Aids to relaxation are ubiquitous, abundant: breathing techniques, benzodiazepines, ASMR, mood music, herbals teas, exercise, heavy drinking. Their opposite — aids to anxiety and panic — are everywhere, too, though typically experienced in- or quasi-voluntarily: personal catastrophe, climate change, world news. Might there be some power in appropriating this process — in self-inducing panic before fate, politics, etc. can do it for us? Not exactly. But from a biological, look-what-the-brain-can-do perspective, this capacity does seem worth investigating. Can someone — starting, let’s say, from a position of relative peace/contentment — actually think their way into a full-on panic attack? To find out, for this week’s Giz Asks we reached out to a number of experts in psychology and anxiety disorders.
Assistant Director of the Columbia University Clinic for Anxiety and Related Disorders and Assistant Professor of Medical Psychology (in Psychiatry) at Columbia University Irving Medical Centre
There are some important concepts to unpack in order to answer this question. (Before doing so, here’s a friendly reminder: don’t try this at home.)
When most people use the term “panic attack” colloquially, they usually mean “anxiety attack.” Unlike mounting anxiety or stress, a panic attack typically comes on out of the blue and is associated with a jolt of intense, visceral, and often terrifying anxiety that is characterised by four or more distressing physical sensations (e.g. heart racing, hyperventilation, feeling dizzy, sweating profusely) and extreme concern associated with the interpretation of these symptoms.
Panic attacks can be caused by internal triggers, such as hyperawareness or paying too much attention to internal experiences, which might cause someone to misinterpret his heart racing as a sign of a heart attack, or feelings of unreality as a sign that he is “going crazy” or will lose control.
Anxiety attacks, on the other hand, can be incredibly distressing as they build, but are usually tied to acute stressors (e.g. try to stay calm after losing your keys!) or chronic stressors (e.g. fear of not meeting a deadline).
Contrary to what you might think, when we treat panic disorder in cognitive behavioural therapy (CBT), we actually deliberately bring on simulated panic attacks, or work to induce common symptoms of panic as best as we can during treatment. This practice is called interoceptive exposure and it is fundamental to the treatment and recovery process.
By bringing on uncomfortable or feared sensations in the therapy room (say, for example, spinning in a chair to bring on a feeling of dizziness), we are helping individuals with panic symptoms learn to change how they relate to their symptoms; this way, they are no longer experiencing these physical sensations as threatening or dangerous, but instead as uncomfortable, short-lived, and manageable.
Bringing on these simulated panic attacks then allows individuals to learn that they are able to tolerate these sensations across settings, that their worst fears do not materialise, and that they can feel these symptoms and still engage in regular and meaningful activities.
I often tell my clients that they themselves have unknowingly brought on panic attacks without even realising it! For example, when they choose to ride on a roller coaster or take a cycling class. These activities induce the same symptoms characteristic of panic attacks, but they do not feel inordinately scared in those scenarios, because they know the cause. The difference with panic attacks is that the sudden and often unexpected onset does not always present with a viable or predictable cause, thereby leaving many feeling stunned.
To simulate a panic attack, as we do in cognitive behavioural therapy, you could “rev up” your body by bringing on a host of acute and unpleasant physical sensations. Although this might not capture the full scope of a panic attack, it would certainly shake things up.
Professor, Psychology, University of Queensland
It is quite possible to bring on the symptoms of a panic attack through, for example, deliberate hyperventilation. However, I would say that it would be more difficult to also have the emotional “out of control” panic feelings when you are intentionally producing the symptoms yourself.
In fact this technique of deliberate and controlled induction of panic symptoms is sometimes incorporated into a cognitive behaviour therapy for panic disorder to help the person experience the distinction between the symptoms and their response to the symptoms. It also can be used to demonstrate that symptoms can be controlled by combining the hyperventilation with slow diaphragmatic breathing. This tends to reverse symptoms brought on by the self-induced hyperventilation and helps to give the person a sense of efficacy and control over their symptoms.
Assistant Professor of Psychiatry at the Centre for the Treatment and Study of Anxiety at Perelman School of Medicine, University of Pennsylvania
In 1987, a study was conducted called the Carbon Dioxide Challenge; the idea was to look at ways to induce panic attacks in people who were in the laboratory. It turned out that if you had people put on an oxygen mask, and altered the formula in the oxygen machine so that there was slightly more carbon dioxide than normal, most people would have a panic attack.
This is important, because it suggests a strong correlation between disruptions in breathing and panic. One of the things we’ve found in many different research studies is that breathing disruptions are really the quintessential feature of panic attacks — that sense of hyperventilation, of not being able to catch one’s breath, is the feature most often reported by people with panic disorders.
