When Panic Attacks
Imagine this…
You just landed your dream job, and have started seeing someone new. You’re you’re excited about these developments, but you’re also balancing more than usual, and very focused on making a good impression. On a Friday morning you wake up, feeling a big groggy from the wine you shared with your new partner last night, but get yourself into the shower anyway. You have a big 9 am presentation to your new boss, and you’re nervous about making a good impression.
But in the shower, you start feeling dizzy, too hot. Your heart starts racing, and you start to fear you’re going to be really sick. You get out and find yourself just hyperventilating on the floor of your bathroom, your vision blacking out at the edges. You’re scared you’re about to pass out, or vomit. You beg your roommate to take you to the emergency room-- there’s really something wrong. You’re afraid you might be having a heart attack, or that you might die.
After many tests at the doctor’s, you’re given the diagnosis- this was all in your head. “Just” a panic attack. Take these calming pills, and here’s a referral for a therapist and psychiatrist.
Like many people who have experienced a panic attack, you might feel surprised about how out of control you felt, and how it felt like it “came out of nowhere.” You’re afraid it could happen again at any time.
What is a panic attack?
If you’ve ever experienced a panic attack, you know how scary it can be. One minute you’re fine, and the next minute you’re sure you’re dying.
A panic attack is a sudden onset of physical and emotional symptoms that are triggered by fear - the actual trigger is often unknown. These symptoms feel so scary that sometimes people develop an intense fear of re-experiencing a panic attack and avoid situations, places or people that may trigger one. Panic disorder occurs when people have experienced multiple panic attacks and develop this fear.
Learning about the physiology of panic attacks can help you recognize when you are experiencing these symptoms and remind yourself of what is happening.
Once you develop this awareness, you can try various tools to help you de-escalate your symptoms before they develop into a full blown attack. You can also learn to calm your body and mind more consistently to decrease the frequency and intensity of your panic attacks. And most importantly, you will be able to approach panic symptoms with the knowledge that though it feels terrifying, panic will not kill you. You can withstand those sensations.
What happens in a panic attack?
Panic attacks can be caused by a number of physiological and psychological factors, including drug use, lack of sleep, consistent stress, mood disorders such as anxiety or depression, or even something as simple as low blood sugar. Oftentimes, the direct “cause” of your panic attacks may never be clear. What we do know is that bodies in constant “fight or flight” are more prone to panic attack, so unfortunately, being on high-alert for future panic attacks only makes them more likely.
When our bodies experience fight or flight — aka “autonomic arousal” — we go through a very fast series of physiological changes that can have lasting effects on our mood, attention, concentration, and our hormone balance.
Typical symptoms of a panic attack are racing heart rate, sweating, shaking, feeling short of breath or dizzy, heaviness in the throat or chest, a choking feeling, over-heating, numbness or tingling in limbs, feeling detached, fear of losing control or fear of dying.
The more we can feel in control of our autonomic arousal responses, the more likely we are to recover from them quickly and with fewer residual effects. A panic attack log is a useful tool to help you identify what your symptoms are and how often they are occurring. This is a great first step to start looking for patterns. For more information on a Panic Attack Log, see 'Tools' below.
Is there an off switch?
Once you understand more about your panic attacks, you can try various tools to help you learn to accept the initial sensations of panic, to learn that panic symptoms won’t harm you, and to build specific de-escalation tools to help yourself while you’re feeling panic symptoms.
Having these skills will lower your overall anxiety and likely lower the frequency of panic symptoms.
For more information, see the Tools section below
Tools
Identification, Tracking & Mindfulness
Panic Attack Log
Click HERE for a link to a Panic Attack Log. In it, you will be asked to identify the initial physical or emotional symptoms that occurs at the onset of your panic attack. Some people start to feel hot or dizzy, while others may first notice their heart racing, or intense fear thoughts. Whatever the initial symptom is, use that as a “light bulb” and try the following steps:
Acknowledge you’re having panic symptoms. Take a deep breath and put your hand somewhere soothing (your face, your chest, your other hand, etc) and say to yourself “Okay, I am having panic symptoms. I have felt this before. I know it will not kill me, or last forever.”
Choose a de-escalation tool that works well for you. Here are some Grounding exercise ideas, but feel free to make up your own as well:
One tool that is useful is called:
4-7-8 breathing
This is a breathing exercise where you breath in through your nose for 4 slow counts, hold your breath for 7 slow counts and slowly breathe out through your mouth for 8 slow counts. Repeat this exercise at least 5-8 times until you notice your heart rate and thoughts slowing down. This and other breathing exercises are most effective at the very first sign of a panic attack.
Grounding Exercises:
Try a few and have at least 2 or 3 of these exercises that you automatically start at the first symptoms of panic. You may have to try several to see what works best for you.
Run cool water over your hands.
Splash cold water on your face or put an ice pack on your face or neck
Grab onto your chair as hard as you can.
Touch various objects around you: a pen, keys, your clothing, or the wall.
Dig your heels into the floor, literally “grounding” them! Notice the tension centered in your heels as you do this. Remind yourself you are connected to the ground.
Carry a grounding object in your pocket, which you can touch whenever you feel triggered - maybe a smooth stone or something with meaning.
Notice your body: the weight of your body in the chair; wiggle your toes in your socks; notice the feel of your chair against your back …
Clench and release your fists.
Walk slowly; pay attention each footstep, saying “left or “right” or count… to yourself.
Focus on your breathing … pay attention to each inhale and exhale.
Lie on the cold bathroom floor
Listen to loud music
Walk fast or run around the block
Use "Talk Backs"
Practice “Talk Backs” to any irrational thoughts that pop up about your current physical experience. When you learn to challenge or “talk back” to these thoughts, anxiety and panic symptoms will start to decrease.
Examples:
What if this time I really am having a heart attack?
Talk-back: Panic attack symptoms seem similar to heart attack symptoms but I’m healthy and these will pass. I will feel scared for a little while but I know I am safe.
I’m going crazy.
Talk-back: Anxiety is very common and can trigger scary thoughts and sensations. I didn’t choose this and it’s not my fault, and it doesn’t mean I’m crazy. I know that this will pass and I’ll feel rational again.
If my panic attack symptoms start while I’m with clients or friends, people will think I’m weird if I get up from the table.
Talk-back: It’s completely normal to get up during dinner. If I experience the first symptom, I’ll excuse myself, go into the bathroom and do my breathing exercise or grounding techniques. Many people have anxiety and I have ways to help me calm down.
Progressive Muscle Relaxation:
Progressive muscle relaxation is an exercise that relaxes your mind and body by progressively tensing and relaxing muscle groups throughout your entire body. If you use this technique or other calming exercises like yoga or breathing, your anxiety and stress level should lower, decreasing the severity and frequency of panic attacks.
Practice these techniques in a calm state, as well as when you are feeling anxious. The more you do this, the stronger impact it will have on your anxiety process.
Meditation sourced from Dr. Matt Lewis.
All in all, panic attacks are scary. Your brain interprets the symptoms as danger, so of course you are scared.
But if you have experienced panic, you should know that it is treatable. Understanding the physiology of panic, noticing and accepting your own symptoms, and learning to use tools to help you with de-escalation can all help minimize the impact of panic on your life. There are also medications that can work to resolve symptoms.
Making lifestyle changes such as getting consistent sleep, eating healthy and consistently, managing alcohol and caffeine intake and avoiding recreational drugs can help you manage your baseline anxiety.
by Kristen Scarlett, LMHC
Therapist