The Nature and Causes of Anxiety and Panic Mark B. Powers, Ph.D. Maarten Zum Vörde Sive Vörding, M.S. Carlijn Sanders, B.S. Paul Emmelkamp, Ph.D. University of Amsterdam 1 Sections of this hand-out were written by Drs. Ron Rapee, Michelle Craske, David Barlow, Michael J Telch, Brad Schmidt. Page 1 of 15 The Nature and Causes of Anxiety and Panic 1.0 Introduction 3.0 Function of Anxiety and Panic Fear is probably the most basic of all emotions. Not Everyone has experienced anxiety or panic at some only is it experienced by all humans, but fear responses time. Common examples include the feelings upon have been found in all species of animal right down to entering a classroom just before an exam, or the feelings the sea slug. Experiences of fear vary tremendously in one gets when one awakes in the middle of the night to their severity from mild worry to anxiety to extreme sounds of a prowler in the house. So what purpose do terror and panic. The experience of fear can also vary in these feelings of anxiety and panic have for us? duration from a brief, almost fleeting flash, to a Protection! Anxiety and panic function as a protective constant, all day affair. While anxiety and panic, by alarm system to aid in coping with potential danger and nature, are unpleasant, they are not in the least bit threat. It is not surprising that Mother Nature in her dangerous. It is this last point which forms the basis of wisdom provided us with a built-in alarm system for this hand-out, namely to increase your knowledge about responding to danger. Our alarm system has two basic anxiety and panic. As you learn more about the nature modes - ANXIETY and PANIC. Both modes are and physiology of anxiety and panic, you may begin to designed to help us respond to danger. Mother Nature realize that (a) many of the feelings and symptoms was very wise in realizing that we needed different which you now experience are the normal result of your alarm responses depending on whether the danger was alarm system being needlessly triggered and (b) that immediate or delayed. As already mentioned, the these feelings are not harmful or dangerous. anxiety alarm gets triggered when we perceive future danger or threat. In essence the anxiety alarm functions as a readiness alarm. It warns us that some danger or 2.0 Definitions of Anxiety and Panic threat is coming. That's one of the major reasons why it is possible to remain in a state of high anxiety for an Although many definitions of anxiety have appeared entire day or more. Think of anxiety as an emotion that over the years, there is a core theme that emerges in is telling you "you're not in trouble yet, but there is these definitions. This theme involves the anticipation of trouble coming down the road and you better be ready". danger or threat. For this reason we define anxiety as a normal innate emotional alarm response to the Panic, on the other hand, is our escape alarm. It is a anticipation of danger or threat. There are several key- more intense and shorter-acting emotional response to terms in this definition that deserve further discussion. assist us in coping with immediate danger. While true First note the use of the term innate. That simply means panic usually lasts only a couple of minutes or less, it that anxiety, like other emotional responses is a natural gives us a major jolt designed to prepare us to quickly part of our biological make-up. We do not have to learn flee the danger. Scientists sometimes refer to the panic now to become anxious. Rather, it is automatically alarm as the fight-flight response. It is so named triggered under certain conditions - namely when one because all of its effects are aimed toward either fighting perceives danger coming down the pike. Note the use of or fleeing the danger. Thus, the primary function of the term normal. Unfortunately, many people believe anxiety and panic is to protect. Back in the cave people that anxiety is bad, dangerous, or abnormal. On the days, it was vital that when faced with danger, an contrary, without the help of anxiety, humans would not automatic response would take over causing us to take have been able to survive! The use of the term alarm immediate action (attack or run). Even in today's hectic highlights the important protective function of anxiety. world this is a necessary mechanism. Just imagine you More about this important feature later! were crossing a street when suddenly a car sped toward you blasting its horn. If you experienced absolutely no What about panic? Panic is similar to anxiety in many anxiety, you would be killed. However, more probably, respects. We define panic as a normal innate emotional your panic alarm would be triggered and you would run alarm response to the perception of immediate danger out of the way to safety. The moral of this story is a or threat. The key distinction here is that unlike anxiety, simple one — the purpose of anxiety and panic is to panic is the normal protective response when the danger protect, not to harm. It would be totally ridiculous for is more immediate. For instance, while many of us nature to develop a mechanism whose purpose is to might respond with anxiety to the news that our job was protect and yet, in doing so, causes harm. being cut, having your air suddenly and unexpectedly cut oft while scuba diving at 200 feet is enough to A number of unpleasant physical sensations occur when trigger panic in even the most well trained diver. As in our panic alarm is triggered. These include sensations the case of anxiety, many people falsely believe that such as dizziness, light-headedness, sweating, and panic is dangerous or harmful On the contrary, panic is breathlessness. When we experience the intense our normal protective response in times of immediate sensations of panic in a situation that would cause panic danger. for most people (for instance, being in a bank in the middle of a robbery), we understand it and do not worry that something is seriously wrong with us. However, Page 2 of 15 The Nature and Causes of Anxiety and Panic when these same sensations appear out of the blue in a when it is activated, all of its parts respond. In other situation where we would not expect them (e.g., words, either all symptoms are experienced or no watching TV) it is easy to become frightened by these symptoms are experienced; it is rare for changes to feelings and to worry that there must be something occur in one part of the body alone. This may explain seriously wrong with us. Some of the common fears why-most panic attacks involve many symptoms and about these sensations include concerns about heart not just one or two. problems, strokes, going crazy, losing complete control and even concerns about dying. Understandably, these One of the major effects of the sympathetic nervous concerns "feed" the fear and can lead to the system is that it releases two chemicals called adrenaline development of panic disorder. and noradrenaline from the adrenal glands of the kidneys. These chemicals, in turn, are used as messengers by the sympathetic nervous system to 4.0 What Happens When our Alarm continue activity. However, it is very important to note System is Triggered? that sympathetic nervous system activity is stopped in two ways. First, the chemical messengers adrenaline and Anxiety and panic manifest themselves through three noradrenaline are eventually destroyed by other separate systems working in close connection with each chemicals in the body. Second, the parasympathetic other. The three systems are: the mental or cognitive nervous system (which generally has opposing effects to system; which includes the actual emotions/feelings of the sympathetic nervous system) becomes activated and nervousness, anxiety and panic and also includes restores a relaxed feeling. It is very important to realize thoughts such as there is something wrong"; the that eventually the body will "have enough" of the physical system which includes all the physical fight/flight response and will activate the symptoms such as dizziness, sweating, palpitations, parasympathetic nervous system to restore a relaxed chest pain, and breathlessness; and the behavioral feeling. In other words, anxiety cannot continue forever, system which includes the common urge to escape or nor spiral to ever increasing and possibly damaging avoid. In panic, the physical system becomes the most levels. The parasympathetic nervous system is a built in important because it is these symptoms which are most protector which stops the sympathetic nervous system easily mistaken for some serious threat. from getting carried away. Another important point is that the chemical messengers, adrenaline and Each of the three systems of the alarm response share a noradrenaline take some time to be destroyed. Thus, common property. They each in their own way function even after the danger has passed and your sympathetic to prepare us for immediate protective action. Let us nervous system has stopped responding, you are likely turn to a more complete description of what happens in to feel -keyed up or apprehensive for some time because each of the three systems when our alarm system is the chemicals are still floating around in your system. triggered. As you become more knowledgeable about You must remind yourself that this is perfectly natural how our alarm system functions, you may find that your and harmless.