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Is it a Heart Attack or Panic?
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David Carbonell, Ph.D.
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Sep 30, 2006 18:26 PDT
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THE ANXIETY COACH®
Helping People Thrive in an Anxious World
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Volume 7, Issue 9
IN THIS ISSUE
Dr. Carbonell answers a reader's question about
distinguishing between a heart attack and a panic attack.
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INDEX
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1. Dave's Note
2. Is it a Heart Attack, or Panic?
3. About The Anxiety Coach®
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Dave's Note
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September 30, 2006
Dear Reader,
This month I answer a reader's question - "How can I tell
the difference between a panic attack and a heart attack?".
It's a little longer than my usual article, so if this is
a topic of concern for you, plan on taking a few extra
minutes to read.
The Association for Behavioral and Cognitive Therapies will
hold its annual conference in Chicago Nov.16-19. If you're
a professional therapist looking for up to date information
and training on the treatment of anxiety disorders, this is
the place to go. For registration and information, visit
http://www.aabt.org/.
On November 9, I'll present a talk for therapists on panic
attacks, at Alexian Brothers Behavioral Health Hospital in
Hoffman Estates. Admission is free. Contact the hospital
for details.
If you're looking for my "Panic Attacks Workbook", you
can purchase it at: http://www.anxietycoach.com/book.htm
And our main office in Schaumburg, Illinois will move to a
new location in Rolling Meadows at the end of October. Watch
this space next month for the new location and phone number.
See you next month!
Dave Carbonell
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Is it a Heart Attack, or Panic?
by
David A. Carbonell, Ph.D.
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A reader writes:
"I have had panic attacks for as long as I can remember, but
I am always afraid that I am having a heart attack. My chest
tightens. My heart beats hard. I am short of breath. I check
my pulse all the time. I have had all sorts of tests done:
EKGs, MRIs, full body scans, you name it and I have had it.
I have visited the emergency room and even called paramedics
to my home in the middle of the night. I have seen specialists
all over town. Each time I learn that I am healthy. I am so
embarrassed and scared. How can I tell the difference
between a panic attack and a heart attack?"
Dr. Carbonell replies:
This is a common and solvable problem. The first point to
keep in mind is that everyone who experiences panic attacks
should have a complete physical evaluation after the attacks
begin, to rule out any possible physical problem behind the
attacks. You’ve already done that, and they found you in
good physical health. Sometimes people are been disappointed
that the doctors don't find any disease, but it's good news.
People often get tricked into looking for some obvious
difference in the physical symptoms which will clearly
distinguish panic attacks from heart attacks. There are good
ways you can tell the difference, and I’ll get to those in a
moment. But looking for distinctions in the physical symptoms
is typically not the way, for two reasons.
One is that panic is the great mimic, filling you with
symptoms that seem to create what you fear most. If you fear
looking nervous, it will make you sweat and flush for all
to see. If you fear insanity, it will make your thoughts run
wild. If you fear a heart attack, it will make your heart
pound and your chest ache. To a surprising degree, panic
produces whatever set of symptoms you most fear and dread.
Second, although the only connection between heart attacks
and panic attacks is the unfortunate similarity of their
names, the distinctions between their symptoms are much too
subtle to be of help in the midst of a panic attack. For
instance, the pain of a heart attack feels like a "crushing
sensation" inside the chest, and the pain of a panic attack
doesn’t have that "crushing" quality. But when you’re
having a panic attack, you lose the capacity to make such
subtle distinctions!
You write that you’ve had panic attacks for a long time, and
you feel both embarrassed and scared. This is a common
reaction to recurrent panic attacks. Most people who
experience recurrent panic attacks feel some embarrassment
during the attack, and try to hide their distress from
others. They probably didn’t feel that way with the first
attack, when they were just scared, but as the attacks
continue, people start to feel embarrassment as well.
This is an unusual combination of emotions, and an excellent
key to the panic puzzle. Why do you feel both scared AND
embarrassed during a panic attack?
Consider these questions:
If a burglar pointed a gun at you, would you feel scared and
embarrassed?
How about a runaway truck heading your way - would you feel
scared and embarrassed?
An accident in which you’re losing large quantities of blood?
Scared and embarrassed?
For most people, the answer to these questions is no! People
generally don’t feel embarrassed when their life is in danger.
They just feel afraid, and react instinctively to protect
themselves in any way possible. That’s part of our basic
survival instinct.
