panic disorder - Mental health 360°

How to manage panic attacks

Find out how to manage panic attacks

This was initially a guest post on Happiness between tails and I’m now sharing it with you. As someone who’s experienced and had to manage severe panic attacks, I understand just how frightening and debilitating they are.

I never want to experience another one and if this is you too, let’s look at how to prevent them.

First tho’, in order to overcome panic attacks, you’ll need to understand what they are. We’ve all had feelings of anxiety – it’s our body’s natural response to stress. It’s a feeling of fear or apprehension about what’s to come.

For example, you may feel anxious about a job interview. During times like this, feeling anxious can be perfectly normal, but some people find it harder to control their anxieties.The most severe form of anxiety can trigger panic attacks.

What is a panic attack or panic disorder?

Panic attacks might follow stressful life events – Image Pixabay

We have panic attacks and panic disorder; one episode is a panic attack, which might occur following a stressful life event i.e death of someone close.

Panic disorder is an anxiety disorder where you regularly have sudden attacks of panic or fear. You experience regular and subsequent attacks. It’s a common yet very misunderstood illness and lots of people with this disorder won’t ever seek help due to fear and stigma.

The attacks can occur often and at any time, seemingly for no apparent reason. It feels like a sudden, unexpected rush of intense fear and anxiety along with a flood of frightening thoughts and physical sensations – so, panic attacks are not merely psychological.

What you should know about panic disorder

Panic attack symptoms are similar to some physical illnesses

Many of the symptoms of panic attack are similar to some physical illnesses i.e. heart attack or over-active thyroid. See your GP to rule these out.
It’s a chronic condition and can lead to changes in behaviour, like avoiding situations or events.
People dread the onset of another attack, and the fear of having one is just as debilitating as the attacks themselves.
Panic disorder knows no boundaries as it affects people of all socio-economic groups and races. It’s more common in women than men. It can also affect children and the elderly.
Although the exact causes are unclear, panic disorders can run in families.
While many attacks are be triggered by stressful life events, they can also occur ‘out of the blue’.
Be aware – anti- malaria medication, cold and flu medications, appetite suppressants and even too much caffeine can trigger panic attacks in some people.

If you experience panic attacks, you might then begin to avoid events or situations because you’re afraid of another attack. However, avoidance can create a cycle of living in “fear of the fear”, which only adds to your sense of panic. This can cause you to have more panic attacks, leading to diagnosis of panic disorder

What are the symptoms of panic attacks?

Panic attack can feel like a heart attack – see your GP

If we encounter a situation that threatens our safety, we’ll experience a series of reactions known as the ‘fight or flight’ response – triggered by the release of chemicals that prepare your body to either stay and deal with a threat or to flee to safety.

During a panic attack, we’ll experience similar symptoms, even when there’s no real threat involved. A panic attack might happen in response to situations that others find harmless. Symptoms include physical and physiological symptoms:

Racing heartbeat, palpitations
Dizziness, light-headedness, or nausea
Difficulty breathing, like you can’t get enough air
Dry mouth and unable to swallow – if you do need fluids, just take smalls sips to avoid choking
Shaking, trembling
Sweating and hot flushes or sudden chills
Sudden need to go to the toilet, the body needs to lighten to fight or flee
Numbness or tingling sensations, initially in your fingers and toes
Your face, feet and hands might go white (as with the tingling, this is the blood leaving your extremities to rush to where it’s needed most i.e. heart and muscles)
Chest pains – you might think you’re having a heart attack – one way to tell is – if your fingers and toes are tingling, you’re more likely to be having a panic attack. However, if you’re afraid call the emergency services to check

You might experience negative thoughts

tender redhead woman with finger on lips — Embarrassed by panic attack — Image by Pexels

I’m so embarrassed, everyone can see me panicking
I feel like I’m dying or I’m having a heart attack.
I can’t cope with this!
I’m so stupid, I’m never going to get rid of this feeling.

and feelings of:

You’re going mad or crazy.
Being out of physical or emotional control.
Unreality/detachment from yourself or your surroundings.
Heightened sound and visual awareness, and hypervigilance (for flight or flee you need to hear and see clearly and be vigilant).

A panic attack generally lasts between 4 – 20 minutes, although it often feels a lot longer. However, they have been known to last an hour. I had them one after another, and all night for around three months and it felt like torture. It’s no wonder I became psychotic!

