How to overcome panic attacks
How to deal with panic attacks
A panic attack is a feeling of sudden and intense anxiety.
Panic attacks can also have physical symptoms, including shaking, feeling disorientated, nausea, rapid, irregular heartbeats, dry mouth, breathlessness, sweating and dizziness.
The symptoms of a panic attack are not dangerous, but can be very frightening.
They can make you feel as though you are having a heart attack, or that you are going to collapse or even die.
Most panic attacks last somewhere from five minutes to half an hour.
How to handle a panic attack
Professor Paul Salkovskis, Professor of Clinical Psychology and Applied Science at the University of Bath, says it's important not to let your fear of panic attacks control you.
"Panic attacks always pass and the symptoms are not a sign of anything harmful happening," he says. "Tell yourself that the symptoms you're experiencing are caused by anxiety."
He says don't look for distractions. "Ride out the attack. Try to keep doing things. If possible, it's important to try to remain in the situation until the anxiety has subsided."
"Confront your fear. If you don't run away from it, you're giving yourself a chance to discover that nothing's going to happen."
As the anxiety begins to pass, start to focus on your surroundings and continue to do what you were doing before.
"If you’re having a short, sudden panic attack, it can be helpful to have someone with you, reassuring you that it will pass and the symptoms are nothing to worry about," says Professor Salkovskis.
Breathing exercise for panic attacks
If you’re breathing quickly during a panic attack, doing a breathing exercise can ease your other symptoms. Try this:
- breathe in as slowly, deeply and gently as you can, through your nose
- breathe out slowly, deeply and gently through your mouth
- some people find it helpful to count steadily from one to five on each in-breath and each out-breath
- close your eyes and focus on your breathing
You should start to feel better in a few minutes. You may feel tired afterwards.
Visit the No Panic website for another breathing exercise to calm panic.
Ways to prevent panic attacks
"You need to try to work out what particular stress you might be under that could make your symptoms worse," says Professor Salkovskis. "It's important not to restrict your movements and daily activities."
- Doing breathing exercises every day will help to prevent panic attacks and relieve them when they are happening
- Regular exercise, especially aerobic exercise, will help you to manage stress levels, release tension, improve your mood and boost confidence
- Eat regular meals to stabilise your blood sugar levels
- Avoid caffeine, alcohol and smoking – these can make panic attacks worse. Panic support groups have useful advice about how you can effectively manage your attacks. Knowing that other people are experiencing the same feelings can be reassuring. Your GP can put you in touch with groups in your area
- Cognitive behavioural therapy (CBT) can identify and change the negative thought patterns that are feeding your panic attacks
Is it panic disorder?
If you feel constantly stressed and anxious, particularly about when your next panic attack may be, you may have panic disorder.
People with panic disorder may avoid situations that might cause a panic attack. They may also fear and avoid public spaces (agoraphobia).
"There's no quick fix, but if your attacks are happening time after time, seek medical help," says Professor Salkovskis.
Read more about panic attacks, including personal stories, at See Me Scotland.
What They Are, How to Stop, and More
Panic attacks can be scary and may hit you quickly. Here are 12 strategies you can use to try to stop or manage panic attacks. Some may help you in the moment, while others can help in the longer term.
Cognitive-behavioral therapy (CBT) and other types of counseling can often help people who have panic attacks and who have panic disorders. CBT aims to help you change the way you see challenging or frightening situations and to help you find new ways to approach these challenges as they arise.
You can find CBT for individuals or groups, online or face-to-face, and the length of treatment can also vary. In exposure-based CBT, your therapist will expose you to something that can trigger a panic attack and help you work your way through it.
As well as changing behavior, there is some evidence that CBT might affect structures in your brain that are responsible for panic symptoms.
In 2018, some researchers found evidence that people who attended four weekly sessions of exposure-based CBT experienced changes in the neural pathways involved in panic symptoms. However, this was an early study, and more research is needed.
