I am pretty sure I am having anxiety or panic attacks, but I want to know which one.

So I have these moments that come out of nowhere where I get really short of breath/shallow breaths, feel very shaky, feel as if someone is sitting on my chest, and feel as though something really bad is going to happen either to me or someone in my life (kinda like the feeling of impending doom). It sometimes feels as if the room is going to close in around me and I start crying because I’m so scared. It happened twice in May when I was about to graduate college and it has happened three times in the last month because I am applying to PA school. It randomly happened while I was driving home and even once while I was in the movie theaters and I had to get up and walk out of the movie for a minute to get myself together. I’ve noticed it happens when something stressful is going on in my life, but I was wondering if these could be panic attacks or anxiety attacks.
Asked by Sammy
Answered
10/21/2022

Hi Sammy, thanks so much for your question!  Without knowing you or your history, it can be hard to know for sure whether you are having anxiety or panic attacks.  However, I can provide some general information about both.  Perhaps some of it will resonate with your experience and be helpful.  

Anxiety can be detrimental to one's quality of life.  It is typically future focused.  It takes us to places we have never been, places we never would want to be if we could avoid it.  We are often contemplating scenarios that have not happened, and possibly never will.  There is a protective function here, in that our brains are trying to keep us safe by imagining everything that could go wrong in order to prepare ahead of time and avoid being hurt. Over time, the neural pathways in the brain get reinforced and thoughts start automatically taking the road to the future, making it difficult to function in the here and now.  

When anxiety starts to get loud, the nervous system begins to experience dysregulation.  This simply means the nervous system is having a harder time doing its job and things like breathing, heart rate, body temperature, etc. start to change.  This is what eventually will lead to an anxiety attack.  With anxiety attacks, there is often a trigger the precedes the episode.  For example, if a person was in a car accident, they might experience anxiety attacks the next time they get behind the wheel of a car because the body/brain fears another accident.  

Panic attacks, while very similar in presentation to anxiety attacks, often do NOT have a defined trigger.  So, it can feel like a panic attack shows up out of nowhere.  Sometimes panic attacks can be a byproduct of a consistently dysregulated nervous system, meaning anxiety has been too high for too long, and now the body is reacting with panic at seemingly random moments.  

It is important to note here that there are five foundational areas that support the nervous system: getting enough sleep, eating enough food, moving your body in an enjoyable way, engagement with healthy social connections, and engagement with spirituality (not spirituality as in a particular religion, but spirituality as in matters of the heart, connecting with nature, art, etc).  When these areas are out of balance, the nervous system can become consistently dysregulated, which can also eventually lead to the panic attacks.  Trauma is another thing that can lead to consistent dysregulation, so it is important to recognize that anxiety and panic have multi-factorial causes.  

Regardless of whether you are having a panic attack or an anxiety attack, the following information can be useful when trying to intervene.  There are many interventions for anxiety.  One is mindfulness.  In addition to the things already discussed, mindfulness can be a helpful way to regulate the nervous system 

Mindfulness is the practice of present-focused awareness, meaning we are in the here and now.  It also entails the acknowledgement and acceptance of thoughts, emotions and bodily sensations exactly as they are in that moment.  We do not judge ourselves, try to solve problems, or plan for the future.  We don't even engage with the thoughts.  We simply notice them like clouds floating in and out of our minds.  The benefit of this practice is that when we are connected to the present, we cannot be lost in the past or future.  

Here are some techniques to practice mindfulness:  

1. Square breathing

Breathe in for four seconds, hold your breath for four seconds, breathe out for four seconds, and rest for four seconds.  Repeat several times. While practicing this deep, slow breathing, imagine a square being drawn in front of you.  This helps because you cannot imagine the square being drawn while examining the past or future.   

2. Using the five senses

Notice your surroundings and take mental note of five things you see; four things you feel (noticing the feeling of your chair supporting your back, noticing your feet on the floor, noticing any breeze or how the temperature feels on your skin); three things you hear; two things you smell; and anything you might be currently tasting.  This activity can be done while sitting, lying down or taking a walk. 

3. Be an observer of yourself

Find a comfortable place to sit, close your eyes and picture the room you are currently in.  Imagine you are observing from the doorway of the room. You can see yourself sitting on the couch in this present moment.  What do you notice?  Take note of your observations, acknowledge them and let them drift away.  Doing this for even a few seconds can help us step outside of our own distressing thoughts and observe them more objectively.  Creating this space brings us back to the present moment.  

4. Utilize the sensation of coldness

If you find your anxiety is getting out of control, connecting with something shockingly cold can be a helpful technique to get your body and mind back to the present.  Examples are holding an ice cube, jumping in a cold swimming pool, or taking a cold shower. 

5. Using a scent

Energizing scents can be another way to bring your mind/body back to the present. Citrus type smells work best, but other calming scents, such as lavender or lilac, can be helpful, too. 

6. The practice of journaling

Journaling, or writing out your thoughts, helps force the mind/body to connect to the here and now.  We cannot be writing something if we are not present.  Sometimes called a “brain dump,” this technique creates objectivity to our thoughts as it gets them outside of our minds and puts them on paper.  Try it, it might surprise you! 

Remember, when we are in a state of anxiety, the nervous system is taxed and dysregulated.  This starts a chain reaction throughout the body and is why we experience the physical symptoms (such as quickened breath, heightened sensitivity to sound, racing heart, etc).  The goal of mindfulness is to get yourself connected to your body and help the nervous system re-regulate itself.  Utilizing these practices listed above can be a helpful way to do just that—connect with yourself, breathe, and let your body settle itself down. 

Mindfulness can be a powerful intervention when it feels like our emotions are taking over. The idea is to remain present-focused, non-judgmental, and aware of your immediate thoughts, feelings and physical sensations.  If you notice you've drifted into the past or future while practicing mindfulness, simply notice this, accept it, and then bring your awareness back to the rise and fall of your breath.  It might take some practice, but it works!  

More than anything, practicing self-compassion is vital for our well-being.  Be kind to yourself.  You are trying, and that is more than enough

(LCSW)