Mindfulness therapy is good for overcoming depression

Panic Disorder: Fear of death out of nowhere

Almost all psychiatrically defined anxiety disorders have an obvious trigger. In the case of fear of certain animals, claustrophobia or fear of heights, the "enemy" is at least known. Generalized anxiety disorder and panic disorder, on the other hand, have neither a trigger nor a deeper cause at first glance.

Anke Faber (51, name changed by the editorial team) suffers from both forms. The generalized anxiety disorder, an incessant cycle of anxiety for constantly changing reasons, is "comparatively not quite as severe, perhaps as increased stage fright," says the mother of three children. "You can tell when it comes - but with panic disorder it starts all of a sudden. I can't predict it. I just know that in certain situations it happens more often, or at least it's worse for me."

An attack lasts about half an hour, "this very intense fear", says Faber, "only lasts a few minutes" - but they are tough. There are also similar attacks with other fears - but with panic disorder the attacks come for no apparent reason and are much more dramatic. "Anyone who has a situational panic attack on the plane usually has a particularly strong phobia," explains the Linz psychotherapist and author Hans Morschitzky.

Death-like experience

In the case of panic disorder, on the other hand, those affected suffered "traumatizing, death-like experiences". The feeling of such an attack is "always an insane fear of death, as if someone had put a gun to your head," confirms Anke Faber. She also knows other typical symptoms well enough: palpitations, sweating, the fear of being admitted to psychiatry right away, and the feeling of depersonalization: "You become so alien to yourself that you think you are losing your mind."

Physically, those affected mostly suffered from tightness in the chest with fear of suffocation and severe dizziness, says Morschitzky. "These repeated spontaneous, unexpected panic attacks are experienced as life-threatening, at least the first time," emphasizes the anxiety specialist.

Fear of losing control

For most panic patients, the development of such a disorder initially has nothing to do with fear, says Morschitzky. Often there is an inundation with strong emotions at the beginning. This can be, for example, an internal blockage through reluctant feelings, for example "anger in the stomach" because one is very angry but feels too powerless to make this clear.

The expert likes to compare this "emotional jam" with trying to give full throttle with the handbrake on. In addition, acute fear of loss can also lead to a panic attack. "With a high level of stress, you only need relatively harmless triggers," says Morschitzky. In doing so, he increasingly notices professional stress as a deeper cause. As a trigger, it is enough to not have slept well one night or to have drunk too much coffee or alcohol once. However, those affected are not aware of this connection, because an attack typically only occurs in the resting phase after prolonged stress, apparently out of the blue.

The violent physical reactions experienced in the process are also experienced as a loss of control. "When I have a panic attack, I have the feeling that it just wipes me away inside," says Anke Faber. Because one is afraid that something like this will repeat itself, fear of the reaction of one's own body gives rise to fear that such an attack could happen again. This fear of anticipation, the "fear of fear", is the real problem with panic disorder. In many cases, it leads to the sufferer also developing agoraphobia. With the earlier "claustrophobia" (literally: "fear of the market") not only the fear of open spaces is meant. Today it is understood as the fear of leaving one's private shelter in order to go to public places where there is no possibility of retreat.

Avoid the vicious circle

"In the United States, agoraphobia was previously interpreted as a consequence of panic attacks," says Morschitzky. About half of the agoraphobics have never had such an attack. Panic patients often fear leaving their home if an attack has occurred in public. "At first people avoid similar situations, then it spreads, and suddenly they can no longer do anything without accompaniment or medication."

Anke Faber also shies away from certain situations since she has been suffering from panic attacks more frequently: "I currently don't go to church or like to go shopping when I know there is a lot going on". She is afraid of getting into a relaxed situation while standing in line, which favors an attack - and if possible she does not want to experience it in public, although she knows that outsiders usually do not even notice what is going on inside her. "When I have that at home, then I get through it differently than when I'm around people," she emphasizes.

Actually, after years of dealing with her suffering, she has also learned that she restricts herself with an avoidance strategy: "The fear of fear makes me plan and shape my life differently than I would if I hadn't," says Faber . The worst thing about avoiding panic is that it is precisely this avoidance behavior that keeps the vicious circle of anxiety and panic attacks alive - "completely independent of the original causes," emphasizes Morschitzky. Avoiding potentially "dangerous" undertakings gnaws at one's self-esteem and prevents the positive experience of having successfully mastered such a situation. Instead, "at some point many people become depressed because they avoid many things that are beautiful in life just out of the fear that they might panic," says the expert.

No counterattack

In Morschitzky's experience, 18 to 35-year-olds are particularly affected, 80 percent of whom could be free of fear again in a short time, for example through behavioral therapy or with the help of a counselor. Because panic disorder is actually considered a prime example of a successfully treatable anxiety disorder - but it is often not the only problem. In clinical practice with general practitioners and psychotherapists, panic disorders are often mixed with depression, occupational stress, an addiction problem or a tendency to increased anxiety and hypochondria, says the psychotherapist.

Dealing with anxiety is also made more difficult by the fact that the obvious reaction is not always the right one. Fatally, it is precisely the attempt to exclude any risk by concentrating on the danger according to the motto "I hope I don't panic now!" That leads to tension and makes an attack more likely. The fight against fear of expectation and panic is therefore a wrong focus of attention - simply to distract oneself, but it doesn't work either, says Morschitzky: "When something is bothering you, you can't easily distract yourself."

That is why elements of mindfulness therapy are helpful: You perceive the fear, but do not direct your attention to it - not even to fight against it. The fear specialist from Linz compares experiencing a panic attack with driving a car during a severe thunderstorm with hail, lightning and thunder, in which everyone draws their attention to getting from A to B and not to not having an accident. "These are examples where people do everything right," says Morschitzky. "You have to remind them that they have the resources for situations like this and that it would never occur to them to consider themselves cowardly because they did not focus on their fear." (Christoph Weymann, January 28, 2019)