Chest Pain and Anxiety


 Many of my clients who have chest pain and anxiety, usually they are suffering from panic attacks or panic disorder.  This pain can be present in both children and adults.    People who are having a panic attacks may not just suffer from chest pain and anxiety, but chills, dizziness, and stomach problems. In our culture it is very difficult to understand that a mental health issues can cause real physical symptoms because of our approach to the mind and body as separate entities.

Statistics show that as many as 25% of patients with chest pain who come to hospital emergency departments have panic disorder . Those rates are even higher for people visiting urgent cares or their primary doctors for this symptom (Huffman et al 2003)! 

People who have generalized anxiety disorder may also have chest pain and anxiety symptoms. In one study half of those with generalized anxiety disorder reported chest palpitations as a symptom of their anxiety (Hoehn-Saric, R. (2007).

 In my office I am familiar with this as a symptom in my clients with generalized anxiety disorder. My clients with generalized anxiety disorder also struggle with stomach problems such as IBS,  and at times asthma. 

Medicine FREQUENTLY fails those with chest pain and anxiety

There are some  factors  used by doctors to determine if chest pain and anxiety are the main issue rather than a heart problem. 

  • 1. The absence of coronary heart disease
  • 2. An atypical quality to the pain
  • 3. A young age for heart pain
  • 4. A high level of anxiety reported by the client
  • 5. Client being a female ( though this is debatable)

For doctors, there are several issues that can account for unexplained chest pain, but anxiety and chest pain is likely responsible for much of those that are unaccounted for. 

Unfortunately, many people who have chest pain and anxiety who present to cardiologists never receive treatment or referrals to mental health providers. All domains of life are impacted by panic disorder or anxiety,  and it can be treated successfully, but all too often a patient is not referred for proper treatment.

There continues to be an effort in medicine to develop screening tools and systems to get people with chest pain and anxiety help, primarily because of the tremendous use of medical resources and the need to efficiently tell the difference between those who have true heart or medical problems and require traditional medical help and those who have anxiety, and require mental health help.

If I have chest pain and anxiety how would I be treated by a mental health professional?

Collaboration with medical professional

When clients are referred to my office for chest pain and anxiety, treatment is always individualized. If the focus of a clients concern is their physical symptom, which often becomes the case ( am I sick or dying?) then collaboration with a medical professional is required.  This may entail conversations with their primary care physician or cardiologist, if they were referred through that route. If they were not, it may include a referral. Sometimes in therapy we might have a goal of reducing emergency room visits and doctor visits depending on how frequent the attacks are so clients can see that they are panic attacks and learn to ride them out. The treatment goals depend on the nature of the panic and chest pain and their relationship to other professionals.

Ruling out medical conditions

It is important to rule out medical conditions especially in the case of panic attacks because treatment hinges on allowing your reactions in your body to happen, and recognizing them as a false alarm. It would be unethical for a therapist to work with a client in convincing them that their body is confused and they are safe and in no danger  if they actually were. Generally treatment for panic attacks require decreasing the fearful thoughts by recognizing that they are false. A therapist needs reassurance from a doctor that there is nothing wrong with a client to be able to treat them for appropriately.

Decreasing anxiety

When a client is in an anxious state, they view their physical symptoms as more severe, even though in actuality it may not be. Working on decreasing anxiety often decreases the client's perception of their pain or the severity of it. Generally I will do this through mindfulness and acceptance based techniques. Turning towards the pain and paying attention to it rather than moving away from it and struggling often can really help lessen it. This can be done through relaxation exercises, cognitive behavioral strategies, or mindfulness meditation. 

Additionally depending on the severity of a client's panic or anxiety, medication may be required. If they are not sleeping, are experiencing severe impairment at work, school or in their relationships, or are unable to leave their home, I will refer them to a psychiatrist who will prescribe medication to help alleviate some of their symptoms.  

It is important to remember that panic and anxiety are treatable, and if untreated it will continue to have a devastating effect on a person's' life.  Getting into therapy if you are having chest pains and anxiety is extremely important. 

Learn about panic attacks 

  • Foldes-Busque, G., Denis, I., Poitras, J., Fleet, R. P., Archambault, P., & Dionne, C. E. (2013). A prospective cohort study to refine and validate the panic screening score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open, 3(10), e003877. doi:10.1136/bmjopen-2013-003877
  • Huffman, J. C., & Pollack, M. H. (2003). Predicting panic disorder among patients with chest pain: An analysis of the literature. Psychosomatics, 44(3), 222-236. doi:10.1176/appi.psy.44.3.222
  • Hoehn-Saric, R. (2007). Treatment of somatic symptoms in generalized anxiety disorder.Psychiatric Times, 24(3), 34.

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Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.