Managing Panic Attacks

Louis Laves-Webb

November 19, 2020

How to Manage Panic Attacks

Panic attacks can be a very challenging, frightening, and often full-body experience. During a panic attack, the amygdala's “sirens” are triggered by circumstances that do not warrant the extent of the body’s reaction. The brain is designed for self-preservation in dangerous situations; the brain prepares the body for “fight-or-flight” in life-threatening situations, as a natural defense. Stress and anxiety can be natural, even helpful responses, in the right magnitude and situation. Panic attacks, however, are an over-extension of this system that causes distress in daily life, and can be very challenging to manage, often due to the body’s potentially overwhelming bodily response. As a note, it is also important to remain up-to-date on medical appointments to ensure that symptoms are not the result of any other medical condition. Here are a few things to keep in mind when faced with panic attacks.

What are some typical feelings during a panic attack?

While these feelings certainly don't feel typical, they are somewhat explainable. The brain is preparing the body for “fight-or-flight” during a panic attack. These bodily responses to “fight-or-flight” messages from the brain may include an increased heart rate, increased respirations, sweating, increased adrenaline and cortisol, and tunnel-like vision, among others. Some people report feeling like they’re going to die, an overwhelming urge to run away or hide, feeling disconnected from their body, or difficulty maintaining clear thoughts. Overall, panic attacks tend to be a very convincing, full-body experience, that something is terribly wrong. This natural response was designed to prepare us for surviving life-threatening experiences long, long ago, to keep us from being eaten by a predator or prepare us to survive a disaster. Experiencing this strong response regularly or in non-threatening situations can be very distressing and cause challenges in daily life.  Many people go to the hospital for panic attacks each year, convinced that they are experiencing a heart attack, or another life-threatening emergency. Considering the response is designed to maintain survival, evaluating the extremely strong feelings for life-threatening potential seems quite natural and inherent. However, panic attacks themselves are not physically harmful events in and of themselves, but rather may be described as uncalibrated "alarm bells", which may point to important information, but are ringing much too loudly and/or regularly for comfort. The good news is that panic attacks are quite treatable with appropriate mental health support. Maintaining regular medical appointments and seeking mental health support to untangle thoughts and feelings surrounding your anxiety can be very helpful in treating panic attacks, and decreasing symptoms.    

Using mindfulness

Panic attacks can be extremely distressing, and it may feel imperative to fight the feelings so that they don’t “overtake” you or cause you distress. However, “fighting” the anxious feelings is often adding fuel to the “fire” of anxiety, adding fearfulness of the experience itself, to the original trigger that caused the anxious feelings in the first place. Most panic attacks last between 5-20 minutes. Mindfulness is the practice of noticing feelings and accepting them, rather than fighting them or denying that they are there. It means simply acknowledging that you are feeling anxious, that these feelings are washing over you here and now, and that they will pass. This is a challenging practice that requires, well, practice. Feelings offer information about your current state, and are “roadmaps” that may provide information about your perception of the world or some of its environments or experiences. Accepting the feelings, acknowledging that they are affecting you, and that they will pass, can be helpful in decreasing the intensity of a panic attack.

The importance of effective breathing

Breathing effectively can be incredibly important in managing a panic attack in the moment. Many people express feelings that they aren’t able to catch their breath. Rather than not having enough oxygen, these feelings are often a result of the reverse - that there is too much oxygen due to shallow, rapid breathing. Using balanced breathing techniques can help decrease these feelings.  Breathe from your diaphragm rather than your chest. You should not feel your shoulders rising while breathing.  Instead, place your hand under your chest above the belly button, and take a deep breath in your nose counting to four. You should feel your diaphragm expanding. Hold for four counts. Release the breath from pursed lips for four counts. You should feel your diaphragm relaxing. Hold for four counts. Continue to breathe in this pattern for a couple of minutes. Simple and effective breathing can be a very useful technique in the middle of a panic attack.

Stay connected to your environment

Some people feel disconnected from their body during a panic attack, or have trouble maintaining clear thoughts. This is a protective response utilized by the brain to keep you from experiencing undue psychological distress in a life-threatening situation; however, since panic attacks occur in non life-threatening situations, it can be a distressing response in and of itself. Using grounding techniques can be helpful to reduce these feelings. Notice things in your environment using your five senses. For example, touch five things with your fingers and notice the textures. Observe four things with your eyes and notice a detail about each one. Listen for three sounds and observe their volume or location of origin. Smell two things in your environment and recognize if they are pleasant or unpleasant smells. Taste something and notice its flavor, temperature, texture. Muscle relaxation can also be a helpful technique. Flex and relax your muscles from your toes up, focusing on each region of your body separately. Start with toes/feet, move up to legs, to hips, to arms, to torso, etc. Utilizing this technique can help provide a distraction and can provide an opportunity to connect your environment and your body.

Avoidance is tempting, but not helpful

If you’ve experienced a panic attack in a certain location or situation, say, a social event, it can often be tempting to avoid that location or situation to prevent another panic attack. Sometimes, people who have experienced panic attacks withdraw from social supports or decline events or locales that may be triggering. It may be difficult to maintain an 8-5 work schedule or drive on the highway, eat certain foods, or attend family gatherings; these avoidance behaviors are unique to each individual’s experiences and perceptions. Avoidance may seem helpful, by decreasing feelings of anxiety in the moment; however, avoidance can cause long-term anxiety in a, possibly less intense, but more perpetual form. Taking small steps towards overcoming anxiety-provoking obstacles takes massive self-compassion and often, support from others. Going to therapy can help you determine if you are utilizing avoidance, and how to begin working towards not only the decrease of anxiety symptoms, but also the re-integration of anxiety-provoking stimuli in a manageable and empowering way.

Seek support

Panic attacks can be extremely distressing, but are often very treatable with appropriate mental health support. Many people who experience panic attacks express confusion when attempting to define the origin of a panic attack, because the situation they were in when they experienced the panic attack is not considered “objectively” dangerous. Few people would be confused as to why they were experiencing significant anxiety and panic when chased by a tiger, but when the strong, anxious feelings come on in the middle of a grocery store or driving to work on a typical Tuesday, it’s more difficult to “nail down” their origin. Your feelings are meaningful and purposeful, telling you something about your unique perception of your environment, thoughts, or feelings. Examining these feelings in therapy can provide an opportunity for you and your counselor to recognize patterns, perceptions, and thought processes that may not be obvious in the moment, and that may be difficult to see from your own vantage point. A counselor can use this information to help you process your unique experiences and provide fitting interventions to work towards decreasing anxiety symptoms.

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