In 2018, 37 people in Korea attended a mindfulness-based program once a week for 4 weeks, to see if brief treatment would help reduce symptoms of panic disorder. One aspect of the treatment was to focus on their heart rate, as some people experience cardiovascular symptoms during a panic attack.
The findings suggested that the participants could better manage their symptoms using their own thought processes after the treatment. However, this was a small study, and there was no control group. More research is needed to find out how effective short-term therapy can be.
2. Take medications
Benzodiazepines, such as alprazolam (Xanax), can help treat the symptoms of panic when they occur.
However, they won’t help treat an underlying anxiety disorder and can quickly lead to dependence. For this reason, doctors only recommend them for short-term use during a crisis.
Because benzodiazepines are a prescription medication, you’ll likely need a panic disorder diagnosis to have the medication on hand.
In some cases, a doctor may prescribe anti-depressants for long-term use. Examples include:
- selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro) or fluoxetine (Prozac)
- serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta)
- anti-anxiety drugs, for instance, azapirone (Buspirone)
Some anti-seizure medications, such as pregabalin or clonazepam, can also help treat anxiety.
Which drugs can treat anxiety disorder?
3. Use deep breathing
While hyperventilating is a symptom of panic attacks that can increase fear, deep breathing can reduce symptoms of panic during an attack.
In one study, published in 2017, 40 people joined either a therapy group that involved deep or diaphragmatic breathing or a control group. After 20 intensive training sessions, those who practiced deep breathing saw improvements in their attention levels and emotional well-being.
Blood tests also showed lower cortisol levels in this group, suggesting lower levels of stress. The participants did not have panic disorder, but the strategies could help people who have panic attacks.
Another group of scientists found that slow breathing could have similar effects. They suggested it could also improve feelings of relaxation, comfort, and alertness and reduce symptoms of arousal anxiety, depression, anger, and confusion.
If you’re able to control your breathing, you’re less likely to experience the hyperventilating that can make other symptoms — and the panic attack itself — worse.
Focus on taking a deep breath in through your nose, feeling the air slowly fill your chest and belly. Then slowly exhale through your mouth and feel the air leave your body. Breathe in through your nose for a count of four, hold for a second, and then breathe out through your nose for a count of four:
What is diaphragmatic breathing and how do you do it?
4. Recognize that you’re having a panic attack
By recognizing that you’re having a panic attack instead of a heart attack, you can remind yourself that this is temporary, it will pass, and that you’re OK.
Take away the fear that you may be dying or that impending doom is looming, both symptoms of panic attacks. This can allow you to focus on other techniques to reduce your symptoms.
It is not always possible to avoid triggers for a panic attack, but if you know what triggers it, this can help you understand that it is a panic attack and not something else.
5. Close your eyes
Some panic attacks come from triggers that overwhelm you. If you’re in a fast-paced environment with a lot of stimuli, this can feed your panic attack.
To reduce the stimuli, close your eyes during your panic attack. This can block out any extra stimuli and make it easier to focus on your breathing.
6. Practice mindfulness
Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening.
- focusing your attention on the present
- recognizing the emotional state you’re in
- meditating to reduce stress and help you relax
Focus on the physical sensations you are familiar with, like digging your feet into the ground or feeling the texture of your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to focus on.
Experts say that mindfulness strategies, such as meditation, can help manage anxiety symptoms, although it’s not clear they can treat an underlying anxiety disorder.
American Family Physician recommended mindfulness as a strategy for dealing with panic and anxiety in 2015, saying it can be as helpful for reducing stress as CBT and other behavioral therapies.
Some research has suggested that mindfulness-based cognitive therapy could help people with anxiety disorders who are receiving medical treatment but haven’t found drug treatment helpful.
Online meditation options
Read our review of the best online meditation options to help find the right fit for you.
7. Find a focus object
Some people find it helpful to find something to focus all their attention on during a panic attack. Pick one object in clear sight and consciously note everything about it possible.
