with curiosity and an effort to understand facts: What is happening, when did it start, what helps, what does not help, how does it get better, how does it get worse. 
• Developing actions that promote health
  • Learning coping strategies and a lifestyle that allows for better management of anxiety attacks. 
  • Though 100% elimination of stress and anxiety is rare, what we can do is develop ways to soften the impact of stress and anxiety. Just like we cannot prevent rain from falling, we can carry an umbrella to protect us from getting completely wet in the rain. 

Just like an umbrella that doesn’t magically appear when it rains, developing strategies to address anxiety attacks requires preparation and practice. Qualified psychologists can help you with that. At Mave Health, we are committed to bridging the gap between people dealing with anxiety and experienced therapists who can help. If you need support, don’t hesitate to reach out! 

References 

Leonard, J (2023, October 13th) How do you know if you're having a panic or anxiety attack? . MedicalNewsToday. 

https://www.medicalnewstoday.com/articles/321798

Additional readings: 

Koranne, D (2023). Latest Statistics of Anxiety Disorders in India. Retrieved from 

https://mindvoyage.in/latest-statistics-of-anxiety-disorders-in-india/

Gupta, Sonali (2020). Anxiety: Overcome It and Live Without Fear