Caffeine & Panic Attacks: Causation Versus Correlation

 

A while back a friend of mine commented after one of my shows that even though he thought that I had a point with caffeine “causing” panic attacks he said he wasn’t going to stop drinking coffee. My friend missed my point completely and demonstrated an error common among psychologists themselves.

 

First, I never said that caffeine “caused” panic attacks or panic disorder. What I said was in treating clients who presented complaining about having panic attacks I observed that approximately half of them had a problem with caffeine. Some appeared to be addicted to caffeinated beverages and a telltale sign of their addiction was when they suffered a dull headache, a withdrawal symptom, when they didn’t have their coffee or other beverage of choice.

 

Second, the context of my comments was that we were pretty much invincible and could our abuse are bodies with almost any substances until the age of approximately 19.  Thereafter, we learn that we needed to take much better care of ourselves and this was usually “inspired” by a rude awakening.

 

Third, my concern was that the current generation of super caffeinated beverages contain so much more caffeine than anything my generation was exposed to when we were growing up or when I was treating people clinically for panic disorder, that I am extremely concerned regarding the outcome for the current generation which indulges in such overly stimulating beverages.

 

I also mentioned that ‘drinking strong beverages’ was not recommended by Joseph Smith of The Latter-Day Church of Jesus Christ. Joseph Smith seemed to know and his recommendations to his followers that they abstain from drinking coffee and tea as well as alcohol seem wise.

 

I never said that caffeine or coffee “caused” panic attacks but I must apologize to my audience for the confusion. What I needed to convey was that there was an observed correlation that is a positive correspondence between the use of caffeine or coffee in some subjects with panic disorder in my clinical practice.

 

In those cases what I typically did was had the person keep an additional log. Aside from the usual detailed log of panic attacks, I assigned them the task of keeping a log regarding their intake of caffeinated beverages. We wanted to see what might happen when they ceased drinking coffee. Some of these clients were drinking a lot of coffee. And when they stop drinking “cold turkey” they often experienced typical “withdrawal” or “discontinuation effects.” Often these consisted of some sort of headache and general discomfort but sometimes there was an increase in panic attacks and generalized anxiety.  And sometimes we found that their anxiety and panic attacks decreased!

 

When we found that either of those were the case, we adopted a program of behaviorally tapering off the use of caffeinated beverages. We did this with the goal of ceasing the use of all caffeinated products for a period of approximately 3 weeks during which we would determine if that might have an impact upon their symptoms of panic and anxiety.

 

Just as in the discontinuation of psychotropic medications, since caffeine is a psychoactive drug, I never rushed my patients in their discontinuation of caffeine/coffee. We always stepped down slowly and backed off from the use of the “drug” slowly. This is exactly what I recommend to anyone seeking to discontinuation psychiatric medications. There is no reason to rush it and there is no sense risking discomfort, such as with the sudden discontinuation of SSRI medications such as Prozac or fluoxetine.

 

A lot of folks when they hear such a presentation, including psychologists, jump (wrongly) to the conclusion that this implies causation. That is nonsense. It is utter nonsense. It is sheer hogwash. All we can do is say that we observe the two events or sequeluae occurring in conjunction. Unless we have a true experimental design with random assignments, we can never make the hard fast conclusion that caffeine causes panic attacks, most certainly not for all people, across all time and all situations.

 

Hence, I observed that the excessive use of caffeine/coffee actually increased certain clients’ propensities to experience panic attacks. In a sense one might say that caffeine lowered the panic threshold thereby allowing the individual to experience greater panic attacks.  I hope this clears the matter up regarding applied psychology.

 

Correlation means we observe a relationship and I need no be positive.  For instance, as we reduce X we see an increase in Y which indicates a “negative correlation.”  Stay tuned for more on this in the future.

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4 Responses to “Caffeine & Panic Attacks: Causation Versus Correlation”

  1. […] Caffeine & Panic Attacks: Causation Versus Correlation « Dr. Kent … […]

  2. admin says:

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  3. Claifiale says:

    I was driving home about a week ago and had a panic attack, called 911 and was driven to the er. It was the first time that I had one and really knew nothing about them
    previously so was completely freaking out. Ever since I have still felt as if I wasn’t breathing correctly (like my throat is closed up), and have had pains and tightness in
    my chest. I was just wondering if this was normal because I have talked to a few doctors and they said I was fine, I read up a little about panic attacks symptoms
    Any ideas?

  4. Dr. Kent says:

    Hello Claifiale,

    First, I can speak about the literature and offer generic advice. And I suggest you establish a professional realtionship with a psychologist listed with the ABCT, the Association for Behavioral and Cognitive Therapies.

    Second, just because one has experienced one panic attack does not mean one has a “disorder.” There must be an established pattern (recurrance) to render such a diagnosis. However, I am not practising.

    Third, I can share my personal experiences with you. My first panic type migraine headache attack was caused by a brain tumor and I experienced perhaps three attacks after near misses in traffic. Therefore, it is always good to get a complete medical work up to rule out possible medical causes.

    Fourth, the last attack I experienced was less of a panic attack. Rather, it was an anxiety attack. Instead of receiving a jolt of adrenaline, the left pectoral muscles of my chest tightened. I thought I might have been experiencing a heart attack, but from my training & experience I watched my breath and observed myself. It was not a cardiac event but the result of multiple stressors and strain. I, too, observed that my glottis muscle [throat], which consists of both automatic and involuntary musculature (smooth muscle & striated muscle), was tightened making it was difficult for me to swallow. This was postive indicator of stress & strain. Immediately thereafter I took myself out of practise for the safety of the public and I have not worked since.

    Finally, to a client who experienced one panic attack I would suggest that rather than reading up on panic attack(s), they focus their attention elsewhere on something more positive.

    The last thing I might suggest would be seeing a psychiatrist because psychiatry is notoriously known for their lack of properly and quickly resolving panic disorder.

    Nothing beats a behavioral psychologist properly employing a hierarchy of desensitization in quickly resolving a panic disorder in six to eight sessions. More than twelve sessions and I would suspect the competency of that psychologist. When I was practising, often I was able to resolve these in two sessions but if I found myself in a fifth session, I would start to wonder whether I was on the right track.

    There is more I could say; however, I am not practising. Tell me where you are located. Perhaps I can recommend a competent behavioral or cognitive behavioral psychologist in your area.

    Psychology has been taken over by the left, the liberals whom I call “illiberals” and almost none of them has competency. I WILL have a LOT more to say about this.

    Stay away from the so-called “eclectics” who haven’t mastered a thing.

    Try to find someone trained in Steven Hayes’ Acceptance and Commitment Therapy (ACT) or an older psychologist.

    In general, avoid anyone with a Psy.D. or an Ed.D.

    Try to find an older practitioner with a Ph.D., peferably in the older degree formally called “clinical psychology.”

    Remember:

    Licensure DOES NOT assure competency.

    Nor does licensing of psychologists protect the public!

    All licensure does is protect the State and the powers that be . . .

    . . . and run up all of our bills more!

    As my mama said, “You’ve Got to Shop around.”

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