For example, you may notice how the hand on the clock jerks when it ticks, and that it’s slightly lopsided. Describe the patterns, color, shapes, and size of the object to yourself. Focus all your energy on this object, and your panic symptoms may subside.
8. Use muscle relaxation techniques
Muscle tension is a symptom of anxiety, and muscle relaxation techniques can help reduce tension and promote relaxation during an attack. Progressive muscle relaxation aims to release tension in one group of muscles at a time to relax the whole body.
Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible.
If you attend muscle relaxation therapy, your therapist might take you through the following steps:
- First, you may learn how to tense the muscles before releasing the tension.
- Then, you will learn how to relax the muscles without tensing them first.
- You may also learn how to relax specific sets of muscles, for example, in the shoulders, for practical use in everyday situations.
- Finally, you may learn how to practice rapid relaxation, when you can identify any areas of tension and release it as needed.
To start relaxing your muscles at home, consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body.
Muscle relaxation techniques will be most effective when you’ve practiced them beforehand.
9. Picture your happy place
Guided imagery techniques can help reduce stress and anxiety. Research suggests that both spending time in nature and visualizing nature can help treat and manage anxiety.
What’s the most relaxing place in the world that you can think of? A sunny beach with gently rolling waves? A cabin in the mountains?
Picture yourself there and try to focus on the details as much as possible. Imagine digging your toes into the warm sand, or smelling the sharp scent of pine trees.
This place should be quiet, calm, and relaxing — no streets of New York or Hong Kong, no matter how much you love the cities in real life.
Here, learn about five visualization techniques that can help you meditate.
10. Engage in light exercise
Research shows that regular exercise can not only keep the body healthy but boost mental well-being, too.
Experts have found that exercising at 60 to 90 percent of your maximum heart rate for 20 minutes three times per week can help reduce anxiety.
If you are not used to exercising, talk with your doctor before starting. There is some evidence that starting aerobic exercise anew can trigger additional anxiety in people with an anxiety disorder. Building up gradually can help your body adjust and avoid breathing problems. Aerobic exercise includes activities such as running on a treadmill.
If you feel stressed or you’re hyperventilating or struggling to breathe, stop and take a rest or choose a more moderate option, such as walking, swimming, or yoga.
11. Keep lavender on hand
Lavender is a traditional remedy that many people use to reduce stress and help them relax.
Research suggests it has a calming effect but doesn’t lead to dependence or cause withdrawal symptoms. Using products that contain diluted lavender oil may help reduce or manage symptoms of anxiety.
However, the Food and Drug Administration (FDA) does not regulate essential oils, and strengths and ingredients vary widely.
If you use lavender essential oil, make sure you:
- get your oil from a reputable source, such as a pharmacy
- follow the instructions for use
- avoid applying concentrated oil directly to the skin
- avoid using lavender with benzodiazepines because the combination can cause intense drowsiness
While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of essential oils. It’s important to talk with a healthcare professional before you begin using essential oils and be sure to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.
Which essential oil is right for you?
12. Repeat a mantra internally
Repeating a mantra internally can be relaxing and reassuring, and it can give you something to grasp onto during a panic attack.
Whether it’s simply “This too shall pass,” or a mantra that speaks to you personally, repeat it on loop in your head until you feel the panic attack start to subside.
Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms.
If you have a panic attack, you might find you have difficulty breathing, you sweat profusely and tremble, and you may feel your heart pounding.
Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they may think they’re having a heart attack. Others have reported feeling like they are having a stroke.
Panic attacks can happen for various reasons, and sometimes they happen for no apparent reason.
You’re more likely to experience them if you:
- have panic disorder
- have another anxiety disorder
- use certain substances or have a substance use disorder
- use certain medications
- have a medical condition, such as an overactive thyroid
- have a condition that involves psychosis
A panic attack often happens when you’re exposed to a trigger, but triggers vary widely between people. In some cases, there may be no clear trigger.
