How to help a friend with anxiety attack


How to Help Someone Having a Panic Attack

A panic attack is a brief but intense rush of fear.

These attacks involve symptoms similar to those experienced when facing a threat, including:

  • intense fear
  • a sense of doom
  • sweating or chills
  • shaking
  • pounding heart
  • difficulty breathing
  • head and chest pain

Panic attacks differ from a typical fear response because there’s no actual threat involved.

“The body is saying there’s danger, when in reality there’s none present,” explains Sadie Bingham, a clinical social worker who specializes in anxiety and provides therapy in Gig Harbor, Washington.

Panic attack triggers aren’t always easy to identify, so people who have one attack often worry about having more, especially in public.

Panic attacks usually feel very uncomfortable and cause significant distress. Many people believe they’re experiencing a heart attack or other life-threatening issue.

If you know someone who experiences panic attacks, there are several things you can do (and avoid doing) to help them in the moment.

Keeping your cool is one of the best ways you can help.

Panic attacks usually don’t last long. “The most intense feelings tend to last between 5 and 10 minutes,” Bingham explains.

But someone having an attack may not have much concept of time as it happens. They might feel terrified or think they’re about to die.

Even if you feel a little afraid yourself, stay calm. If your voice seems to help (and they haven’t asked you to keep quiet), talk to them in a calm voice.

What to say

Try:

  • reassuring them you won’t leave
  • reminding them the attack won’t last long
  • telling them they’re safe

Most people who experience panic attacks or live with other types of anxiety have their own go-to coping methods. When offering support, keep in mind your loved one knows best when it comes to what will help most.

During an attack, however, they might find it harder to communicate this. Consider asking in advance how you can offer assistance if they experience an attack around you.

During an attack, it’s okay to calmly ask what you can do to support them. Just prepare for the possibility of a short or curt response.

The fight-or-flight stress response can affect the ability to think and behave logically, according to Bingham. “Try to remain neutral, and don’t take their response personally,” she recommends.

What if they want me to leave?

As long as they’re not in immediate danger, take a few steps back and give them some space. Stay nearby so you can still keep an eye on things, and let them know that should they change their mind, you’ll come right back.

If you haven’t already, take some time to familiarize yourself with the early signs of a potential panic attack.

Panic attacks commonly begin with:

  • a feeling of terror or dread
  • hyperventilation or shortness of breath
  • feelings of choking
  • a pounding heart
  • dizziness and shaking

Not everyone experiences panic attacks in the same way, so it’s best to ask what signs they tend to experience.

The sooner you realize what’s happening, the faster you can help them get to a more private place, or wherever they need to feel more comfortable.

A soothing, familiar voice helps some people, but try to avoid repeatedly saying things like “don’t worry” or asking them if they’re alright over and over.

Of course you mean well, but your words may not have much benefit in the moment. They can also make the situation more stressful, since your loved one may believe they’re doing something wrong by not being alright.

How to make your words more actionable

Take action with your words by:

  • asking if they want to leave the room and go somewhere else
  • reminding them to keep breathing
  • engaging them in light conversation, unless they say they don’t want to talk

Panic attacks can be confusing as well as scary. People generally can’t predict them and there’s often no clear cause. They can happen in stressful situations but also during calm moments or even during sleep.

It might seem helpful to tell your friend there’s nothing to be afraid of. But they’re probably perfectly aware there’s no actual threat.

That’s part of what makes panic attacks so confusing. The reaction matches a fear response — but nothing’s happening to cause that fear. In response, someone who gets panic attacks might begin to fear the symptoms themselves, or link them to a serious health issue.

“It’s typical to feel embarrassed or ashamed of such an intense reaction,” Bingham explains. “But having a trusted companion offer compassion can allow space for the person to return to baseline.”

You can be that person even without understanding why they get panic attacks. That’s far less important than your ability to offer empathy and recognize their distress as real and significant.

People often have a hard time sharing their experiences with mental health issues, including panic attacks.

Some avoid talking about mental health issues because they believe others won’t understand what they’re going through. Others worry about being judged or told what they experience isn’t a big deal.

Outsiders often don’t understand the fear caused by panic attacks and may even consider it illogical.

But the response is real, and the person experiencing the attack can’t control it.

An empathic response can be as simple as, “That sounds really tough. I’m sorry you experience that. Let me know what I can do to support you.”

Grounding techniques can have benefit for a range of anxiety issues, including panic attacks.

“Grounding techniques can help contain panic attacks after they begin,” explains Megan MacCutcheon, a therapist in Vienna, Virginia.

These techniques help the person focus on what’s actually happening, not their fear of the attack. They’re often most helpful once the intensity of the attack has faded a bit.

Quick grounding tips

To help someone ground themselves, you can try:

  • physical touch, like holding their hand (if they’re okay with it)
  • giving them a textured object to feel
  • encouraging them to stretch or move
  • encouraging them to repeat a soothing or helpful phrase, like “this feels awful, but it’s not going to hurt me”
  • talking slowly and calmly about familiar places or activities

Say you just sat with your friend while they had a panic attack. When it’s over, they seem calmer but tired. You had plans to see a show, one you’d both been looking forward to, but your friend asks you to take them home instead.

