PTSD Panic Attacks: Symptoms, Causes, & Treatment

What Is Post-Traumatic Stress Disorder (PTSD)?

Post-Traumatic Stress (PTSD) refers to a disorder which can occur in response to a single, or multiple, traumatic event(s).  Due to changes in the brain that can occur as a result of trauma, one can experience ongoing physical, emotional and cognitive reliving, rather than remembering, of the worst parts of the traumatic events and distressing feelings.

PTSD can result in serious, and at times debilitating, symptoms that can impact one or more areas of a person’s life. Common symptoms of PTSD include:

• Nightmares
• Night terrors
• PTSD flashbacks (can be visual, auditory, smell, taste, physical sensations, thoughts, or emotions)
• Intrusive thoughts
• Avoidance of trauma reminders (e.g., people, places, objects, thoughts, memories, discussions).
• Panic attacks
• Negative beliefs about yourself and/or the word
• Unable to trust others
• Irritability and/or emotional outbursts
• Self-medication of pain through use of alcohol, substances, sex, food, etc.
• Concentration and/or memory issues
• Sleep issues
• Dissociation (commonly described as “zoning out”)

What Are Panic Attacks?

Panic attacks are symptoms that can be related to PTSD,  panic disorder, another type of anxiety disorder, or other types of mental illnesses (e.g., substance use disorder, depression).  Panic attacks are characterized by an abrupt wave of intense fear (i.e., related to losing control or dying) and physical distress, such as racing heart, shortness of breath, chest pain, or trembling, that reaches its peak within minutes.¹

What Are PTSD Panic Attacks?

A PTSD panic attack is different from a panic attack related to panic disorder.  PTSD panic attacks occur as a direct result of exposure to a reminder of the trauma² such as a person, place, object, memory, or discussion, whereas, within the diagnosis of a panic disorder, panic attacks are typically unexpected and have no obvious trigger.¹

Common symptoms of PTSD panic attacks include:²

• Chest pain
• Fear of losing control/going crazy
• Shortness of breath
• Chest pain
• Sweating
• Dizziness/feeling faint
• Abdominal distress/nausea
• Numbness or tingling
• Hot flashes or chills
• Trembling or shaking
• Fear of dying

PTSD Panic Attack Causes

PTSD Panic Attacks are caused by trauma triggers.  These can be sights, sounds, smells, physical sensations, or taste.  Other triggers might be people, types of people (e.g., of a certain body type, appearance, occupation, etc.), places, or objects.  Certain strong emotions, thoughts, memories, or discussions related to the trauma, might also trigger PTSD panic attacks.

Trauma that leads to PTSD changes the way the mind and body perceive potential threats such that the person’s survival/protective system, within the most primitive part of the brain, becomes very overly sensitive to trauma reminders.  Trauma reminders might not only trigger fight, flight, freeze, or fawn survival responses, but might also trigger panic attacks due the perception of a heightened threat level.

Without treatment,  it is possible for individuals to live in prolonged fight, flight, freeze or fawn survival modes – and to continue to experience PTSD panic attacks –  for months, years, or decades following trauma.  This can be very debilitating in all aspects of one’s life, which is  why intervention is so important.

How to Prevent PTSD Panic Attacks

PTSD panic attacks are caused by trauma reminders which set off the alarm in the threat surveillance center of the brain. If you feel a PTSD panic attack coming on, there are things you can do to try to reduce symptoms or actually avert a panic attack.

If you feel a PTSD panic attack starting, get yourself to a safer setting if possible.  If you are driving, find a place to park.  If you are in a crowd, go into a private room or bathroom.  If a loved one is with you, let them know what is happening, so that they can offer support. Most importantly, be compassionate and supportive in your self-talk.