But a person having a panic attack who finds himself thinking
it might be a heart attack usually does something very
different. That person might quietly excuse himself from a
meeting or party, and drive himself home in order that no one
find out about his trouble. He’s embarrassed about the
problem, and doesn’t want anyone to notice.
If he really was dying, wouldn’t he cry out for help? If I
ever have a heart attack, I will want everyone within shouting
distance to notice! I’ll want an ambulance and a backup
ambulance! I’ll be very afraid, but not embarrassed!
In what kind of circumstance might you feel both afraid and
embarrassed? One in which you recognize, from your own
history, that you’re getting fooled by panic. You can’t get
the idea of heart attack out of your mind, no matter how hard
you try, but you recognize, from your own experience with
panic, that you’re getting fooled. Again. That’s why you
feel embarrassed.
So when you notice that you’re embarrassed, and want to hide
your distress from others, this is a powerful signal that
you’re experiencing panic, rather than a heart attack.
In a similar way, people who experience panic attacks often
try to distract themselves from the attack. They’ll get on
their cell phone and chat with friends about other subjects;
they’ll sing and hum to themselves; they’ll balance their
checkbooks, and engage in a wide range of distractions which,
they hope, will get their mind off the panic.
If an angry dog charged you on the street, teeth bared,
growling, ears back, and fur up, would you hum a happy tune,
or balance your checkbook?
Probably not! You’d be too busy trying not to get bit. But
distraction does help with some fears. It might be helpful,
for instance, to distract yourself from a scary movie, if you
happened to get more afraid than you wanted.
What kinds of problems are helped by distraction?
Distraction helps people with problems that aren’t dangerous.
If you find yourself trying to distract yourself when afraid,
that’s powerful evidence that you weren’t in danger to begin
with. It means you know, on a deeper level, that you’re not
truly in danger, despite what the phobic part of your mind
is telling you.
Hundreds of thousands of years of evolution have equipped us
with three means of responding to danger: fight, flight, and
freeze. If something threatens me and it doesn’t look as
strong as I am, I’ll fight it. If it looks stronger, but
slower, than me, I’ll run away from it. And if it looks
stronger and faster than me, I’ll freeze, and hope it doesn’t
see so well.
Those are our only responses to danger. Distraction is not one
of our responses to danger. If it was, we’d be extinct sooner
than you could say "Look, a saber tooth tiger! Let’s balance
our checkbooks!"
The questions that have been most useful to my clients in
distinguishing a panic attack from a heart attack are these:
Am I embarrassed?
Am I trying to distract myself?
A "yes" answer to either is a good indication that it’s panic,
not heart attack - that it’s discomfort, not danger. Once
you get a "yes" answer, discontinue your internal debate, and
move on to some good coping steps for panic attacks, such as
the AWARE steps - http://anxietycoach.com/pan7.htm
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THE ANXIETY COACH®
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The Anxiety Coach® is a publication of the Anxiety
Treatment Center, Ltd. The Center is a small group of
clinical psychologists who specialize in the treatment of
anxiety problems. The Center has offices in Chicago and
several nearby suburbs.
Dr. Carbonell, a licensed psychologist, is the founder and
director of the Anxiety Treatment Center.
The information contained in this publication is not a
substitute for consultation with healthcare professionals.
Each individual's health concerns should be evaluated by a
qualified professional.
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SUBSCRIPTION INFORMATION
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If you received this copy from a friend or colleague and
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http://www.anxietycoach.com/newsletter.htm.
If you would like to see past issues of our newsletter,
you will find them in the archive at:
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To unsubscribe, follow the link at the very end of this
newsletter.
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CONTACT INFORMATION
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David A. Carbonell, Ph.D.
Anxiety Treatment Center, Ltd.
E-mail: dire-@anxietycoach.com
Web: http://www.anxietycoach.com
1340 Remington Road, Suite D
Schaumburg, IL 60173
847.605.0453
© 2006, Anxiety Treatment Center, Ltd.
All rights reserved.
Anxiety Coach® is a registered mark of Anxiety Treatment
Center, Ltd.
Distribution Rights: The above material is copyrighted,
but you may retransmit or distribute it to whomever you
wish as long as not a single word is changed, added or
deleted, including the contact information. However, you
may not copy it to a web site without prior permission.
Reprint permission will be freely granted, upon request,
to periodicals and non-profit educational and service
organizations.
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