Naturally, you’re probably disappointed. But remember: Your friend can’t help what happened. They’re probably disappointed and exhausted. They may also feel bad about ruining your plans, which can compound the distress associated with the attack itself.

It’s common to feel completely wiped out as your body and its processes return to normal after an extreme fear response. Someone who’s just had a panic attack might not feel up to anything beyond quiet relaxation.

“Inquiring what they need and honoring that request is crucial,” Bingham says. “Asking too much after a panic experience can aggravate the healing process.”

You might think going to see the show will cheer them up or improve their mood, but forcing them to keep engaging when they would prefer space can keep that stress response lingering, Bingham explains.

If someone chooses to tell you about their panic attacks, take this as a sign of trust.

To show respect for their experience and honor this trust:

  • respond with compassion
  • be mindful of your words and actions, during an attack and at any other time

You might have all the best intentions, but it’s entirely possible to make someone feel bad without realizing you’re doing so.

Keeping these suggestions in mind can help you avoid unintentional harm:

Don’t compare normal stress and fear to panic

Maybe you’ve felt stressed or terrified in a dangerous situation. You might even have anxiety yourself.

These experiences aren’t quite the same as a panic attack, though. Avoid trying to draw comparisons between your different experiences. Unless you also get panic attacks, you probably don’t entirely understand how they feel.

If you have experienced extreme fear, let that memory inform you on what your friend is going through. Remind yourself they aren’t just afraid or stressed.

They may also feel:

  • helpless
  • unable to manage what’s happening
  • physical pain or discomfort

Don’t shame or minimize

It’s pretty common to worry about having a panic attack, especially in front of strangers, or believe the attack might annoy or inconvenience friends or loved ones.

“People struggling with anxiety or panic attacks might intellectually understand the response is illogical. But hearing that from someone else can increase their isolation,” Bingham explains.

Avoid saying things like:

  • “Just relax. There’s nothing to be afraid of.”
  • “You’re upset over that?”
  • “What’s wrong with you?”

You might not intend to make your friend feel ashamed, but denying the reality of their distress can certainly have that effect.

Don’t give advice

Not every coping technique works for everyone. Deep breathing and other relaxation techniques can have benefit, but they often help most when practiced regularly, MacCutcheon says.

“When these techniques are only utilized during moments of panic, they often wind up backfiring. Deep breathing turns into hyperventilating and the mind becomes too overwhelmed to focus on unfamiliar things.”

While it can help to remind your friend to breath, telling them to take deep breaths may not help.

In short, avoid telling someone how to manage symptoms. Sure, you may have heard yoga, meditation, or giving up caffeine can help. But you don’t know what your friend has already tried unless they’ve told you.

Wait until you’re asked for suggestions. If you have personal experience, you might say, “I get panic attacks too and I’ve found yoga really helpful. If you’re interested in trying it out, we could go together sometime.”

It can be frightening to watch someone have a panic attack, but at what point should you bring in additional help? It’s hard to say.

Calling your local emergency number might seem like the safest move, but this can often make the situation even more stressful for the person having a panic attack.

Simply sticking around and seeing them through the experience might not feel like much to you, but it can make a significant difference for the person having the attack.

That said, reach out for emergency help if:

  • chest pain feels like squeezing (not stabbing) and moves to their arms or shoulders
  • symptoms persist for longer than 20 minutes and get worse, not better
  • shortness of breath doesn’t improve
  • pressure in the chest lasts more than a minute or two

Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.

How to Help Someone Having a Panic Attack

A panic attack is a brief but intense rush of fear.

These attacks involve symptoms similar to those experienced when facing a threat, including:

  • intense fear
  • a sense of doom
  • sweating or chills
  • shaking
  • pounding heart
  • difficulty breathing
  • head and chest pain

Panic attacks differ from a typical fear response because there’s no actual threat involved.

“The body is saying there’s danger, when in reality there’s none present,” explains Sadie Bingham, a clinical social worker who specializes in anxiety and provides therapy in Gig Harbor, Washington.

Panic attack triggers aren’t always easy to identify, so people who have one attack often worry about having more, especially in public.

Panic attacks usually feel very uncomfortable and cause significant distress. Many people believe they’re experiencing a heart attack or other life-threatening issue.

If you know someone who experiences panic attacks, there are several things you can do (and avoid doing) to help them in the moment.

Keeping your cool is one of the best ways you can help.

Panic attacks usually don’t last long. “The most intense feelings tend to last between 5 and 10 minutes,” Bingham explains.

But someone having an attack may not have much concept of time as it happens. They might feel terrified or think they’re about to die.

Even if you feel a little afraid yourself, stay calm. If your voice seems to help (and they haven’t asked you to keep quiet), talk to them in a calm voice.

What to say

Try:

  • reassuring them you won’t leave
  • reminding them the attack won’t last long
  • telling them they’re safe

Most people who experience panic attacks or live with other types of anxiety have their own go-to coping methods. When offering support, keep in mind your loved one knows best when it comes to what will help most.

During an attack, however, they might find it harder to communicate this. Consider asking in advance how you can offer assistance if they experience an attack around you.

During an attack, it’s okay to calmly ask what you can do to support them. Just prepare for the possibility of a short or curt response.

The fight-or-flight stress response can affect the ability to think and behave logically, according to Bingham. “Try to remain neutral, and don’t take their response personally,” she recommends.

What if they want me to leave?