How to manage panic attacks

Practice breathing through your panic attack — Photo by Pexels

Breathe as slowly and deeply as possible, exhaling firstly through your mouth – slowly for a count of 8-10 seconds, then in through your nose slowly and so on.
Some people use a paper bag to cover their nose and mouth, and breathe in an out. This is known to work but it’s not something I’d teach because you’re not always going to have access to a paper bag.
Recognise that this is a panic attack and tell yourself that it will pass, because it will.
Use muscle relaxation techniques – try slumping your shoulders, letting them drop down from your ears, give your jaw a little wiggle then let it relax, uncross your legs, unclench your fists and lay the palms of your hands lightly on your thighs (remind yourself that your body cannot be relaxed and tense at the same time).
Try to get to a quiet space and sit down if necessary and continue with the breathing.
If you’re at work or outside, ask for help, I know this might feel a little embarrassing, but do ask if you need to.
Count backwards slowly from 100 or
Look around for 5 things that you can see and name them out loud i.e. “I can see a red truck,” etc. You can go onto things you can hear, smell, taste, or touch in the same way – until the panic subsides. This technique will help you stay in the present and grounded by using your five senses.
Put a few drops of lavender (known to ease anxiety) on a tissue, exhale then breathe it in slowly.
Call emergency services if the symptoms continue or get worse, or if you’re afraid it might be something else i.e. heart attack.

How to manage someone else’s panic attacks

Ask the person if they’ve had a panic attack before, and what they think might help or has helped them in the past.
Encourage them (or tell them quite firmly if they’re confused and unable to follow directions) to breathe (as above). Do this with them if necessary, as often they think they can’t breathe and won’t be able to do this alone.
Follow the above steps and call emergency services if necessary.

Self-help to combat panic attacks

Notice the tension in your body — Photo by Pexels

Listen (regularly) to free mental wellbeing audio guides online. These will help prepare you so that you can manage your panic attacks as you need to.
Search and download relaxation and mindfulness apps or online community apps.
Learn other skills like visualisation to help you relax and practice them often.
Notice when your body is tense i.e. when your shoulders are up round your ears or your fists are clenched and let them relax. When your body is constantly tensed up, it’s effectively telling your brain you’re on alert, tensed and ready to fight or flee.
Ask your close friends or family members to support you by gently pointing out when you’re all hunched up and tense. Even better, perhaps they’ll give you a light head massage, or lightly rub your arms and hands in a soothing way.
Practice the breathing exercises often so that you’ll be able to use them easily when needed. Honestly, practice this all day, every day — it’s a great feeling and you’ll have it ready to use when you need it.
Try mixing lavender oil with other aromatherapy oils like geranium or camomille to produce your own stress reliever.

I really can’t stress enough the need to practice the coping techniques. You know you wouldn’t be able to drive say on a motorway after having just one lesson. It takes practice!

Treatment for Panic attacks

Talking therapy for panic attacks — Photo by Pexels

Treatment aims to reduce the number of panic attacks you have and ease your symptoms:

Psychological (talking) therapies and medicine are the main treatments for panic disorder
Depending on your symptoms, you may need either of these treatments, or a combination of both

When to get help

See your GP to rule out other causes — Photo by Pexels

If you’re having suicidal thoughts, please seek professional help. Or talk to someone close.
See a GP if you’ve been experiencing symptoms of panic disorder. Regardless of how long you’ve had the symptoms, if panic attacks are interfering with your life, work, or relationships you should seek professional help.
Although panic disorder is a medical condition in its own right, there can sometimes be a physical reason for your symptoms – and treating it can bring the anxious feelings to an end. See your GP to rule out any other causes and don’t self-diagnose.

Over to you

Have you ever had panic attacks, or do you know someone who has? Do you have other coping techniques that might help readers? Do you think you’d be able to support someone having a panic attack now? I look forward to your comments as always and I’m happy to answer any questions.

Tips to help you with your anxiety and panic attacks

Panic attacks can be sudden and overpowering. They can affect anyone and may be caused by general anxiety, panic disorder, or depression (Medical news today).

You’re probably reading this because you’ve experienced or you’re still having anxiety/panic attacks. I know when I was suffering from them, I tried absolutely anything I could think of because I was so desperate.

I couldn’t sleep for days on end because of the panic attacks. I experienced most of the common physical symptoms of anxiety: muscle tension, headaches, backaches, a clenched jaw, feeling keyed up, restless, and “on edge”, as well as difficulty concentrating. These symptoms are a side effect of our body’s attempts to protect us; blood moves around our body and brain, into our large muscles, like our arms, legs, back, and neck, to get us ready to ”fight” or to “flee.”

Eventually I became psychotic (you may want to read about it here) . After only three or four nights without sleep, anyone can start to hallucinate (a psychosis or a psychotic episode is not schizophrenia).

When we experience anxiety/panic, the first thing that happens is our senses observe our environment, and we feel that rush of cortisol in our brain as the fight-or-flight mentality begins to set in. This is something humans have evolved to do to be able to sense danger and respond quickly, which is why it all happens in a matter of seconds (Sal Raichbach, Ambrosia Treatment Centre). This means we need to feel some kind of anxiety in response to danger i.e. if a car was thundering towards you, you’d feel anxious and try to get out of its way.

