Panic attacks – or anxiety attacks as they are commonly called – can be so painful and difficult that some people actually go to the emergency room thinking that they are having a heart attack. At the very least, people who experience them might have a racing heart, feel dizzy, nauseous, or numb. Not something anyone wants to experience, right? So what can be done?
While there are many different ways to cope with panic attacks, I will attempt to describe just one way that I have found to be successful when working with clients. It’s based on Cognitive-Behavioral Therapy. Disclaimer: this does not mean that panic attacks will disappear, that it will be easy, or that it’s a one-size-fits-all approach. If they become more than what feels manageable, please seek the help of a licensed professional.
What are Panic Attacks / Anxiety Attacks?
While many people actually call them anxiety attacks, they’re actually called panic attacks in the Diagnostic and Statistical Manual of Mental Disorders. Before we get into how to address them, let’s talk about what anxiety attacks are. In essence, panic attacks are false alarms that your body’s sympathetic nervous system sends. The sympathetic nervous system is responsible for the fight-or-flight system in our bodies. During a panic attack, a person feels intense fear and 4 or more of the following physical symptoms:
- Racing heart
- trembling or shaking
- feeling short of breath/hyperventilating
- chest pain or discomfort
- feeling dizzy or lightheaded
- feeling of choking
- feelings of unreality or feeling detached from oneself
- fear of losing control or going insane
- chills or hot flashes
Learn Relaxation Skills for Panic Attacks First
Panic attacks are false alarms from the fight-or-flight system, one important thing to do is learn how to calm the sympathetic nervous system down and relax. I recognize that telling someone to relax when they’re in the middle of a panic attack is like telling a hungry, overly-tired, bored two year old to stop throwing a tantrum because they don’t need to watch Moana again. However, I have found when working with clients that practice makes things come easier, just like everything else in life.
To begin with, try practicing relaxation skills outside of panic attacks. This way it’s like studying for a test before the test happens. On a similar note, try practicing relaxation skills at the first sign of a panic attack, if possible, before it becomes full blown.
There are countless ways to relax. What’s important is to find a good fit for each individual. I will list just two in greater detail. Other skills include muscle relaxation techniques, yoga, distraction things such as going for a walk, listening to music, or calling a friend.
Deep breathing for panic attacks
Because so many people experience shortness of breath or hyperventilating and a racing heart with panic attacks, deep breathing is so important. Obviously, deep breathing is the opposite of hyperventilating. There are many different ways to practice deep breathing. For example, one might breathe in 5 seconds and out 6 seconds. Or, it can be paired with visualizing. Breathe in the good and out the bad. It can also be as simple as trying to focus 100% on the sensations of taking long, deep breaths.
Mindfulness for panic attacks
Panic attacks are all about the brain becoming too focused on bodily sensations (kind of like patrolling), misinterpreting what’s going on, and then sending false alarms. The opposite of this is to stay mindful of the external world instead of being hyper-focused on bodily sensations (such as a racing heart). One way to be mindful is to use your 5 senses to stay focused on the present and what is going on around you. For example: I can hear the ticking clock. I can see the motivation poster hanging on the wall and the frame is dusty. I can smell the cinnamon scented candle. Being mindful is all about being conscious and aware of what is going on around oneself instead of going further and further down the panic road. It’s a pretty hot topic in the mental health field right now; simply google it and a plethora of books and articles with mindfulness exercises will come up.
Identify Triggers for Panic Attacks
Even though panic attacks often seem out of the blue, I have found that most people can identify situations or places that trigger feels of anxiety and even anxiety/panic attacks. This awareness is really important because with the knowledge an individual can put more concentrated, directed effort toward learning how to cope with them. Without an awareness of what triggers an attack, the panic might continue to seem out of the blue and unmanageable.
Triggers can include places (such as someone’s office or school room), a situation (such as public speaking or a test), and overall feelings and moods (such as having a stressful week or not engaging in activities that refresh and rejuvenate oneself). Although I am not an expert at physical health, I’m certain that sleep and nutrition can also play a factor.