As long as they’re not in immediate danger, take a few steps back and give them some space. Stay nearby so you can still keep an eye on things, and let them know that should they change their mind, you’ll come right back.

If you haven’t already, take some time to familiarize yourself with the early signs of a potential panic attack.

Panic attacks commonly begin with:

  • a feeling of terror or dread
  • hyperventilation or shortness of breath
  • feelings of choking
  • a pounding heart
  • dizziness and shaking

Not everyone experiences panic attacks in the same way, so it’s best to ask what signs they tend to experience.

The sooner you realize what’s happening, the faster you can help them get to a more private place, or wherever they need to feel more comfortable.

A soothing, familiar voice helps some people, but try to avoid repeatedly saying things like “don’t worry” or asking them if they’re alright over and over.

Of course you mean well, but your words may not have much benefit in the moment. They can also make the situation more stressful, since your loved one may believe they’re doing something wrong by not being alright.

How to make your words more actionable

Take action with your words by:

  • asking if they want to leave the room and go somewhere else
  • reminding them to keep breathing
  • engaging them in light conversation, unless they say they don’t want to talk

Panic attacks can be confusing as well as scary. People generally can’t predict them and there’s often no clear cause. They can happen in stressful situations but also during calm moments or even during sleep.

It might seem helpful to tell your friend there’s nothing to be afraid of. But they’re probably perfectly aware there’s no actual threat.

That’s part of what makes panic attacks so confusing. The reaction matches a fear response — but nothing’s happening to cause that fear. In response, someone who gets panic attacks might begin to fear the symptoms themselves, or link them to a serious health issue.

“It’s typical to feel embarrassed or ashamed of such an intense reaction,” Bingham explains. “But having a trusted companion offer compassion can allow space for the person to return to baseline.”

You can be that person even without understanding why they get panic attacks. That’s far less important than your ability to offer empathy and recognize their distress as real and significant.

People often have a hard time sharing their experiences with mental health issues, including panic attacks.

Some avoid talking about mental health issues because they believe others won’t understand what they’re going through. Others worry about being judged or told what they experience isn’t a big deal.

Outsiders often don’t understand the fear caused by panic attacks and may even consider it illogical.

But the response is real, and the person experiencing the attack can’t control it.

An empathic response can be as simple as, “That sounds really tough. I’m sorry you experience that. Let me know what I can do to support you.”

Grounding techniques can have benefit for a range of anxiety issues, including panic attacks.

“Grounding techniques can help contain panic attacks after they begin,” explains Megan MacCutcheon, a therapist in Vienna, Virginia.

These techniques help the person focus on what’s actually happening, not their fear of the attack. They’re often most helpful once the intensity of the attack has faded a bit.

Quick grounding tips

To help someone ground themselves, you can try:

  • physical touch, like holding their hand (if they’re okay with it)
  • giving them a textured object to feel
  • encouraging them to stretch or move
  • encouraging them to repeat a soothing or helpful phrase, like “this feels awful, but it’s not going to hurt me”
  • talking slowly and calmly about familiar places or activities

Say you just sat with your friend while they had a panic attack. When it’s over, they seem calmer but tired. You had plans to see a show, one you’d both been looking forward to, but your friend asks you to take them home instead.

Naturally, you’re probably disappointed. But remember: Your friend can’t help what happened. They’re probably disappointed and exhausted. They may also feel bad about ruining your plans, which can compound the distress associated with the attack itself.

It’s common to feel completely wiped out as your body and its processes return to normal after an extreme fear response. Someone who’s just had a panic attack might not feel up to anything beyond quiet relaxation.

“Inquiring what they need and honoring that request is crucial,” Bingham says. “Asking too much after a panic experience can aggravate the healing process.”

You might think going to see the show will cheer them up or improve their mood, but forcing them to keep engaging when they would prefer space can keep that stress response lingering, Bingham explains.

If someone chooses to tell you about their panic attacks, take this as a sign of trust.

To show respect for their experience and honor this trust:

  • respond with compassion
  • be mindful of your words and actions, during an attack and at any other time

You might have all the best intentions, but it’s entirely possible to make someone feel bad without realizing you’re doing so.

Keeping these suggestions in mind can help you avoid unintentional harm:

Don’t compare normal stress and fear to panic

Maybe you’ve felt stressed or terrified in a dangerous situation. You might even have anxiety yourself.

These experiences aren’t quite the same as a panic attack, though. Avoid trying to draw comparisons between your different experiences. Unless you also get panic attacks, you probably don’t entirely understand how they feel.

If you have experienced extreme fear, let that memory inform you on what your friend is going through. Remind yourself they aren’t just afraid or stressed.

They may also feel:

  • helpless
  • unable to manage what’s happening
  • physical pain or discomfort

Don’t shame or minimize

It’s pretty common to worry about having a panic attack, especially in front of strangers, or believe the attack might annoy or inconvenience friends or loved ones.

“People struggling with anxiety or panic attacks might intellectually understand the response is illogical. But hearing that from someone else can increase their isolation,” Bingham explains.

Avoid saying things like:

  • “Just relax. There’s nothing to be afraid of.”
  • “You’re upset over that?”
  • “What’s wrong with you?”

You might not intend to make your friend feel ashamed, but denying the reality of their distress can certainly have that effect.

