While OCD and Panic Disorder are two separate conditions, they can certainly co-occur, and often do!
If you’re familiar with ERP treatment, you know that the discomfort that comes from confronting a fear can be intense. As a result, the initial hesitation to engage in this form of therapy can be high, and understandably so. While numerous emotions can be triggered, such as anxiety, disgust, shame, or the feeling that something isn't "just right," for the purposes of this post I am going to focus on when the primary feeling is anxiety.
When discussing an ERP exercise with a patient, I’ll sometimes hear, “I’m afraid my anxiety will get so high that I’ll have a panic attack.” Can you relate? If you’ve ever experienced a panic attack, and/or are fearful of experiencing one in the future, this is a valid concern, and one that can greatly interfere with your OCD treatment if not properly addressed.
Experiencing panic is another way of saying your fight-or-flight response is being erroneously activated. We need our fight-or-flight response for survival, and therefore cannot permanently shut it off (nor would we want to!) If we were being attacked, or needed to flea a burning building, we want our heart to race, our respiratory rate to increase, and our muscles to tighten. This helps blood and oxygen circulate more quickly, and our muscles to become engaged, all of which we need to quickly and effectively escape a dangerous situation. However, our body is also capable of experiencing “false alarms,” meaning our fight-or-flight response may be briefly activated when there is no real imminent threat or danger (think about when a friend scares you from behind!). False alarms can happen anywhere - on your couch, a coffee shop, work, your car. You may be sitting quietly when you have a scary thought, or notice a random physical sensation in your body, and boom! – your heart begins to race and your chest tightens. Within a split second, that random thought or sensation was mistakenly perceived as “danger,” just as a frightening scene in a horror movie can feel real, leave you sitting on the edge of your seat, heart pounding, muscles tight.
Panic attacks happen when you misinterpret what these brief, normal, and adaptive anxiety symptoms mean. Instead of thinking “whoah, my body just got revved up thinking about ____,” you may mistakenly think any of the following:
Something is really wrong! My body isn’t supposed to feel this way.
I’m having a heart attack!
I’m going to collapse!
What if I die?
I’m about to lose control, go crazy!
These are all scary thoughts to have, and the more strongly you believe them, the more that fight-or-flight response will rev up even further. As that response becomes even more intensified (faster heart rate, quicker, more shallow breaths, shakiness from tight muscles…), you may start to really believe those catastrophic thoughts listed above. This will intensify that fight or flight response even further, which ultimately leads to a full-blown panic attack. Essentially, you wind up scaring yourself into panic.
Naturally, when you confront a feared situation via exposure therapy for OCD, your anxiety level is going to rise. This is to be expected. The goal is to ride out this uncomfortable feeling without the use of compulsions. If you mistakenly interpret this feeling of anxiety as something “bad” or “dangerous” that your body cannot handle, feelings of anxiety will continue to rise, and yes, you can induce a panic attack.
Once you’re able to practice reframing this anxiety response as uncomfortable, but safe, you’ll then be able to work more effectively with ERP, so that you can feel more prepared to experience and ride out uncomfortable feelings and sensations, without it turning into panic. This is an essential component of treatment, because if you continue to fear a panic attack, you will most likely use compulsions to prevent your anxiety from getting too high during exposures. This will compromise the effectiveness of the exposure, and not lead to the treatment outcomes you are hoping for, and deserve.
While incredibly uncomfortable, panic attacks are safe to have (remember, panic is your fight or flight response being revved up when it's not needed, then misinterpreted as being something "bad"). While they are not dangerous, it is important to still treat panic disorder, as repeated panic attacks can greatly interfere with the quality of your every day life.
Having a history of panic attacks does not mean ERP therapy will be ineffective, or that it should not be done. It’s just one piece of information, among many, that will be incorporated into your individualized treatment plan to get you on the road to living a meaningful, enjoyable life.
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