对于某些类型的焦虑症（即恐慌症）的人来说，运动可能是22个情况。我们知道，运动总体上会使我们感觉更好，但与此同时，运动有时会导致焦虑增加甚至引发恐慌发作。本文将探讨为什么和何时发生这种情况。本系列的第2部分将提供实用的技巧，以帮助管理运动引起的焦虑。

什么是恐慌症？

Before describing what panic disorder (PD) is, I first have to describe a panic attack. A panic attack is a bout of extreme anxiety that most commonly emerges via physical symptoms including, but not limited to, sweating, shaking, shortness of breath, heart palpitations, hot or cold flashes, sense of dread or intense fear, and much more. It is a good idea to first rule out physical causes — such as cardiac problems — if you are experiencing these symptoms. Panic attacks look different in different people, but regardless of the type of symptoms, people often describe wondering if they are having a heart attack or if they are dying while in the throes of a panic attack. This only increases their levels of panic and anxiety at the moment.

恐慌症是一种特定类型的焦虑症，其特征是反复发作和意外的恐慌发作，其次是一个月或更长时间的恐惧，害怕发生更多的恐慌发作。恐慌症在生活中的某个时刻将影响约4.7％的美国成年人，而女性比男性更有可能体验（哈佛医学院，2017年）。

恐慌症可能会或可能不会伴有恐惧症，或者担心在逃脱可能很困难的情况下。有了恐惧症，人们担心的是，任何时候都可能发生惊恐发作，到达感知安全的地方将是困难或不可能的。通常，这会导致人们避免他们预期的情况会引起焦虑，例如公共交通，开放或封闭的空间，排队或人群。在最严重的形式下，人们很难离开家。

运动引起的惊恐发作

对于患有恐慌症的人们，运动有时可能是增加焦虑或恐慌发作的触发因素。关于为什么这样做的理论很多，这里有几个理论：

• 自主性失调：如果您回想起战斗或飞行系列，自主神经系统（ANS）调节呼吸，血压，心率和循环。在ANS中，我们具有交感神经（战斗或飞行）和副交感神经系统。患有恐慌症的人会经历自主神经功能障碍（他们的交感神经系统是过度敏感和过度活跃的），并且在副交感神经系统中的激活较少。这会增加对压力源的敏感性，并在经历这些压力源时使用技术使身体平静下来。运动就是一种压力源，即使是理想的，身体也无法区分和导致焦虑增加（Muotri＆Bernik，2014年）。
  
• Conditioning:The physiological symptoms of a panic attack (described above) overlap significantly with some of the symptoms of exercise, namely, shortness of breath, sweating, dizziness, etc. These feelings have been conditioned or associated over time with panic. Therefore, when people start to exercise and experience these feelings, they associate them with a panic attack. This cognitive association then perpetuates the presence of the panic attack.
  
• 增加乳酸积聚：乳酸是体内锻炼过程中人体产生的化合物。我们很清楚，这种乳酸积聚会导致肌肉酸痛，但也会影响大脑。有些人很难从大脑中清除乳酸，这导致了过度敏感的杏仁核（大脑的情绪中心）。因此，当人们从事剧烈的体育锻炼时，身体会增加乳酸并可能导致惊恐发作（Martinsen等，1998）。

Technically, anyone could experience anxiety or panic during exercise, but folks with panic disorder or family histories of anxiety disorders are more likely to experience them.

研究表明，对于患有恐慌症的人来说，中等强度锻炼确实会在锻炼后立即增加一个人的焦虑程度，但即使在10分钟后，实际上即使lowersthe individual’s level of anxiety compared to their baseline (Ströhle et al., 2009; Lattari et al., 2018). Therefore, this subjective experience where people report increases in anxiety during exercise, but then long-term reductions in their anxiety, is supported by empirical literature.

Impact of the type of workout

It is not exactly clear from the research which types of workouts are most likely to lead to panic symptoms; however, we know anecdotally that people tend to experience them during higher intensity cardiovascular workouts. Harkening back to the conditioning explanation above, within high intensity cardio workouts (like HIIT), our bodies quickly reach the physiological state that reminds us of a panic attack. When we are unable to then either cognitively distinguish that an increased heart rate from exercise is actually a好的事情和/或阻止我们的身体自动螺旋式刺激恐慌发作，我们对焦虑程度几乎没有控制。

However, research shows that mild to moderately intense exercise does lead to a reduction in anxiety in the long-term (Ströhle et al., 2009; Lattari et al., 2018) and there is even burgeoning research that shows high-intensity exercise can be tolerated by folks with panic disorder under the right conditions (Plag et al., 2019). In particular, gradually increasing your heart rate with a longer warm-up and easing into the high intensity portions can help signal to the mind and body that this is a good and intended physiological response.

在本系列的下一部分中，我们将提供管理焦虑症的技巧，这些焦虑会因锻炼而出现，以及如果这是您的常见经历，则可以尝试进行锻炼！In the meantime, check out this article about mindfulness for anxiety. What helps you to manage anxiety during workouts?

哈佛医学院（2017年8月21日）。国家合并症调查（NCS）。从...获得哈佛大学. Data Table 1:终身患病率DSM-IV/WMH-CIDI疾病通过性和队列.

Martinsen, E. W., Raglin, J. S., Hoffart, A., & Friis, S. (1998). Tolerance to intensive exercise and high levels of lactate in panic disorder.Journal of Anxiety Disorders,12(4), 333-342.

Muotri, R. W., & Bernik, M. A. (2014). Panic disorder and exercise avoidance.Revista Brasileira de Psiquiatria，36岁，68-75。

Lattari, E., Budde, H., Paes, F., Albuquerque Maranhão Neto, G., Carlos Appolinario, J., Egídio Nardi, A., Murillo-Rodriguez, E., & Machado, S. (2018). Effects of aerobic exercise on anxiety symptoms and cortical activity in patients with panic disorder: A pilot study.Clinical Practice & Epidemiology in Mental Health, 14,11-25.

O'Connor，P。J.（2005）。恐慌症患者最大程度和次最大运动后，状态焦虑症减少。International Journal of Sport and Exercise Psychology,3(4), 501-508.

Plag, J., Ergec, D. L., Fydrich, T., & Ströhle, A. (2019). High-intensity interval training in panic disorder patients: a pilot study.The Journal of Nervous and Mental Disease,207（3），184-187。

Ströhle, A., Graetz, B., Scheel, M. Wittmann, A., Feller, C., Heinz, A., & Dimeo, F. (2009). The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects.精神病学杂志，43，1013-1017。