Don’t give advice

Not every coping technique works for everyone. Deep breathing and other relaxation techniques can have benefit, but they often help most when practiced regularly, MacCutcheon says.

“When these techniques are only utilized during moments of panic, they often wind up backfiring. Deep breathing turns into hyperventilating and the mind becomes too overwhelmed to focus on unfamiliar things.”

While it can help to remind your friend to breath, telling them to take deep breaths may not help.

In short, avoid telling someone how to manage symptoms. Sure, you may have heard yoga, meditation, or giving up caffeine can help. But you don’t know what your friend has already tried unless they’ve told you.

Wait until you’re asked for suggestions. If you have personal experience, you might say, “I get panic attacks too and I’ve found yoga really helpful. If you’re interested in trying it out, we could go together sometime.”

It can be frightening to watch someone have a panic attack, but at what point should you bring in additional help? It’s hard to say.

Calling your local emergency number might seem like the safest move, but this can often make the situation even more stressful for the person having a panic attack.

Simply sticking around and seeing them through the experience might not feel like much to you, but it can make a significant difference for the person having the attack.

That said, reach out for emergency help if:

  • chest pain feels like squeezing (not stabbing) and moves to their arms or shoulders
  • symptoms persist for longer than 20 minutes and get worse, not better
  • shortness of breath doesn’t improve
  • pressure in the chest lasts more than a minute or two

Crystal Raypole has previously worked as a writer and editor for GoodTherapy. Her fields of interest include Asian languages and literature, Japanese translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues.

Panic attacks: what to do?

Panic attack (PA) is an episode of intense fear or discomfort that occurs suddenly, for no apparent reason, which is characterized by the following symptoms, (minimum 4):

  • increased heart rate,
  • increase in blood pressure,
  • sweating,
  • dry mouth,
  • chills,
  • sensation of suffocation,
  • labored breathing,
  • chest discomfort,
  • lump in throat,
  • nausea,
  • burning in the stomach,
  • feeling dizzy,
  • numbness or tingling sensation,
  • derealization or depersonalization,
  • fear of death,
  • fear of losing control of oneself.

Symptoms should not be due to other diseases.

The first PA are more common at a young age, but are found after 60 years. PA can occur during any activity and even at rest. Often they occur for no apparent reason, but they can occur against the background of stressful and traumatic events, emotional stress, life difficulties, situations of isolation from the family, experiences associated with loneliness. The impact of the above situations may cease, but PA will continue to occur.

PA is based on a complex of biopsychosocial factors, the combination of which leads to the appearance of the first PA.

After some time and after several episodes of panic attacks, a person may develop anxiety about the next attack and the formation of avoidance behavior in relation to public places, being in a crowd, large open spaces, traveling alone. This is due to the fact that often the thought “they won’t be able to help me with an attack and I can die / lose control” often arises.

People who have had PA often describe it as: “the ground is slipping from under their feet”, “the heart is about to jump out of the chest”, “there is not enough air”, etc.

It should be noted that not a single panic attack led to the death of a person. However, knowing this does not always help to cope with PA.

If you are experiencing similar conditions, you should definitely see a doctor for an examination. Once other medical conditions have been ruled out and panic disorder has been established, psychotherapy and/or medication support may be recommended.

There are self-help methods for panic attacks. They are most effective at the very beginning of an episode of PA.

Physiological:

  1. An increase in the concentration of carbon dioxide and a decrease in the level of oxygen in the blood, reflexively inhibits the mechanisms of PA.

For this you can use the breath in a paper bag. The bag must be positioned so that it covers the area of ​​​​the mouth and nose. Breathe in slowly and continuously through your nose and out through your mouth. If you don't have a paper bag nearby, try using your palms folded in a boat.

  1. Reducing the frequency and strength of heart contractions through stimulation of the parasympathetic system by abdominal breathing.

Diaphragmatic (abdominal) breathing is performed in a comfortable standing/sitting/lying position and is a slow continuous breath through the nose for 3 counts. Imagine that you are inflating a balloon with your stomach. Then perform the same slow and continuous exhalation through the mouth for 5-6 counts.

Psychological:

  1. Return to reality:
  • Grounding. If you are standing, then feel how your feet are in contact with the surface, if it is difficult to feel this, tap your feet on the surface. If you are sitting, sway from side to side and feel the support in the area of ​​the buttocks. Shift the focus of attention to the body and your points of support.
  • It may be helpful to wear an elastic band around your wrist. When an episode of PA occurs, pull and release the elastic band, focus on the sensations at the point of contact between the surface of the hand and the elastic band. Repeat several times.
  • Use a positive voice setting, for example, “Everything is fine, there is no catastrophe”, “I'm fine, it's just a fantasy”, “I'm calm, I'm not afraid”.
  • Switch the focus of attention to the external environment, describe what is happening in reality next to you. For example, “a red car drove past”, “a girl in a green scarf passed by”, “there are three people at the bus stop”, “at 6:45”, “the green traffic light is on”, “an old shop”, “you hear music from a cafe ” and so on, at least 10 facts.
  1. Use positive visualization. Remember in the form of a photo card a pleasant event or a place where you are usually safe. Close your eyes and immerse yourself in the exploration of the photo in memory. Feel the body relax and the physical symptoms go away.
  1. Explore your fear through metaphor. Answer yourself the questions: “what form is my fear?”, “what color?”, “what does it look like?”, “what can it be called?” "What does he want from me?" - this will allow you not to move away from yourself, plunging into a panic state, but, on the contrary, will approach your experiences through a metaphor.