However, some people find that the following can trigger an attack:
- social events
- public speaking
- situations that remind you of past or current stress in your life
Here, learn more about the causes and triggers of panic attacks.
The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) defines a panic attack as “an abrupt surge of intense fear or discomfort.”
They tend to start without warning, and symptoms reach a peak within minutes.
If you have a panic attack, here are some of the symptoms you might experience:
- a pounding heart, palpitations, or rapid heart rate
- shaking or trembling
- difficulty breathing or feeling as if you are choking or being smothered
- chest pain or discomfort
- nausea or stomach upset
- feeling dizzy, light-headed, or faint
- feeling unsteady
- chills or feeling hot
- numbness or tingling
- feelings as if things are unreal
- feeling detached from yourself.
- fear of losing control or “going crazy”
- fear of dying
It is not always possible to prevent a panic attack, but the following tips may help:
- do breathing exercises every day
- get regular exercise
- follow a diet that is low in added sugar and eat regularly to avoid glucose spikes
- avoid caffeine, smoking, and alcohol, as they may make anxiety worse
- seek counseling and other professional help
- ask your doctor about local support groups
Avoiding specific triggers may help prevent a panic attack, but this may not always be possible or appropriate. Some experts encourage people to “ride out” the attack and continue doing things, if possible.
However, if a situation is likely to cause severe distress, consider waiting until you’ve worked with a professional to develop skills and strategies to help you cope.
If you have concerns about panic attacks, consider talking with a doctor, especially if:
- You have one or more panic attacks and continue to worry about panic attacks for a month or longer.
- You find yourself changing your behavior after an attack.
- Your concerns or feelings of fear or anxiety are affecting your work, studies, or daily life.
Many people experience panic attacks, in which they suddenly feel anxious and not in control of a situation, possibly without knowing why.
You may feel breathless or as if you are having a heart attack, and it can be very frightening.
Panic attacks can occur unexpectedly and have a significant impact on your daily life, but there are ways to manage them. Treatment is also available for panic and anxiety disorders, which may be an underlying condition.
If you have concerns about panic attacks, speak with your doctor. They can help you work out a suitable strategy to manage symptoms and reduce the impact. This may involve medications, such as antidepressants, alongside counseling.
Read this article in Spanish.
Panic. How to help yourself, some useful tips.
A panic attack is a condition when a person experiences strong and unreasonable fear. At the same time, such emotions are almost impossible to control. Fear causes a whole chain of reactions in the body: heart rate increases, pressure rises, there is not enough air. The legs become "cottony", trembling and chills appear, the mouth dries up, and the ability to concentrate on something is sharply reduced. Also, some people experience
a feeling of impending death, and this further increases the panic attack. This state can last only a few minutes, or it can last for hours.
Panic disorder is fairly common, affecting 1.5 to 2% of the adult population, and occasional panic attacks occur in up to 10% of people during their lifetime. Women get sick 2-3 times more often than men. The prevalence of the disease does not depend on education, social status, income level and profession. The typical age of onset is 20 to 30 years; the disease very rarely occurs before 14 or after 40 years of age. nine0003
Panic attacks can happen to anyone. However, there are also special “risk groups”. More than other people, it is the residents of large cities who are afraid of it, where daily stress overloads the nervous system. Also, the "risk group" includes people with the so-called catastrophic thinking. Owners of this type of thinking are prone to drama and exaggeration - even a minor problem in their eyes grows to the size of the apocalypse. Often people with anxiety disorders, social phobia or with heightened emotional susceptibility suffer from panic attacks. nine0003
These attacks can be triggered by severe overwork or the expectation of an important event. We must not forget that such a state arises, among other things, as a result of various psychological traumas. It is not at all necessary that the traumatic event happened recently - the psyche does not always “quickly” react to what happened, so a panic attack may be the result of some severe and unprocessed childhood trauma.
