Anxiety and panic attacks are, like depression, common mental health presentations in therapy. Panic attacks will not accompany all cases of anxiety, however, it’s highly unlikely for them to be present with clients that do not suffer from anxiety. They are especially common with social anxiety. We need to take all this into account when treatment takes the form of psychotherapy or counselling.
Before going further into the topic, it is important to lean how anxiety differentiates from fear, feelings of agitation or feelings of nervousness. In everyday language we will tend to regard much more as anxiety than anxiety really is. More about that in a related article here.
Anxiety and panic attacks can go hand in hand
Unlike anxiety and depression (related article: Anxiety and Depression in Therapy), anxiety and panic attacks actually do go hand in hand. When a client that is presenting with panic attacks comes for psychotherapy or counselling, they will usually also describe themselves as anxious.
The symptoms may vary in intensity between different people. Some will have more problems with severity and frequency of their panic attacks, whereas others will only experience them once every so often and will have more incapacitation caused by being anxious.
Difference between anxiety and panic attacks
Anxiety and panic attacks usually accompany each other because they will tend to stem from the same intra-psychic processes. Meaning, the same unconscious material may be surfacing into consciousness, causing anxiety on one hand and panic attacks on the other.
On symptomatic level, the main difference between anxiety and a panic attack will be in the continuity of symptoms. Anxiety, as mental health phenomenon, will usually manifest itself in continuous manner, whereas a panic attack will occur and last for the duration measured in minutes.
This is not a surprise given that panic is closely related to how we perceive time and threat in relation to time—i.e. time to get out of the situation that causes us to panic. Anxiety, on the other hand, is related to how we perceive ourselves in the world and how we perceive ourselves as we see us.
Panic attacks and anxiety can have the same psychological source
On bodily and cognitive level, a panic attack will usually result in hyperventilation, heart palpitation, sweating, dizziness, light-headedness and trembling. It will be accompanied by fear of having a heart attack or even fear of dying. Bodily reactions are in line with fright and flight response to potential external threat. Usually the fear that is the base for the panic attack is not justifiable in reality and never actually comes true.
When panic attacks accompany anxiety, they will usually have the same mental or psychological source. As such, they may also be accompanied by intrusive thoughts that can range from thoughts of self-harm (e.g. committing suicide by jumping in front of a train) or thoughts of violence. Such thoughts are not solely present with clients that are anxious but can also be symptomatic of other mental health issues.
Real sources of anxiety and panic attacks are usually hidden from consciousness
Similar to anxiety, panic attack will also represent individual’s response to something they do not know whether they can cope with. For example, an individual will identify themselves as someone that is performing and strong and will repress any of their characteristics that do not meet these views of self.
Psychological sources of panic attacks will, therefore, be in person’s unconscious, which is also why anyone suffering from anxiety and panic attacks will not be able to explain why they are experiencing whatever they are experiencing. A client will usually be able to tell they are having a panic attack when they “fear losing consciousness in public”, however, the underlying fear will typically remain hidden from consciousness and will only arise during the course of therapy.
Because of psychological reasons that cause anxiety and panic attacks and because these reasons are usually unconscious, treatment in the form of therapy (psychotherapy or counselling) will preferably engage in resolving and eliminating the underlying psychological structures that are the actual cause of the problem and not the symptoms as such.