Remember the formula "STOP Crane" for an emergency stop of the onset of a panic attack:

С - "Stop!"

It is necessary to say this to yourself clearly and clearly, without thinking "what does this mean?" and "why?" describing what is happening around you.0005

P - Positive setting.

Focus returns to thoughts, repeat settings like "Everything is fine, there is no catastrophe", "I'm fine, this will pass", "I'm calm, I'm coping" and any other close to you.

Crane - Early action!

Switch your attention to the action that you performed before the attack or any routine, everyday activity that you would do outside of the attack.

Treating panic disorder is a lengthy process. Self-help methods reduce the fear of PA, soften its manifestation, and shorten the duration of the episode. Psychotherapy still has the main effect, do not neglect the help of specialists.

Prepared by: Sinkevichiute E.R., psychotherapist,

medical and psychological department.

symptoms, signs, causes and how to get rid of them

Ksenia Krivova

psychiatrist, psychotherapist

Ksenia Terletskaya

editor

I am a psychotherapist and. One of the questions I work with is how to deal with panic attacks.

I want to help those who have experienced this condition. I will tell you how to relieve symptoms and make sure that panic attacks do not return as long as possible. At the same time, I will give recommendations on how to behave if a loved one has an attack.

An important point

The examples described in the article are fictitious. The real stories of my former patients are published with their consent. Do not self-medicate: only the attending physician can make an accurate diagnosis and select help. Take care of yourself and take care of your mental health.

What are panic attacks

From 4 to 25% of the world's population suffer from anxiety disorders. This data is for the beginning of 2020. Over the past year, people began to contact me more often with complaints of uncontrollable fear and panic. In many cases, this is due to the situation around the coronavirus. Many sick people with COVID-19There are complications in the form of panic attacks.

Systematic review of surveys of the prevalence of anxiety disorders in the adult population - article by Olivia Remens

Covid and panic attacks: panic attacks as a complication of covid - article by the Korsakov Medical Center

Official statistics on how the number of people with panic thoughts increased after the announcement coronavirus pandemic, no. But my colleagues and I already see this relationship in our practice.

Before we know how to deal with a panic attack, we need to figure out what we are going to deal with. A panic attack is a state of intense fear accompanied by unpleasant physiological symptoms such as nausea and dizziness.

This is a psychological disorder, it does not directly relate to diseases of the body. But when emotions overwhelm us, we cannot resolve a life conflict, then a failure occurs - and emotions begin to manifest through our body, the autonomic nervous system.

For example, a person has problems at work: bosses press, there is no time to rest, sleep is disturbed. There is no one to cry, everything grows like a snowball. As a result, an attack of a strong heartbeat and shortness of breath occurs.

Another was greatly frightened by doctors in childhood. Now, with a certain medical manipulation, panic arises: it darkens sharply in the eyes and nausea rolls over.

Someone recently lost a loved one and is also experiencing panic attacks. They are manifested by the fear of death, a semi-conscious state, and agoraphobia has also developed - the fear of open spaces.

I want to say right away: panic attacks are not life threatening, you will not die or go crazy. It is simply a very strong reaction to stress, strong emotions and anxiety associated with internal or external events.

One of the main signs that a panic attack has happened to you is that it seems that something bad is about to happen to you. You will feel sick, you will faint, your heart will stop and so on. This feeling usually occurs during a panic attack. A person tries to interpret it logically and connects it with some physical problems, considers it a sign of illness.

/psy-stories/

“I realized that there are no unsolvable problems”: 7 stories about how psychotherapy changed lives

I don’t know of such cases when during a panic attack a person actually vomited or fainted . These are always very unpleasant sensations - dizziness, nausea or obvious nausea, palpitations - but what you are afraid of does not happen.

This is a reaction of the body, in which there is no damage to the internal organs. If a person really vomited, then this indicates that there is some kind of illness, you need to check the stomach. The psychotherapist makes the final diagnosis, for this he collects an anamnesis: he talks with the patient, finds out how the attack goes.

Why panic attacks occur

Panic disorder, or episodic paroxysmal anxiety, is classified as a disease in the International Classification of Diseases - F41.0 ICD-10 and 6B01 ICD-11. In the new edition of the ICD, which is recommended for use in Russia from January 1, 2022, a separate symptomatic code is allocated for a panic attack - MB23.H.

International Classification of Diseases 11th revision

For a person who has a panic attack, his intrapersonal conflict is very important, otherwise the attack would not have happened. This means that some situation is internally difficult for him. He cannot resolve it on his own, so the psyche tries to isolate him from this situation with the help of a symptom.

This condition can manifest itself in neurosis and in somatic diseases. Competent treatment can be selected only by establishing the cause.

Neurosis is psychological difficulties, something that relates to psychiatry and personality problems, the internal organization of a person. Under neurosis there is never a physiological background, as is the case with ordinary somatic diseases.

