When stress gets out of control it can lead to a “panic attack.” These can be frightening experiences, especially when it happens for the first time. These are unforgettable experiences because there is a very heightened physiological reaction with considerable anxiety and sometimes even a fear of death while in a panic state. It is not unusual for someone with a first time panic attack to end up in the emergency room of a hospital because these can feel like a heart attack.
If you have ever had a panic or anxiety attack, we do have some good news: these can be treated successfully with a variety of techniques depending on the severity of the problem. Fortunately, for most people who have ever had a panic attack, these are infrequent episodes that are not likely to cause any major social or medical problems. A combination of the skills taught in the iCope books and possibly medications for those who have had several panic attacks will provide a successful approach to preventing and managing these intense experiences.
If you have had one or more panic attacks that ended up with a visit to an emergency room, it would be wise to get a medication evaluation from your family physician or a psychiatrist. There are some medications that can be quite helpful. One approach is to use a mild tranquilizer on what is called an “as needed basis.” In these instances, you only take the medication when you feel that a panic attack is pending. Even if you rarely need the medication, having it readily available provides a sense of security even if you never have to take the pills. A second approach with medication is to regularly use one of the anti-depressant medications that help keep the neurotransmitter serotonin at the right level, which tends to have a calming effect over time. This seems to help decrease panic attacks, especially if the person has generally high levels of emotional arousal. In some cases, your doctor might prescribe both types of medication.
The strategies that we will discuss in more detail below are the ones that go along with the iCope methods. These are the specific steps to use when you are trying to prevent or short-circuit a panic attack. However, if you take some of the preventive steps to increase your resilience to stress in general, this will help minimize any vulnerability to panic attacks. As you will see below, relaxation skills, rational self-talk, and proactive problem solving will all be helpful in controlling panic.
KEEP THE PANIC IN PERSPECTIVE
From a psychological perspective, it helps to remind yourself that even though these attacks can be very scary, they do not mean you are in a life and death situation. As indicated above, when someone has their first panic attack and does not understand what is happening, they often go to their doctor or an emergency room as a safe guard. If you have done this, and your doctors have reassured you that you are having a panic attack and not a major medical problem, then you will be better prepared to keep any future panic attacks in perspective.
What does this all mean? Well, you would want to remind yourself of certain things if you are experiencing a panic attack, or beginning to sense that a possible attack might occur soon. You want to remind yourself that although scary, “there are things I can do to short circuit the panic.” Even if you do experience a panic attack, these are typically short time-limited experiences that often end within 30-60 minutes. Our bodies literally get exhausted and the panic eventually has to stop, even if you do nothing about it. Try to remind yourself that a panic attack will typically be a short-term event.
FOCUS ON YOUR BREATHING TO RELAX
When a panic attack begins, our breathing changes. We start to breath faster and take shorter shallow breaths. This creates a cycle that can lead to hyperventilation where the faster you breathe, the less oxygen you actually get into your body. As soon as you feel stress increasing and begin to fear a pending panic attack, one simple thing to do is to focus on your breathing. Just as described in the iCope books, take a few slow deep breaths and hold them for a while before breathing out slowly. A good pace is 4-5 seconds to breathe in and 4-5 seconds to breathe out. After that, purposely slow your breathing and try to take slow deep breaths until you feel calmer and more in control of your arousal. This will begin to short circuit the production of adrenalin and other stress hormones and allow you to relax. For added practice when you are NOT trying to control a panic attack, try to use the 5-minute mindful meditation exercises, which can also help as a preventive strategy.
TALK CALMLY AND RATIONALLY TO YOURSELF
Actively talk to yourself in order to reassure yourself that you will be okay. If you have had any prior successes with short circuiting panic, this is the time to focus on that previous success. Say positive things like:
I’ve handled these in the past and I can get through this.
I am not in danger and my goal is to just slow down the high arousal.
Let me focus on slowing my breathing. This is something I can control.
This might take a little time, and even though I hate this, I can manage it.
Avoid any catastrophizing, which exaggerates your panic and will only generate more adrenaline and stress. If you say things like “I’m going to die,” or “this scary feeling will never end,“ you will actually fuel more anxiety. If you happen to have a prescription for a mild anti-anxiety medication, remind yourself that you have this backup “insurance” available. However, whenever possible, try to stop the panic if you can without the medication. This will build your confidence should you ever be in a situation without medications.
MAINTAIN YOUR SENSE OF CONTROL
Psychologically a panic attack is challenging because it makes us feel out of control. The more out of control you feel, the worse the panic will be. In order to combat this, you want to have some ways to remind yourself that you do have some control of physical and emotional arousal. Your first defense will be remembering to change your breathing. If you can change this, you have direct evidence that you have some control of the situation. Your next step is to think about what steps you can take to gain even more control. Think of options you can use to take more control when panic is building. For example, some people find that being active like going for a walk in or around your home, office, or school can actually help you feel better. Simply getting up and going to get a drink of water might be helpful. If you are driving, and if it is safe to pull off the road, do that and focus on your breathing or listen to some music in the car until you feel back in control. The main point here is to generate some proactive problem solving steps and think of behavioral ways that you believe will help restore a sense of control. Then, when you begin to have any signs of panic building, use those steps to give yourself more control of the situation. This will be a much better approach than waiting until you are in a panic attack to do your problem solving at that time.
When you feel panic building or find yourself in the midst of a panic attack, try to do the following:
1. Keep your physical and emotional reactions in perspective. Remind yourself mentally that you know what to do to manage your panic attacks. Expect that this will be a time limited situation lasting on the average of less than an hour.
2. Take a few slow deep breaths. Remember, a good pace is 4-5 seconds to breathe in and 4-5 seconds to breathe out.
3. Adjust your regular breathing pattern into a pace where you take slow deep breaths rather than rapid shallow breaths.
4. Use positive and rational self-talk about what you are doing to manage the situation. Remind yourself of any prior successes in handling panic and look at this as a practice exercise to get more skilled at short circuiting panic. You will get better with practice.
5. Avoid feeling out of control. Maintain your awareness of all of the things you can do to keep the panic under control. Remember to use your problem solving alternatives like taking a walk, getting a drink of water, talking to a friend, or even taking your medication if needed.
If you continue to have difficulty with panic attacks after trying these strategies and you have not already done so, contact your doctor or a therapist through your health plan or EAP. Most psychologists are familiar with treating panic with various strategies, but they cannot prescribe medications. You can also read the book iCope: Building Resilience Through Stress Management, which can help you learn to manage stress more effectively and indirectly prevent panic.
Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.