Create a Sequence of Events Chart (Chain Analysis) of Panic Attacks
Panic/anxiety attacks happen so quickly and so suddenly that it seems pretty difficult to break them down. The whole sequence might start happening in a matter of seconds. However, I found that with some deep thought, clients were able to break down the sequence of events in a panic attack. This is helpful because they could then address various parts and characteristics to try to turn it around and calm the fight-or-flight response. It also becomes more understandable and comprehensible instead of a massive attack that seems to come out of no where. They can use this knowledge to fight the false alarm signals the body is sending.
A chain analysis might look something like this:
Situation: driving to school in the morning. 1) pit in stomach 2) the thought: I’m not sure I prepared enough for the test today 3) slight increase in heart rate and more feelings of anxiety 4) the thought: I’m probably going to fail the test 5) greater increase in heart rate and start of shortness of breath 6) The thought: I’ll fail the class. I can’t go today. I just can’t do it. 7) start of hyperventilating, feeling light-headed 8) Oh no. Here we go again. I hate this. Why me?! 9) Sweating and dizziness 10) I can’t get through this. I can’t handle these attacks.
Turning Panic Attacks Around
Once a general pattern of a panic attack is sequenced out, individuals can start figuring out how to respond to the different components of the panic attacks. There are many different possibilities of what could be done. They could first recognize that their body is patrolling for signs of an attack (as discussed above) and use that awareness to feel more accepting of the different body sensations. They could recognize when they’re first starting to feel anxious and use relaxation skills (maybe even something as simple as listening to and focusing on calming music) well before anything else happens in the chain of events. Unhelpful thoughts about the test can be identified and addressed, as described in more detail below. Once shortness of breath starts, individuals can focus on deep breathing. Turning on the radio and using mindfulness skills to focus on the music instead of bodily sensations is another option.
Identify Unhelpful Thoughts
A necessary part of Cognitive Behavioral Therapy (CBT) is to start noticing “thinking errors,” or illogical or untrue thoughts, in order to change them. People, with practice, can learn how to modify them to more acceptable or true thoughts. For example, in the example above, the person could start recognizing either that he/she studied enough for the test, or else that make-up work is possible. Even if they did fail, they can still go to college and get a good job. One failed test does not ruin the future. There are many CBT workbooks that will guide readers step-by-step through these skills.
There are also different ways of reacting to thoughts. Instead of identifying thinking errors and changing them, people can simply start identifying whether they are helpful or unhelpful and putting distance between themselves and their thoughts. So, instead of thinking, “This is awful and I can’t handle it” try thinking something more along the lines of “I am not enjoying this and I’m having a thought that I can’t handle it, but that’s just a thought and not truth.” To read more about this concept and what Acceptance and Commitment Therapy (ACT) is, you can read a brief synopsis of it here. Basically, it means that you accept negative emotions (including anxiety attacks) and move on instead of kicking and screaming against it with beliefs such as not being able to handle it.
I know, I know…you’re probably thinking this all sounds way too over-simplified, and it is. Like anything, it requires lots of practice and awareness. Other people, including family members or mental health professionals, can be a great support in learning these and other skills.
Seek Outside Help for Panic Attacks
If you feel like panic attacks are more than you can handle on your own, please seek the help from a licensed professional such as a medical doctor or therapist. Licensed therapists that are knowledgable about panic attacks can act as a valuable aid in understanding and applying the skills mentioned here. They can also provide other, different approaches and skills. Again, this post is not a cure-all, one-size/one-read cures all approach. Additionally, many people have found medication to be helpful in coping with panic attacks and a right fit for them.
Disclaimer: this post is not indended to provide therapeutic services or diagnose anxiety disorders, including panic attacks. Please seek the help from a licensed professional if needed, including if suicidal ideations or self-harm is present.