A somatic disease always refers to some kind of damage to an organ or organ system. It is as if a serious breakdown of the mechanism has occurred in the engine of a car, which can be diagnosed and corrected. For example, a piston has gone. So it is with a person: it is a breakdown at the level of physiology, tissues. This is a problem that can be identified on an MRI, confirmed by tests, and operated on. For example, a brain tumor, coronary heart disease, or hyperthyroidism.

When there are health problems, it is enough to cure them, and the symptom - a panic attack - will pass. If the cause of panic is neurosis, this condition also needs to be treated. There are several reasons for this.

Neurosis tends to expand symptoms. If you do not take care of your condition in time, other symptoms may join the neurosis. For example, obsessive thoughts, discomfort in the body and depression.

/trevoga/

How I Treated Generalized Anxiety Disorder under CHI

Panic attacks reduce the quality of life and prevent you from developing. Neurosis is built on internal contradictions and on an inadequate request to the world or to oneself. You need to figure this out, otherwise the symptom will not recede. Pills, a trip to the sea or walks in the forest will only help for a while, but then the condition will worsen.

Panic attacks strain the endocrine and autonomic nervous systems. Recurring panic attacks for a long time do not cause disturbances in the work of internal organs. But they deplete the body. Sooner or later, this can lead to illness.

Reactivation of dormant tumor cells with modified lipids derived from stress-activated neutrophils - Science article

How panic attacks can manifest

Panic attacks manifest themselves in different ways. Shortness of breath, palpitations, faintness and nausea are just some of the symptoms.

Panic disorder - NHS article

Anxiety, fear and panic - NHS article

The manifestations of a panic attack may occur individually or together. Seizures last from a few minutes to half an hour. The main thing is to remember that no matter how strong they are, you will not faint, you will not go crazy and you will not die.

Track the situations in which you have a panic attack, how it manifests itself. Usually, the symptoms go away with panic attacks. It is better to deal with these manifestations than to get used to living with them.

Manifestations of panic attacks: what to be prepared for

Symptom How it manifests itself
Feeling of suffocation It seems to a person that there is not enough air and he can suffocate
Feeling of unreality of what is happening It seems to a person that he looks at the world as if through a haze
High blood pressure Panic builds up - pressure rises, panic passes - pressure returns to normal
Gaze defocus Difficult to keep eyes on one object
Fear of death and fear of going crazy It seems to a person that he is losing control over himself and his body, can harm himself or loved ones
Permanent alarm Any, even the most insignificant event, can lead to disturbing thoughts
Sleep disorder A person falls asleep badly, sleeps little, wakes up abruptly. I don't feel like I've had enough sleep
Fear of swallowing food There is a feeling that during swallowing air disappears and you can suffocate
Agoraphobia A person is afraid to leave the house, he is afraid to go to the store, to meet friends
Trembling Shakes with small or large shaking
Chest pain Pain in the chest, and it seems to the person that a heart attack has begun
Chill or fever Some people get chills or have a fever
Numbness or tingling Numb limbs

Symptom

How

A feeling of suffocation

It seems that there is not enough air and it may suffocate

The unreality of

,

people who watches that he watches to the world as if through a haze

Increased blood pressure

Panic builds up - pressure rises, panic subsides - pressure returns to normal over oneself and one's body, can harm oneself or loved ones

Constant anxiety

Any, even the most insignificant event, can lead to anxious thoughts

Sleep disturbance

A person falls asleep badly, sleeps little, wakes up abruptly. No feeling that you had enough sleep

Fear of swallowing food

There is a feeling that during swallowing air disappears and you can suffocate

Agoraphobia

A person is afraid to leave the house, he is afraid to go to the store, to meet friends

Trembling

large trembling

Chest pain

Pain in the chest, and the person thinks that a heart attack has begun

Chills or fever

Some people feel chills or have a fever

Numbness or tingling

Numbness in limbs

What to do in case of a panic attack

Short-Term Plan: Manage Symptoms

There are many ways to deal with panic attacks on your own. But I must warn you: in this way you will only remove the symptom, and the neurosis or disease that provoked the attack will not go anywhere. You will not feel relief, there will be internal tension and pain.

Here are some techniques to help you deal with panic.

Call an ambulance. If you have not yet been diagnosed with panic attacks, it makes sense to call an ambulance for a severe attack. So you exclude a somatic disease. For example, a heart attack, an allergy attack or bronchial asthma have similar symptoms. Better to be safe.

I had cases when the ambulance team after the ECG said that everything was fine with health and assumed that it was panic attacks. After the visit of doctors, the person turned to a psychotherapist.

Don't fight the attack, embrace it. Instead of resisting, accept what is happening, then the attack will end faster. This will not work right away: repeat to yourself that everything will be fine and your body is just trying to protect you from imaginary danger.

Breathe. Inhale for four seconds, then hold your breath for seven seconds, exhale for eight seconds. Repeat one or two times. A simple breathing practice will help the autonomic nervous system switch from a sympathetic, sensitive state to a parasympathetic, calm state.

Correlation and differences between brain and body vibrations - article in Neuroscience Letters

The sympathetic nervous system is responsible for tone, for escaping from danger. In ancient times, it turned on when a predator approached a person. It is the activating part of the nervous system.

The parasympathetic nervous system is responsible for calming and relaxing. It slows down the pulse, normalizes breathing and makes it more even. The parasympathetic nervous system turns on the cerebral cortex, which helps us realize that we are in a safe place and nothing terrible is happening.