Tips for preventing/reducing PTSD panic attacks include:

• Avoid caffeine and alcohol
• Exercise regularly, to provide an outlet for trauma-related energy that is held physically in your body.
• Eat regularly so that your body doesn’t experience physiological panic due to lack of food and water – which can then trigger a PTSD panic attack.
• Try to get enough sleep, since not enough sleep can lower your ability to tolerate and effectively manage distress.
• Use grounding techniques (e.g., the 333 rule, mindfulness)
• Practice  breathwork – particularly any type of breathwork that involves breathing in through your nose, and out through your mouth, with an extended hold of the breath (i.e., at least 5 seconds).  This type of breathwork can be helpful because holding your breath for a time requires your attention in the present moment.  This can be  helpful in anchoring you to the safety of the present – since PTSD panic attacks are linked to reliving trauma in your past.
• Step into “dual awareness”.³ While you will already be very aware of the part of you that is experiencing the early symptoms of a PTSD panic attack, you can consciously choose to take a moment to “step into” the other part of you that is observing the panic attack and understands that this is a trauma response from the past and not a reflection of your current situation.  Compassionate and supportive self-talk from this observer-perspective can reduce distress and offer comfort.

PTSD Panic Attack Treatment

In order to effectively treat PTSD panic attacks, the underlying PTSD needs to be addressed. First-line recommended treatments typically include a combination of counseling/psychotherapy, and medication.⁴ It is important to find a therapist who specializes in trauma therapy, and who you feel comfortable with.  In terms of medication, a psychiatrist or online psychiatric service can determine if medication is right for you.

Psychotherapy

Treatment for PTSD panic attacks is generally different from panic disorder treatment.  Treatment for PTSD tends to use trauma-specific interventions and approaches, and tips for dealing with trauma triggers, while treatment for panic disorder instead focuses on thoughts and behaviors to reduce anxiety and increase relaxation responses.

There are a number of different types of trauma therapies, and it is important to realize that any one specific therapy is not the answer for everyone.  Individuals will have different preferences and reactions.  It is important to find the right therapist and therapy approach “fit” for each client.

What trauma therapies seem to have in common is that they use interventions that help with:

• Shifting the mind and body from reliving the trauma in the present, into remembering it as something that happened in the past – that is “finished” and no longer a threat.
• Managing and/or eliminating distressing physical, emotional, and cognitive reactions to reminders of the trauma.
• Enhancing one’s ability to experience the safety of the present moment.
• Reclaiming one’s sense of self from a compassionate and supportive perspective.

Common therapies used to treat PTSD panic attacks include:

• Cognitive Behavior Therapy for PTSD:  In CBT for PTSD approaches, you work with your therapist to identify, explore, and change maladaptive beliefs and behaviors related to the trauma experience, and are connected to triggering PTSD panic attacks.
• Trauma-focused Cognitive Behavior Therapy (TF-CBT):  Trauma-focused CBT is a short-term  therapy approach that was developed specifically to help children and adolescents to process trauma. In terms of addressing PTSD panic attacks specifically, TF-CBT provides: psychoeducation;  teaches emotion regulation, coping, and relaxation skills; and facilitates trauma processing.
• Narrative Exposure Therapy (NET): Narrative exposure therapy is a short-term (usually 12-week) trauma therapy that was designed to assist survivors of prolonged/complex trauma.  You work together with your therapist to create a chronological written account of both traumatic and positive events in your life. Traumatic events and positive experiences are processed, as your thoughts and physical/emotional reactions to your story are explored and validated.  This helps you view a broader perspective of your story, and can neutralize trauma triggers that might trigger a PTSD panic attack.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR uses bilateral stimulation of the brain (through tapping, light, or sound), as you recall the traumatic event(s), in order to desensitize yourself to the trauma and trauma triggers that would previously have led to a PTSD panic attack.
• Prolonged Exposure (PE): Prolonged Exposure Therapy is a form of CBT that involves you confronting real and/or imagined trauma reminders that trigger PTSD panic attacks, rather than avoiding them.  By exposing yourself to these trauma triggers, you can learn how to better manage your fear and distress, as well as experience the natural reduction of your fear over repeated exposures since the outcomes you are most dreading, do not actually occur.

Medication

Medications that are used to treat PTSD symptoms might also be appropriate to manage PTSD panic attacks.  SSRIs and antidepressant are the most common medications used to treat PTSD^{4, 5} and can be prescribed by a primary care doctor or psychiatrist.  Some will find that medication can help to reduce overall physical, emotional, and cognitive PTSD symptoms related to trauma reminders – and thus, reduce the occurrence of PTSD panic attacks.