We obviously realise we are panicking and that’s all we can think of in that moment. We don’t automatically think OMG, why am I panicking, do we? We just think OMG I’m panicking. Let’s have a look first at the onset of anyone’s anxiety/panic attack. Something happens, something causes the panic attack to start.

Only you will know how your anxiety/panic attack starts, though you may not even be aware of it – yet. So now we’ll learn the mechanics of how a panic attack begins. It might start with:

(1) negative thoughts i.e. “I’ll fail all my exams”, “I’m always going to have panic attacks”, “I shouldn’t have shouted at the kids this morning, I’m such a bad mum/dad” or “I’ll get thrown out of my home cos I can’t pay the rent” etc.

(2) negative physical feeling i;e. stomach churning, heart palpitating, sweating, dry mouth, shaking, nausea, vomiting.

(3) negative emotional feelings i.e. sadness, fear, disgust, shame.

(4) negative behaviour i.e. stealing your friends medication, isolating yourself, turn to alcohol or illicit drugs.

So, let’s clarify – a panic attack could start after -thoughts, -physical feelings, -emotional feelings or -behaviours

Let’s take a look at the following diagram, used in Cognitive Behavioural Therapy (CBT), which is the psychological treatment of choice recommended for a variety of mental health problems by the National Institute for Health and Clinical Excellence (NICE).

Look at how our thoughts, feelings and behaviours all interact with each other.

For example: the -behaviour was to overeat, stop dieting or eat unplanned food which evoked -thoughts i.e. I’m so weak willed and this led to -feelings i.e. depressed, ashamed which, in turn perpetuated the -behaviour i.e. continue to overeat because you’ve blown the diet anyway.

Still looking at the diagram, see how you can turn this on it’s head and you may have the -feelings first i.e. depressed which led to your -behaviour of overeating, after which you had -thoughts i.e. I’m such a pig, I can’t even stick to a diet.

I’ve only used the above as an example. However, it doesn’t matter what the issue is, this CBT model can be used for all negative thoughts, feelings and behaviours. Let’s take a look at another issue:

We’re still looking at the links between -thoughts, -feelings and -behaviours; it’s just the issue itself, example above, will be different and personal to you.

I’m going to share a little known fact with you here. Just have a think for a moment. What has previously or what would make you feel really excited (and I don’t need to know)? Don’t read any further until you’ve got that thought!

Now, you might absolutely love or hate roller coaster rides and, depending on how you feel about them, your thoughts or feelings might have started to kick in when you saw the photo. If you hate them, you might be thinking “yuk, I hate roller coasters” (-thought) or your stomach may have turned over at the sight of the picture (-feeling). If ever I saw a spider, even on a page – it made me anxious and I had to turn the page quickly (-behaviour).

While I’ve just made you think about whether you like roller coasters or not – that wasn’t really my whole intention. I wanted to distract you from reading any further until you’d thought of what has or would excite you. I hope you’ve been able to think of at least one event, occasion, gift or …………

Do you remember what it felt like to be so excited? Think about that for a few seconds………

Did you ever get that butterflies feeling in your stomach? Have you ever felt shaky and tearful when someone gave you a lovely surprise? Did your heart ever pound with excitement pre-Christmas or your birthday party? I really hope you did – because I would feel really sad for anyone who had never experienced any of these sensations.

Here’s the little known fact -both excitement and panic/anxiety involve the same chemical process in the brain. That’s because anxiety and excitement are both aroused emotions. In both, the heart beats faster, cortisol surges, and the body prepares for action. In other words, they’re “arousal congruent.” The only difference is that excitement is a positive emotion‚ focused on all the ways something could go well (Alison Wood Brooks, a professor at Harvard Business School).

When we feel anxious/panicky, we’re most likely to tell ourselves to just relax or calm down. But this might be precisely the wrong advice, Brooks said. Instead, the slogan should be more like, “Get Amped and Don’t Screw Up.” In other words, it’s so much easier to convince yourself to be excited rather than calm when you’re anxious.

So, if you could retrain your mindset, rather than saying/thinking “OMG I feel anxious about my driving test”, try saying “I feel excited about my driving test”. It boils down to telling yourself that you feel excited whenever you feel nervous. It sounds stupidly simple, but it’s proven effective in a variety of studies and settings. Try it.

The excitement reappraisal won’t actually make you less anxious, nor will it lower your heart rate. That’s because your underlying anxiety is the same—it’s just reframed as excitement.

The way this works, Brooks said, is by putting people in an “opportunity mindset,” with a focus on all the good things that can happen if you do well, as opposed to a “threat mindset,” which dwells on all the consequences of performing poorly.