Method 5-4-3-2-1. This is one of the "grounding techniques" variations. It works like this: look around and mark five items. Select four sounds. Touch three things. Catch two smells and then one taste.

For example, you are standing on the street. Select five items: house, stairs, railing, curb, hatch. Note four sounds: a car drove by, a door slammed, a dove flew up, someone coughed. Touch three things: a button on a coat, a wall of a house, a lamppost. Catch two smells: the cafe smells of fresh croissants and coffee. Feel the taste: put chewing gum in your mouth.

The method works by bringing the person back to reality. During PA, consciousness is narrow, tunnel-like. A person focuses on feelings, listens to the body and anxiety, and this accelerates him even more. When he starts to switch to reality - pays attention to smells or touches something - he returns to the here and now. The tone of the sympathetic nervous system begins to decrease, the parasympathetic nervous system turns on, the person calms down.

In a panic attack, we are fixated on frightening thoughts in our heads. The 5-4-3-2-1 method helps to switch from disturbing thoughts and start thinking about something else: about smell, objects, and so on.

Consciously intensify the panic attack. Don't tell yourself to "relax" or "calm down", on the contrary, create panic. The opposite method works well, but it should not be used by a person who has experienced a panic attack for the first time. It is suitable for experienced people who know that PAs are not dangerous, they don’t die and go crazy with them, that this is just a reaction of the nervous system to an internal conflict.

The method of consciously intensifying a panic attack will help to cope with an attack more quickly. When we stop resisting, the attack passes faster. Resistance can increase anxiety.

There is also a popular “breathe into the bag” technique. Do not abuse it, and if you resort to it, control your condition. If you feel that it is becoming stuffy or your head hurts, then the carbon dioxide rate has been exceeded, take a break.

/list/meditation-apps/

Deep Inhale and Long Exhale: 5 Meditation Apps

The best defense is offense. Do not run away from a panic attack, live it, so it will recede sooner. And then still contact a psychotherapist to deal with the cause.

What to do in case of a panic attack

Long Term Plan: Check Your Health and See a Psychotherapist

This plan is best for preventing attacks from returning for as long as possible. To begin with, it is worth checking if you have any pathologies that can cause panic attacks.

The illnesses that sometimes underlie panic attacks can have serious health consequences. That is why, in order to exclude diseases of the body, I always first refer my patients to a therapist. With panic attacks, you can first go to the clinic, then the therapist will issue directions for the necessary tests.

I do not want to scare anyone, but this advice can help a person realize that it is worth going and being examined, and then the process of moving towards treatment will begin. During the examination, the doctor may say that there is nothing at the level of physiology, the help of a psychotherapist is needed.

One patient came to me with high levels of anxiety, restlessness, panic attacks and sleep disturbance. I sent him to a general practitioner, the doctor suspected thyroid disease based on symptoms and referred the patient to an endocrinologist. The analysis revealed hyperthyroidism.

This diagnosis explained that there was nothing wrong with the person and why there were problems. The hormones were balanced, the patient's condition improved, my help was not needed.

/somatic-symptom-disorder/

What is hypochondria and how much does it cost to cure

Panic attacks are treated by a psychotherapist. He does this using special psychotherapeutic techniques. Cognitive-behavioral therapy has proven to be effective. It helps a person to understand that if you want to change your state, then you need to change the reasons that led to it. I myself practice this method. We analyze situations that are alarming for the patient, and the person learns to choose not the worst scenario, but the logical and optimal behavior.

5 books on cognitive psychology - an article by Maria Falikman

Find a doctor with whom you feel comfortable talking and connecting. Describe what is bothering you. So he will be able to understand how urgently you need to make an appointment. This is how my patient's initial appeal looked like:

The patient described how and at what moments she manifests panic, whether she went to other doctors

How is the treatment with a psychotherapist for panic attacks

The number of sessions with a psychotherapist individually. But get ready for the fact that this is not fast, usually working with a doctor lasts several months. With my patient, whose story is given in the article, we worked for six months. Meetings stop as soon as the doctor understands that the patient has come to a calm state, found the cause of anxiety and learned to cope with it.

The class usually lasts an hour. For people who still find it difficult to leave the house, it is convenient to call on Skype. No need to go to an unfamiliar place and get used to a new environment. It is easier to talk about your problem in a familiar and safe atmosphere.

11 types of psychotherapy that work

In the sessions, we analyze the internal problems that led to panic attacks. In addition, I give my patients various techniques to help smooth out anxiety and consolidate a calm state.

Do the Jacobson exercises. They are perfect for unloading during the working day. I advise you to perform them in a secluded place.

The Jacobson method directly for a panic attack is not as effective. But it helps to reduce overall levels of anxiety and tension and reduces the risk of future attacks.

The Jacobson method works by consciously tensing the muscles in certain places. Due to the strong contraction, the muscles begin to relax. Tension knots are also relaxed, so anxiety is reduced

Under the supervision of a psychotherapist, catch thoughts about what causes anxiety. So you will know what makes you uncomfortable. Over time, learn to limit communication with people you don’t like, to avoid stressful situations.

Examples of anxious thoughts are: "I'm a failure", "I'm not going to succeed", "I'm ugly". Sometimes the people with whom we are in contact contribute to the emergence and intensification of disturbing thoughts. They can impose problems, convince a person that he is helpless.

