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Panic Attacks
by Shirley Babior, LCSW
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, social workers or psychiatrists.
About the Author:
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.
Revised 04/29/2009 by Marlene M. Maheu, Ph.D.
Mine started from social anxiety. my language barrier caused social anxiety and depression. Then I had panic attacks. I was terrible. You never know when you are going to have one. That fear is the hardest one to overcome.
This may be one of the most helpful articles I've read about panic attacks--it hits very close to home for me. I also get panic attacks at work...And it happened once in a meeting where I confessed--fortunately my boss understood (his sister suffers from panic attacks), but I know he is concerned that it will happen often enough to affect my performance--which, sadly, I confess that it does. While sometimes projects I can heavily engage in are a good distraction, an onslaught of mutable projects can make me feel overwhelmed--and if I panic in between--unbearable. If I wasn't so nervous to get fired, I would send this article to my boss. However, I think its best to draw as little attention as possible to my handicap.
While it may have been an aside, the part about the physical symptoms causing the mental panic--in THAT ORDER-- was very significant to me. That is precisely how it goes but I hear other people describing the panic that causes the physical symptoms. Perhaps it can go either way.
Thank you for writing this article, as it is comforting to know that other people go through the exact same things that I do in the work place. My phobia is actually my hypochondria (and so it follows me wherever I go), and when I get a panic attack, the fact that my blood pressure goes up when I panic makes me incredibly nervous, which makes my blood pressure go up and so on. So much so in fact, that I, a female 26-year-old vegetarian and runner, was put on blood pressure medicine for nine months. I stopped taking Zoloft, Klonopin and Ambien successfully, but have been struggling with coming off of the blood pressure meds because it is my safety net. My doctor reminds me frequently that I do not have high blood pressure, that I have anxiety. I have had four cardiograms and one echocardiogram for the pains in my chest with no worrisome results. Still, the pains persists and I remind myself that, as my cardiologist says, the pain is coming from my brain and not my heart—a pretty hard concept to grasp when you are experiencing obvious and pronounced chest pain, numbness of the arms, sweating, nausea, etc. I will end with another thank you, as 80% of my post has been nothing but cathartic venting, but I did truly enjoy this article. Very helpful.
Maybe you could try purchasing a self help book. I have suffered 13 years. A book helped me.
Best Wishes.
Great info re: panic attack!
I was very intrigued when reading your post titled "Panic Attacks" because it is a common issue that many people experience in the world. I found it very interesting when you described the work environment to be a place that can trigger panic attacks and depression. It's interesting because many of us need a job to survive in this world, whether it's paying our bills, purchasing resources like food or even paying the rent for shelter. While reading your post, you began to explain that stress can lead to a panic disorder. For example, "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." I completely agree with this quote because there are other issues outside of the work environment that can lead to panic attacks and bringing the issues into the work place can cause more distress and make work harder. Another thing you mentioned was the amount of time spent on the job. When working, your time is consumed by the amount of work that needs to be finished and worrying about other factors besides work can be a problem. I've also learned that how experiencing a panic attack can cause fear for another one to occur.
I have experienced panic attacks for a period of time a while back and they were absolutely awful so I sympathise.
I always get panic attacks at work and actually work has been one of my biggest problems. I've left jobs, stopped going in, etc-not because I'm a deadbeat lazy loser but because if I screw up something, or if I feel overwhelmed or if I have a problem with my boss or co-worker, I feel like I can't deal with it. The fear of dealing with the conflict is so severe that sometimes I feel paralyzed. I would stay up all night because I didn't want to go to work the next day and I wanted more time away from work, if that makes any sense at all. ( I know it sounds insane.) I set up these really really high expectations of myself and I always fail them. I am great at interviews, always get the job, always have these high hopes for me but once the actual job begins, I start panicking. The beginning is the worst. I hate new things.
I feel like I have no life anymore and I feel completely miserable.