Related to that, a researcher named Alicia Meuret, at Southern Methodist University, did some research in the early-to-mid ‘00s showing that people with a tendency to panic have different baseline breathing rates than people who don’t have a history of panic attacks.
So the idea is that you can make just about anybody have a panic attack, or symptoms that resemble one, if you make them hyperventilate for long enough. And in fact this is an important part of treating panic attacks: by bringing on some sensations that resemble panic attacks, through strategies like hyperventilation, people can learn that the symptoms themselves aren’t dangerous.
Mental health researcher at the University of Cambridge, whose research focuses on anxiety and depression
Yes, it is possible to do this. First of all, to briefly define a panic attack: it is a rapid crescendo of intense anxiety that peaks within minutes. You might feel like you are about to have a heart attack, go crazy, lose control, or die. You might also experience symptoms like heart palpitations, shortness of breath, and dizziness. Sometimes panic attacks arise out of the blue — for no reason — other times, they are triggered by specific events or situations.
So can you bring on a panic attack on your own? Yes, you can do so if you start thinking about your worries. This is especially the case if you are prone to anxiety, and you start catastrophising or thinking about the various ways that things might go wrong in the future and how you are going to fix them. This exercise may seem useful to you, because you are figuring out how to avert potential problems — this is commonly done by many people with anxiety. But thinking about worries and future problems can lead to a downward spiral — one worry can lead to a second, and then to a third, and before you know it, a panic attack can take hold.
Interestingly, recent research has also linked negative mood with anxiety. Studies have shown that being in a negative mood can make you more prone to generalised anxiety disorder, which is characterised by excessive, oftentimes uncontrollable worrying, among other symptoms. And having generalised anxiety disorder can make it more likely that you develop panic attacks in the future.
So essentially, the mood you are in right now can serve as a trigger for later panic attacks. Sometimes we choose the moods we are in, while other times they seem to just take hold of us and there is nothing we can do to escape them. So in those particular instances when we choose to remain in a negative state, then that can be a possible risk factor for a future panic attack.
Professor Emeritus, Psychiatry and Behavioural Sciences, Stanford University
It depends on whether or not you have had panic attacks. If you have, it is possible to bring one on by hyperventilating, (or sometimes spinning around) remembering previous situations/thoughts that may have precipitated one or going to places where you know you are likely to have one etc. However, most panic attacks just come out of the blue. If you are not prone to panic, it is pretty much impossible to bring one on, even by hyperventilating.
Clinical Assistant Professor, Psychiatry, NYU Langone Medical Centre
I’ve seen folks bring about anxiety attacks by worrying themselves into it — ruminating, what-if thinking, catastrophising, assuming the worst case scenario happening. It often happens at night, though it can happen anytime. People have insomnia; and when things quiet down outside at night, but the tape is still playing in their heads, they get out of bed and start pacing. Some people dry heave or vomit, out of panic.
Assistant Professor and Director of the Program for Anxiety Disorders at the Child Study Centre of the Yale School of Medicine
The short answer is ‘Yes, but…’ with two important ‘buts’. First the yes part: It is possible to trigger a panic attack in a number of ways. Thinking very anxiety provoking thoughts can bring on a panic attack in some people. For example, if you have a strong fear of small places (a form of agoraphobia) and you vividly imagine yourself enclosed in a small place, trapped, and unable to escape or call for help, the thoughts themselves might be sufficient to trigger a panic response. Limiting your oxygen intake or breathing air that is enriched in carbon dioxide (don’t try this at home!) can also trigger panic attacks.
Now the buts: First of all, not everyone is susceptible to panic attacks and triggering a panic attack is much more likely in people who have a vulnerability or susceptibility to panic. If you have had one or more panic attack in the past, or if you are the close relative of someone who suffers from panic disorder, you are considerably more likely to trigger panic attacks in yourself than if you have never experienced panic and panic does not run in your family.
Second, although panic attacks are very unpleasant (and I’m not sure why anyone would want to trigger one just for fun) panic attacks are usually not dangerous for healthy people. Panic disorder is a mental health condition that occurs when people spontaneously experience panic attacks and become highly anxious about experiencing additional attacks in the future. The fear of recurring panic attacks can lead to significant impairment and avoidance of a wide variety of situations and can really limit a person’s ability to function normally in day to day life.
For example, if someone had a panic attack on a bus they may start to avoid all means of transportation and become home-bound because of the fear of having panic attacks. The worry and avoidance are natural but are generally a much bigger problem in the person’s life than the actual panic attack which lasts only a few minutes and would not cause them harm.
So, panic attacks can be triggered but few people would want to bring them on voluntarily and if you experience panic attacks in your life it’s best to accept them or seek professional help in coping with them, rather than getting stuck in worrying about them or starting to live a limited life because of the fear they will return.