Anxious thoughts, a person can speak so automatically that he does not notice them. A conflict situation arises, a thought flashes through the head, say, “I won’t succeed,” but the person does not catch it. That's why it's automatic. Then behavior follows: for example, a person does not start learning a new course, does not move towards his values. He stops developing, and this worries him.

/psychotherapy/

How much does psychotherapy cost

Such beliefs are most often formed in childhood. A person gets along with them so much that until he consciously reveals, sometimes he does not even know that they exist. Everything seems to be fine, but for some reason he does not do what is important to him. When automatic thought is detected, it becomes clear why. The person works out the automatic persuasion and the anxiety goes down.

Under the guidance of your therapist, try to identify automatic anxious thoughts. This will help you figure out how you really feel about yourself.

Exercise for nervousness. A simple meditation that does not require the study of spiritual practices will help.

Let's talk about panic attacks. Workbook with exercises and tests - David Carbonell

You can do breathing exercises. For example, stay in a calm position for 5-10 minutes and concentrate only on your breathing, try to let go of thoughts. Imagine your thoughts as leaves floating away from you down a stream, or clouds running across the sky. Get back to breathing.

What medications are used to treat panic attacks

Your doctor may prescribe medication to treat a panic attack. It is important to understand the following here: tablets most often help temporarily, at the time of taking the drug, and after their cancellation there is a high risk of symptom resumption.

With neurosis, the nervous system is gradually depleted, the nervous system becomes very sensitive. There is an imbalance of neurotransmitters, that is, transmitters of physiologically active substances in the nerve cell. For example, dopamine or serotonin. Changes after taking the drugs occur, but they are temporary.

Borderline mental disorders - article by Doctor of Medical Sciences, professor, psychiatrist A. B. Smulevich

Pills work while a person takes them, while the internal conflict that worries remains unresolved. After discontinuation of the drug, the symptoms return, and often new, more severe ones join them. This leads to a deepening of the neurosis. That is why psychotherapy is needed for neurosis.

How to help a loved one if he has a panic attack

If you are not sure that a loved one is having a panic attack, and the attack is severe, call an ambulance. Do not leave a person alone, try to find out what is happening to him. If he can't talk, try switching his attention: show a neutral or positive video, offer to listen to a song, or tell a funny story. Do together the 5-4-3-2-1 exercise I described earlier.

In no case do not scold your loved one and do not devalue his experiences. During a panic attack, a person experiences fear of death, it seems to him that he can go crazy. Try to be understanding about this.

Bad: “You are pretending! You can't be that bad!"

Better: “I will be there for as long as it takes. Everything will be fine".

A simple technique will help to calm the person - offer to drink water. Due to the swallowing reflex, the autonomic nervous system calms down. The fact is that the vagus nerve, which is part of the parasympathetic nervous system, is involved in the act of swallowing. The sympathetic nervous system reflexively switches to the parasympathetic, the person calms down.

Human Anatomy - a textbook edited by M. G. Prives

After the attack has passed, advise you to consult a doctor.

The cost of panic attack treatment

For the treatment of panic attacks, you can go to a neuropsychiatric dispensary or polyclinic that has a specialist, or to a psychotherapist in private practice. Antidepressants are usually prescribed in clinics, their prices depend on how modern the medicine is. The course of admission is from six months, at least six packs are needed. But, as I said earlier, pills without therapy give a temporary effect, after they are canceled, the symptoms return.

Treatment by a psychotherapist takes an average of six months. In the first three months, sessions are held weekly, then once every two weeks or once a month as supportive sessions.

/psychotherapy-search/

How to choose a psychotherapist

In the table I have given the average prices in Moscow. I took as a basis the scenario for the treatment of panic attacks without complications.

I note that the videos and exercises recommended to the patient by his psychotherapist are freely available and free - a person spends only his time working on them.

The cost of treating a panic attack is from 600 R with antidepressants and from 34,800 R with a psychotherapist

What do we pay for How much is
Antidepressants 100-10 000 R per pack
Session with a psychotherapist From 2000 R per session
General practitioner consultation From 800 R with a paid specialist, free of charge at the clinic
Exercise Free

Antidepressants

100-10,000 R per pack

Session with a psychotherapist

From 2000 R per session

Consultation with a specialist therapist

free at the clinic

Exercises

Free

Looking at the table, you can conclude that it is more profitable to treat panic attacks with antidepressants than go to psychotherapy. But let me remind you that the pills give a temporary effect, after their cancellation, the symptoms return and sometimes become stronger. As a result, it is more profitable to immediately go to a psychotherapist and learn how to cope with the cause of a panic state.

Remember

  1. Panic attacks are not life-threatening, a person in this condition will not die, go crazy, lose consciousness, or vomit.
  2. If something did happen - for example, a person fainted - it is worth contacting a doctor as soon as possible for an accurate diagnosis.
  3. In any case, it will not be superfluous to consult a doctor and undergo an examination to rule out a serious somatic disease that provokes panic attacks.
  4. You can stop a panic attack on your own, but this is only half the battle. A psychotherapist will help to deal with its cause.
  5. Before starting psychotherapy, it is important to undergo a medical examination in order to exclude neurotic, neurological and somatic diseases that can lead to panic attacks.

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