OMG! My Heart is Racing! Is it a Panic Attack or Am I In Love?
anonymous Asks ...
Sometimes heavy exercise, which gets my heart rate up, triggers feelings of panic. It makes me want to not exercise, which I think also makes my anxiety worse. How can I learn to differentiate between the heart pounding of a panic attack and the heart pounding of aerobic exercise?
Dr. Richard Schultz Says ...
Hello and thank you very much for writing to me. This is an awesome question!
You have asked how you can differentiate between racing of your heart due to a panic attack, and that which is simply a result of aerobic exercise. The fact is, there really is no difference, other than how you are interpreting the sensation.
The sympathetic nervous system, which is responsible for the physiological sensations you experience during anxiety (the "fight or flight" response), is also responsible for the the changes your body undergoes during exercise; your sweat glands activate to cool you down, your blood oxygen and glucose levels increase in order to send more energy to your large muscle groups (heart, legs), your attention becomes hyper-focused on your goal, and yes, your heart pumps faster to keep the machine running.
For individuals who have ever experienced a panic attack, the appearance of any of these body changes may now trigger fear (whereas that had not done so before), because these changes have now been "conditioned" through their association with the panic episode (remember the way Pavlov's dogs started drooling at the sound of the bell only after it had been rung at the same time as he presented the dogs with meat powder? If not, go ahead and Google "Pavlov" and you will understand). This is known as "classical conditioning." Thus, as soon as your heart begins to race during exercise, your brain generates a thought such as, "Uh-oh, this could be a panic attack!!" Of course, the common emotional reaction to such a thought would be to become more anxious, because you are anticipating something awful (whether or not your prediction is accurate) and to start to pay even more attention to your racing heart (which of course generally causes your heart to race even faster). More anxious thoughts follow, and then behavior is chosen, such as "I better stop whatever I am doing and go sit down, go home and relax, or stop exercising so hard." Now, of course, it is easy to understand why one would want to do these things given the unpleasantness of the the "fear of panic" (anxiety is often described as the "fear of fear"). However, the truth is that, when we perform any behavior to avoid or terminate an unpleasant stimulus (heart racing that you think is panic), we are rewarded with some short term relief (reduction of anxiety). This is called "negative reinforcement," and it's occurrence does indeed predict even more anxiety and avoidance of a racing heart in the future (which is why exercising less due to your anxiety actually makes your anxiety worse...it is also depressing to see ourselves run from what scares us). So, avoidance leads to short term reduction of discomfort, but an increase in mid to long-term persistence of anxiety.
To reiterate, the only difference between a racing heart from exercise and a racing heart that leads to panic is the INTERPRETATION you make of what is happening inside of you, and what you PREDICT is going to result from it. In addition to learning to re-label your racing heart as non-dangerous and normal, you will also benefit from eliminating any "avoidance" or "safety behaviors" you may be performing in order to terminate or prevent the racing heart (exercising less vigorously, taking more breaks, pouring cold water all over yourself [which one anxious patient of mine used to do when he was playing basketball], or simply sitting on the sidelines. In fact, it will help you to really go out there and show your fear who is boss by pushing yourself (within reason) in terms of the exercise, and show your brain that you are not running from the fear. Your brain will like you better and you'll feel more courageous and confident.
Remember, every step we take TOWARD that which we fear strengthens us, while every step we take AWAY from what we fear weakens us.
Finally, as a caveat, if you have any personal or family history of heart disease, or are experiencing other more unusual and persisting symptoms in addition to those described, please get cleared by your PCP before "pushing" it as described above.
Thank you again for the great question, feel free to write back if you would like any additional explanation, and check out my blog at www.mindset.mobi for more information about how to change the way you think and behave to combat anxiety, depression, anger and other difficult feelings.
Richard E. Schultz, Ph.D.