Toward Serenity: Understanding Physiology May Help Panic Disorder Treatment

A study led by Dr. Alicia Meuret of Southern Methodist University examined the somatic evolution of a panic attack by attaching ambulatory devices to the waists of 43 people who suffer from panic disorder. The devices monitored a variety of respiratory and autonomic symptoms, including body movements, skin temperature, and vocalization. The participants were told to engage in their normal life activities, push a panic button if they began experiencing a panic attack, and keep a written record of their symptoms. In total, 13 full-scale panic attacks were recorded during the study. When the data was collected and analyzed, a pattern was established; in the hour before onset, the participants experienced marked cardio-respiratory changes:

Physiological instabilities occur in repeated bouts or waves and are often initiated by heart rate accelerations, followed by changes in breathing and carbon dioxide levels. Ultimately, breathing becomes much shallower, causing a spike in carbon dioxide levels that lead to symptoms that could no longer escape the attention of those who panic. More precisely, they experience terrifying sensations, such as dizziness, air hunger, and shortness of breath.

Dr. Meuret hypothesizes that the body may be repeatedly resisting physiological instability, resulting in the waves observed by the researchers. This process appears to be imperceptible to the person experiencing it, and it is only when the body is no longer able to fight that symptoms break through as a full-blown panic attack and are recognizable. For some, this suggests that approaching panic from a point of acceptance rather than catastrophization may change your perspective and, hence, your experience of panic attacks. Dr. David Barlow of Boston University says, “Perhaps we should […] foster a non-threatening attitude of acceptance. This might in itself modulate the subsequent intense emotional experience that is a panic attack.” Instead of framing attacks as a trauma to be fought, it may be therapeutic to decrease the fear of panic itself; recognizing panic as a predictable series of physiological events may strip attacks of their power and minimize psychological and physical damage.

So what should you do when you hit the point where you feel an attack? Because panic manifests primarily as a respiratory event, controlled breathing can help. Contrary to popular belief, however, long, deep breaths are not the way to go. In fact, the hyperventilation that makes you feel like you’re gasping for air is actually causing you to take in too much air and release excess carbon dioxide, increasing your anxiety and prohibiting oxygen from reaching the brain. Dr. Meuret found that training yourself to breathe at a normal or shallow level can increase carbon dioxide levels and reduce distressing symptoms. In fact, some subjects in her research were able to prevent attacks altogether by taking control of their physiological activities before they hit the point of panic. What Dr. Meuret’s work suggests is that heightening sensitivity to the physiological changes brought about by anxiety may offer a new way forward in the treatment of panic disorder.