Okay. We’ve looked at anxiety and panic attacks so, what can we do about them? Right at the start, when you have the initial -thought i.e. when you wake up and you think “Oh, no. I feel yuk about today’s presentation” or you have a -feeling i.e your heart starts to race:

Stop. Take stock of the situation. Try “Oh, I’m excited about today’s presentation”, “I’m excited that my driving test is today”or “I’m excited about my interview today”.

Accept and recognise: You might have experienced panic attacks in the past. During an attack, it can help to remember that it will pass and cause no physical harm, though they are unpleasant. Acknowledge that the attack is a brief period of concentrated anxiety and that it will end (Medical news today).

Learn what triggers your anxiety/panic attack: it may be crowds or small spaces etc.

Do an evidence-based breathing technique like Slow Diaphragmatic Breathing:

Sit comfortably in a chair with your feet on the floor. You can lie down if you wish.
Fold your hands on your belly.
Breathe in slowly and calmly. Fill up the belly with a normal breath. Try not to breathe in too heavily. The hands should move up when you breathe in, as if you are filling up a balloon. Avoid lifting the shoulders as you inhale; rather, breathe into the stomach.
Breathe out slowly to the count of “5”. Try to slow down the rate of the exhale. After the exhale, hold for 2-3 seconds before inhaling again.
Work to continue to slow down the pace of the breath.
Practice this for about 10 minutes.

This works best if you practice this two times each day for 10 minutes each time. Try to find a regular time to practice this each day. The more you practice, the easier you’ll find it to use when you most need it.

Try Relaxation; this happens when the body stops trying to protect us, which helps us feel more calm and at ease. Relaxation skills are like exercise! Imagine a friend of yours telling you that she is planning to train for a 10K race. Despite the fact that she has never run a race before and does not jog regularly, she tells you her training will consist singularly of practicing running the full 10 kilometers on the day before the race. What would you think about this?

We know that the body needs time to learn how to run for long distances and build strength. She would need to practice at least a few times per week for a number of weeks to be ready. Relaxation skills are developed just like exercise: in order to see significant results, we must use them regularly over long periods of time. This is not a one shot deal (medicine.umich.edu). Each person is different as we all relax in different ways:

Find a relaxation exercise that you can practice daily or multiple times per week.
Increase awareness of tension in your body and improve awareness of the difference between tension and relaxation – remember, your body can’t be tense and relaxed at the same time. Choose relaxed over tense. Let your shoulders drop down, away from your ears, unclench your jaw by doing a few facial exercises and breathe.
Progressive muscle relaxation, yoga, mindfulness, and deep breathing.
Adjust your lifestyle to make it less busy, hectic, and rushed.
Take part in activities that give you pleasure, make you feel competent, or give you a chance to take a break from other, more stressful activities.

Try sniffing Lavender which has long since to relieve anxiety and evoke calmness.

Limit stimuli i.e. switch the tv off, perhaps close the curtains to reduce outside noise and distractions.

Try Mindfulness – there are a variety of exercises (not just breathing) you could try.

I know Mindfulness isn’t for everyone but many people benefit from it, myself included. So much so that I attended certificated courses and am now able to teach Mindfulness. I have to admit, I don’t practice it as much as I did in the beginning and my son reminds me to use these techniques more often.

See your GP. Some people avoid getting needed medical assistance because they fret that the GP will think they are silly or petty if they report anxiety. If anxiety regularly impacts your life, contact your doctor. Medication might be needed initially, but this doesn’t have to be long-term. Speak with your GP.

Panic attacks can be frightening and disorienting, especially the first time. Symptoms can be similar to those of other health conditions. Seek medical advice if:

a panic attack lasts longer than usual — most last between 5 and 20 minutes
a panic attack is noticeably worse than usual
panic attacks are inhibiting your life, possibly by stopping you from engaging with others, socialising or working

Cognitive Behaviour Therapy, is a talking therapy which is clinically proven to help treat a wide range of emotional difficulties. This form of therapy is centered on identifying and changing inaccurate or distorted thinking patterns, emotional responses, and behaviors. Speak to your GP and ask for a referral to a CBT practitioner. There’s often a lengthy wait so, in the meantime, you may want to try some of the other suggestions mentioned.

Anxiety and panic attacks are very real and they tend to get worse over time, particularly if you don’t do anything to alleviate the symptoms. You wouldn’t be able to drive a car without practice so please understand that you need to practice the techniques regularly.

You might find another post of mine “Strategies to help relieve your stress” helpful too. Click here.

Have you learnt anything you didn’t know previously? Have I missed anything?

Category: panic disorder

How to manage panic attacks

Find out how to manage panic attacks

What is a panic attack or panic disorder?