

By Madeline Vann, MPH

Reviewed by Niya Jones, M.D., MPH

Los Angeles entrepreneur Neal Sideman was in the middle of an intense workout at the gym when he felt lightheaded and realized his heart was pounding. Alarmed, he immediately worried about his heart -- never thinking that he might be having a panic attack instead.

However, a visit to the doctor the next day and an EKG reassured him his heart was fine. His doctor told him that what he'd experienced were, in fact, the symptoms of anxiety.

Signs Of Anxiety And Panic Attacks

An anxiety or panic attack often comes on suddenly, with symptoms lasting only a few minutes. For doctors to diagnose a panic attack, they look for at least four of the following signs: sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, fear of losing your mind, fear of dying, flushing, feeling that danger is nearby, a racing heart (heart palpitations) and feeling an intense need to escape.

Stress, Anxiety And Panic: Neal's Story

As Sideman said, his attack occurred in the early 1990s, and few people seriously considered the possibility of a panic attack in a 39-year-old man. So, he went home thinking all would be fine, only to have another, more severe attack one week later.

Now, looking back at age 60, the situation seems clearer.

"I was under a lot of stress -- starting a new business, working 16-hour days, a close friend was ill and dying and on top of all that, I was doing a super heavy workout regimen at the gym with a trainer," Sideman said. "So it was a lot of physical stress, emotional stress and a lot of financial stresses." He said he also can see roots of anxiety in his childhood and teen years as well as in other family members.

In the moment, he didn’t know what to think because it can be tough to know what a panic attack is like until you have one. His second panic attack "was really a full-blown panic attack, where I thought I was going to die," Sideman said. "I thought I was going to pass out, not wake up, go crazy, have a heart attack."

He recalled being terrified, and the response he chose was one that can actually make panic disorder worse: He started to avoid the situations where he had attacks.

"I thought I would be smart, take care of myself, and not go out as much," Sideman said. He managed to find ways to build his business without leaving his home office. After he had a panic attack on a freeway, he decided to avoid driving on the freeway -- a tough stand to take in Los Angeles. He kept withdrawing from activities to try to avoid panic attacks, but that never solved the problem, he said, and after 2-and-a-half years, he realized the attacks were getting worse.

Coping With Anxiety And Panic Attacks

Desperate for help, he reached out to the Anxiety and Depression Association of America, which sent him a list of therapists experienced in treating panic attacks and anxiety. "This is how I got better," Sideman said. "I found a therapist who understood what panic disorder was, understood agoraphobia, and knew cognitive behavioral therapy, which I had not known about." He also started practicing meditation.

Cognitive behavioral therapy can help people with panic disorder and agoraphobia reduce their symptoms for long periods, as long as two years, according to research published in Behaviour Research and Therapy.

People generally can overcome panic attacks faster if they seek help after the first one or two, said psychologist Cheryl Carmin, Ph.D., director of clinical psychology training at Ohio State University's Wexner Medical Center and a professor at Ohio State in Columbus. When you do seek help, your doctor or therapist will ask about your symptoms and the situations when they arise and might also recommend additional medical testing to rule out other health concerns.

Don’t wait too long to seek help or that might mean you'll also have to do extra work to undo the habits you may have developed to try to protect yourself -- like avoiding triggering situations, which Sideman had tried to do.

"If it's beginning to interfere with your life, if you're more fearful, or you're avoiding doing things that provoke the symptoms, that’s when you need to seek help," Carmin said. "At its worst, people with panic disorder become housebound. Or, they stop doing things they really like."

Looking To The Future

Sideman said that his recovery has also made him a better friend. While he was struggling with anxiety, he would call friends for help. As he recovered, he realized that he could cope on his own and would then call them to share his success.

"I changed the way I talked about my condition," he said. "Now, I focus on my recovery, not my suffering."