What is a panic attack

* A panic attack is when you experience a sudden increase of intense anxiety

* During a panic attack you may be afraid that you are going crazy or dying

* Also during a panic attack you are likely to experience intense bodily sensations
                                                 
Why are panic attacks so distressing?
Panic attacks are distressing because you can experience a range of disturbing bodily sensations including: heart palpations, dizziness, sweating, choking, trembling or shaking, breathlessness and feeling unreal. These intense physical sensations can make you feel like you are suffocating, and this is what makes you feel as though you are either dying or going crazy.

What can trigger a panic attack?
A number of things can trigger a panic attack
1. Feared situations                                                                                                                              Sometimes situations which create fear can cause you to have a panic attack
2. Waking from sleep
Panic attacks can also occur on waking from sleep. In these situations you may wake from sleep in a state of intense anxiety 
3. Phobias
Panic attacks can also occur as a result of phobias such as social or agoraphobia and claustrophobia.

Nothing triggers my panic attacks?
You are likely to experience a panic attack occurring spontaneously or un-expectantly, and that's why you often feel like there is nothing obvious which has triggered your panic attack.
  
What we know about Panic attacks

Panic attacks have triggers
It is widely understood that panic attacks follow a particular sequence of events which begin with a trigger. Often you might be unaware of the threat leading to an increase in fear and anxiety, this is because once a trigger fuels a panic attack, you become caught up in a rapid increase of anxiety. A rapidly increase in anxiety, also makes it difficult to think about what actually triggered the increase in your anxiety.

Vicious circles
The second feature of panic attacks is what is called vicious anxiety circles. In vicious circles, thoughts, emotions and sensations stoke anxiety like wood stoking a fire. This is why panic attacks flare into high anxiety very quickly.

An imagined catastrophe
Vicious circles of anxiety develop because of the underlying belief in panic attacks of an impending catastrophe. These imagined catastrophes are usually based on you misreading your bodily sensations or state of mind.

a). Misunderstanding your body
In a panic attack you are likely to misinterpret your bodily sensations as sign of an immediate impending disaster, such as having a heart attack, collapsing, suffocating, or going crazy. For example, some people think that dizziness is a sign that they are about to faint, or a speeded heart rate as a sign that you are about to have a heart attack.

b). Misunderstanding your thoughts
In a panic attack you are also likely to find yourself with racing thoughts, and often this is mistakenly thought of as a sign of a psychological or social catastrophe, such as losing control of one’s mind or behaviour.

c) Misunderstanding other sensations
Sometimes people also misunderstand bodily sensations which are not a result of anxiety. For example light headedness resulting from low blood sugar, or changes in blood pressure due to changes into body posture, can also trigger anxiety which might lead to a panic attack.

Reference
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Wiley.

What is social anxiety?

* Social anxiety is a persistent fear of social situations.

* When you Interact with other people, or perform a task in public this can create enormous fears.

* If you have social anxiety you will avoid social situations, or endure them with a sense of dread.                                                                                                                                                                             
Fear of judgement
In social situations you will be fearful that other people are judging you harshly. Underlying social anxieties are often beliefs that other people are viewing you as either overly anxious, weak, or that people see you as either crazy or stupid. The fear of being harshly judged can restrict your social activities in the following ways.

Social anxiety shrinks your life

Everyday tasks
You may become overly anxious about performing activities in public such as eating, signing your name, standing or even walking, because you fear that other people are scrutinizing your every actions. You may also become anxious about eating in public because you believe others will see that your hands are trembling with fear.

Interacting with people
You may be very fearful about meeting or speaking to people, and fearful that you may appear inarticulate or too emotional in conversations. You may also become fearful about showing signs of nervousness such as trembling, stumbling over words, or blushing.

At work or university

At work or university you may become fearful about working and speaking in groups, giving presentations, or socialising during lunch and coffee breaks. You might also become fearful that you may appear socially awkward or incompetent to other people, which will lead to people rejecting or socially humiliating you.

Distressing thoughts, feelings & sensations 

Fear
You are likely to experience everyday routines, work or social life as being significantly disrupted by fear. Having your daily routines frequently disrupted can also increase your distress.

High anxiety

You will usually experience anxiety as soon you begin to think about, or are faced with your feared social situations.  Anxiety can take the form of trembling, feeling hot, breathlessness, feeling paralysed, a racing mind or going blank. Sometimes you may also experience panic attacks.

Panic attacks
If you have a panic attacks in social situations, you will tend to experience four or more of the following symptoms which suddenly increase rapidly: palpations, dizziness, sweating, choking, trembling or shaking, breathlessness, depersonalization, a fear of dying, suffocating or going crazy.

What causes social anxiety
Negative thoughts
Social anxiety leads to you overly focusing on negative thoughts connected to how well you are doing in a social situation, as well as other people’s perceptions of how well you may be doing. Focusing intensely on yourself in social situations, also tends reduce your competence in social settings. Also, by focusing intensely on yourself in a social situation, this leads to a situation where you do not experience other people’s real perception of your performance.

Overly focusing on bodily sensations
Social anxiety tends to lead to you overly focusing on your bodily sensations such as trembling, feeling hot, breathlessness, or feeling paralysed.

Vicious circles
With social anxiety you become absorbed and trapped in vicious circles of thinking about your bodily sensations, social performance and other peoples' feared judgements.

References
Wells, A.& Clark, D. M (1997). Social Phobia: A Cognitive approach. In Davey. D,. C. L (Ed), Phobias: A Handbook of Description, Treatment and Theory. Chichester. Wiley.

Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Wiley.