Pacifying the Panic

Panic disorder warning signs and potential help through exercise

/ Author:  / Reviewed by: Robert Carlson, M.D

Everyone is afraid from time to time, but if you suffer from a panic disorder, the feeling can strike quickly and without warning in a way that impedes your ability to live a normal life.

Now research is attempting to give us a better understanding of the physical effects of the disorder and explore new possible treatments.

Panic Disorder

These episodes of sudden and uncontrollable fear, or panic attacks, typically last for several minutes and symptoms can linger for longer.

According to the National Institute of Mental Health (NIMH), panic attacks “are characterized by a fear of disaster or of losing control even when there is no real danger.”

Panic attacks can strike at anytime and include physical symptoms like breathing problems, dizziness, a pounding heart and chest or stomach pain. NIMH advises that just because someone experiences a panic attack does not necessarily mean that the disorder will develop.

Panic disorder patients often live with regular dread about when an attack might strike, sometimes interfering with work or school.

According to NIMH, “A person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to the grocery store or driving.”

The symptoms of panic disorder tend to show up during the late teenage or early adulthood years, and the disorder is more common in women. The two most common treatments are psychotherapy and prescription medication, often of the anti-anxiety or antidepressant sort.

Spontaneous Attacks?

Panic attacks have long been thought of as events that occur without warning. However, research led by Alicia E. Meuret, PhD, from Southern Methodist University and published in 2011 in Biological Psychiatry, showed a different story.

Meuret’s research found subtle, but measurable, physiological signs of change up to an hour before panic attacks struck.

In the study, 43 panic disorder patients wore fanny pack monitors for 24 hours straight on two different days, providing researchers with 1,960 hours of recorded data.

The monitors were connected to various sensors on the body, which measured factors like breathing patterns, sweating, heart rate and carbon dioxide (CO2) in the breath.

When a panic attack occurred, as they did 13 times during the study, the patients pressed a “panic button” and recorded the symptoms they experienced.

According to Meuret, "We found 15 subtle but significant changes an hour before the onset of the panic attacks that followed a logical physiological pattern. These weren't present during the non-panic period.”

The most drastic of the change seen was in CO2 levels, which were abnormally low, possibly showing that the patients experience chronic hyperventilation. These CO2 levels rose right before the patient indicated that a panic attack was being experienced.

Though researchers saw what Meuret called an “accumulating pattern of subtle physiological instabilities” in the hour before the attack, the patients themselves did not report noticing any changes and classified these attacks as “unexpected.”

Though patients may feel physical sensations like heart attack symptoms or trouble breathing during a panic attack, the study did not reveal anything inherently wrong with their physical health. “The fluctuations that we discovered are not extreme; they are subtle. But they seem to build up and may result in a notion that something catastrophic is going on," explained Meuret.

Follow up research is needed to further explore the spontaneity of panic attacks. This exploration of subtle signals in the body may invite new treatments or at the very least, a deeper understanding of the nature of panic disorder.

Another Reason to Get Moving

We have all been taught the benefits of a healthy lifestyle with plenty of exercise, but a study published in Psychosomatic Medicine in July 2011 showed that physical activity may be especially beneficial for panic disorder patients looking to ward off attacks.

The study specifically examined “anxiety sensitivity,” or a fear of the symptoms that often come along with a feeling of panic, which is seen as a risk factor for developing anxiety disorders.

Led by Jasper A.J. Smits, PhD, also from Southern Methodist University, the study involved 145 adults ranging from ages 18 to 59 without a history of panic attacks .

The participants answered questions related to their levels of both physical activity and anxiety before participating in a test in which required breathing in air enriched with CO2. This process is monitored and not dangerous, but can induce anxiety-provoking symptoms like a racing heart, dizziness and trouble breathing.

Participants informed researchers of their anxiety levels after the CO2 exposure. Results showed that those who have high, regular levels of physical activity reported lower anxiety levels (low "anxiety sensitivity") in response to the experimental stressor.

The two factors seemed to share an inverse relationship, with lower physical activity tied to higher anxiety sensitivity and higher physical activity tied to lower anxiety sensitivity.

According to Smits, "Anxiety sensitivity is an established risk factor for the development of panic and related disorders. This study suggests that this risk factor may be less influential among persons who routinely engage in high levels of physical activity."

The authors took care to note that they do not suggest patients switch to exercise as a replacement for psychotherapy or medication. However, the results suggest that physical activity might be a useful addition in the lives of those with panic disorder.

Further research will explore the potential of exercise to help people ward off panic attacks, but in the meantime, exercise can have numerous other benefits to the body and the mind.

As more research is conducted, methods to better treat and perhaps alert patients of oncoming panic attacks will be further explored. For now, NIMH recommends talking to a general medical doctor first when panic disorder symptoms are felt, to ensure a physical problem is not to blame. 

Reviewed by: 
Review Date: 
August 24, 2012