What Missionaries Ought to Know about Panic Attacks
Dr. Ronald Koteskey
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was walking down the street near his home when his heart started pounding, it
was hard to breathe, his chest tightened, and he had pain in it. He was
terrified and thought he was going to die of a heart attack. He went immediately
to an urgent treatment center only ten minutes away, but by then he felt much
better. Tests there showed no sign of a heart attack or any other physical
He had served in two countries where there were many reasons to be afraid,
but he had never felt this kind of fear. How could it be that he had it here
back in his peaceful passport country after serving for three years in a job he
loved at headquarters? What caused it? Will it happen again? What can he do
What is a panic attack?
A panic attacks occur when, without warning, individuals experience intense
fear that occurs suddenly and for no apparent reason. It is one of the most
unpleasant, terrifying, and upsetting experiences individuals can have. Although
the attack is usually over in a few minutes, it may take people days to fully
get over it, and those individuals may fear having another one.
The American Psychological Association notes that “Many people experience
occasional panic attacks, and if you have had one or two such attacks, there
probably isn’t any reason to worry” (http://www.
apa. org/topics/anxiety/panic-disorder. aspx#).
However, people who continue to have them are diagnosed with panic disorder,
about 1 in every 75 people. To get some indication of whether you have cause for
concern you may want to take the Panic Disorder Severity Scale. A self-report
form of that scale is at
http://serene. me. uk/tests/pdss. pdf. This is just a screening test, but if
you score above ten, it is a good idea to look for professional help.
For some unknown reason, during a panic attack the sympathetic branch of the
autonomic nervous system arouses the whole body. Its neurons are interconnected
so it arouses glands and smooth muscles all over, including the adrenal glands.
Adrenalin (epinephrine) from those glands flows throughout the body through the
blood stream. The heart pounds, breathing increases, sweat glands secrete,
pupils dilate, etc. All of this unexpected arousal is terrifying. It can occur
even while asleep.
What are the symptoms of a panic attack?
As would be expected from what scientists know about the sympathetic nervous
system, the symptoms are:
- Heart palpitations or racing heart
- Feeling sweaty or having chills
- Shortness of breath, hyperventilation, or feeling of choking
- Chest pain or discomfort
- Dizziness, lightheaded, or feeling faint
- Nausea or stomachache
- Trembling or shaking
- Numbness or tingling in hands and fingers
- Fear of losing control, going insane, or dying
What does the Bible say about panic attacks?
The Bible has several references to panic. Some are about soldiers in battle
panicking, deserting, and running away. Others are about people terrified by
disease or fire. Still others are about horses fleeing in fear. All of these
have someone terrified of a known problem and getting away as fast as possible.
However, the Bible says nothing about panic attacks. Such attacks are
internal rather than external. The persons experiencing them are keenly
aware of the feelings of panic but often try not to express those feelings. Most
people are embarrassed to show the signs of panic when no “reason” is apparent.
What will panic attacks do to one’s ministry?
The immediate effects of panic attacks on missionary ministry are obvious.
Whether missionaries are teaching, preaching, counseling, or interacting in any
other way with people, their effectiveness will decrease when they experience
the symptoms above. People interacting with the missionary will wonder what is
Later effects, after recovering from the attack, include the following.
- Avoidance. The missionary may quit doing
anything, including ministry, that may trigger an attack.
- Anticipatory anxiety. The missionary may
become anxious just thinking about having another attack.
- Agoraphobia. Afraid of having an attack
when people are around, the missionary may avoid people and crowds, even to
the extent of staying home nearly all the time.
How can panic attacks be treated?
- The good news is that most, 70% to 90% of people who have even frequent
attacks, find relief. Just knowing about the nervous and hormonal basis of
the attacks helps. Here are some things to do.
- Renew your commitment to God and ask him to help you.
- Avoid caffeine and other habit forming drugs, especially
- Get a half-hour of aerobic exercise daily.
- Learn stress management techniques, such as deep breathing.
- Learn relaxation techniques, such as breathing retraining and
- Remind yourself that attacks have a physical basis and decrease
- Gradually increase exposure to situations that have triggered
- Consult a physician about the possibility of anti-anxiety or
How can panic attacks be prevented?
The bad news is that attacks cannot be completely prevented. Remember
that the American Psychological Association said that “Many people experience
occasional panic attacks. ”Sometimes the sympathetic branch of the autonomic
nervous system just arouses the body.
The good news is that many of the things missionaries can do to treat it also
can prevent it.
- Meditate on God’s word and prayer each day to maintain your
relationship with him.
- Eat a healthy balanced diet while avoiding caffeine and other
- Exercise daily and get needed sleep.
- Minimize over-the-counter supplements and herbal remedies which
may contain a variety of chemicals.
- Avoid stressful situations and manage stress when it does occur.
Can missionaries with panic attacks lead normal lives?
Of course, the good news is that they can lead normal, productive lives of
Unfortunately, missionaries may feel shame or guilt thinking they lack the
faith needed to keep the attacks away. They self-diagnose the problem as a
spiritual one rather than a physical one. Their concern may increase the
probability of more attacks.
Missionaries are unlikely to feel guilty if they have diabetes because their
pancreas secreting too little insulin. Just as there is no need to feel guilty
if the pancreas is not aroused enough by the sympathetic nervous system, there
is no need to feel guilty when the sympathetic nervous system and adrenal glands
provide too much stimulation to organs all over the body.
Given that things may trigger the sympathetic branch at “random” times when
missionaries do not expect it, these missionaries need a plan to calm that
system. Here are some suggestions.
- When you feel one “symptom,” do not let your anxiety about it
bring on a full-blown attack. For example, if you notice that your breathing
has changed, do not worry about it and bring on a full attack.
- Learn how to decrease or stop an attack if a full one does occur.
Note the ways attacks can be treated above.
- Avoid triggers if possible, and respond to them immediately if
they do occur.
- Replace negative thoughts, such as “My faith is weak” with
realistic, positive ways of viewing attacks.
- Join or begin a support group so you can share with others facing
What does the Bible say that would help a panic attack?
The Bible has many promises and passages that help reduce anxiety and
increase confidence and comfort. Make a list of verses that are particularly
meaningful to you and memorize some of them to recall when a panic attack
strikes. Here are some suggestions.
- 1 Peter 5:7. Cast all your anxieties on him, because he cares for
- Philippians 4:6. Do not be anxious about anything, but in
everything by prayer and supplication…
- John 14:1. Don’t let your hearts be troubled, believe in God. . .
list could go on and on, but these are passages that speak to me. Develop a list
through which the Holy Spirit speaks to you, and then memorize them. God can use
his Word to calm you enough to prevent such attacks and help you control them.