Usually the first panic attack occurs in a person completely unexpectedly, without any apparent reason. A panic attack is characterized by a strong, rapidly growing feeling of anxiety, a feeling that some kind of trouble is about to happen. The fear builds up quickly and may be accompanied by a feeling of lack of air, in some cases up to a feeling of suffocation, a strong heartbeat, sweating, dizziness, weakness in the legs, numbness of the limbs or other parts of the body. As a rule, the autonomic disturbances that accompany a panic attack cause a person to assume that something is wrong with his health, many people assume that they have had a heart attack, or their blood pressure has skyrocketed. All of these symptoms are usually accompanied by a strong fear of death or fear of going insane. nine0003
It is not surprising that after a panic attack, a person assumes that he is seriously ill and goes to the doctor for examination. However, in most cases, the patient does not show any serious health problems. But, despite the fact that panic attacks do not pose a serious danger to life and health, they can greatly complicate a person's life.
Treating panic disorder is not a matter of a day or a week. The first real results require at least 2-3 months and depend to a decisive extent on the involvement of the patient himself. nine0003
It is very useful to keep a diary where you can record the features of the disease and your successes in the fight against it - where and under what circumstances attacks occur, what provokes them, what are the first signs of an approaching attack. What steps did you take and how did they help?
The most important thing in a panic attack is to take your mind off the feeling of terror. And in this case, all means are good (if you like to play games, launch your favorite game, read a book, turn on music, etc.) Any of these actions require concentration, therefore, weakens the panic attack. nine0003
In addition to having something to do for the brain, it's not a bad idea to keep the rest of the body (all other senses) busy with something. Psychologists advise massaging the earlobes, squeezing and unclenching the palms - this will give the muscles work and help you “feel your” body again, in order to use the taste buds, you can put a lollipop in your mouth, for tactile sensations, sort out the rosary.
Separately, it must be said about the benefits of breathing. A panic attack causes a rapid heartbeat, which creates additional fear and discomfort. One of the easiest ways to help yourself in this situation is to normalize your breathing. At the first panic attacks, start breathing in cycles: four for inhalation, four for holding the breath, and four for exhalation. nine0003
It must be understood that panic attacks are just the tip of the iceberg, the underlying causes of anxiety are the presence of erroneous, irrational thoughts, fears and stereotypes. The deeper goal of treatment is to find these thinking errors, sort them out and correct them. And experts will help you with this.
Psychological emergency telephone 352-44-44 or 304-43-70
Panic attacks - psychosomatics, causes and methods of treatment As a rule, it is accompanied by malaise, fear and increased anxiety, which reach their peak within a few minutes after the onset. nine0003
The attack takes 10-20 minutes and is accompanied by various vegetative-multiorgan symptoms - the duration depends on a wide range of factors, including the individual characteristics of the organism. During this period, a person practically does not control his actions, which can lead to various negative consequences for physical and mental health. According to official statistics, in Ukraine, more than 5% of residents of large cities experience periodic panic attacks - this indicates the magnitude of the problem. nine0003
Panic attacks - causes
Neurological disorders are a key cause of panic attacks. Today, the true causes of occurrence are not precisely defined, but psychotherapists know that either one or a combination of factors can serve as a catalyst for a state, including:
- A number of mental illnesses;
- Some physiological problems associated with cardiac pathologies: mitral valve prolapse, ischemia, after a stroke, as well as other diseases: hypoglycemia, hyperthyroidism; nine0044
- As a response of the body to certain medications and stimulants, during hormonal therapy, etc.;
- Depressive conditions associated with problems in personal life, loss of loved ones, difficulties with work, as well as other factors that surround a person every day;
- Genetic predisposition, pregnancy, childbirth, menopause.
It should be understood that a panic attack can occur suddenly or when exposed to a specific stimulus. If characteristic symptoms are found, you should not wait for the problem to resolve itself - this can only aggravate the situation and lead to the appearance of various phobias! Contact psychotherapists for qualified help, they will diagnose and develop an optimal treatment regimen! nine0003
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Symptoms and signs of a panic attack
The most striking sign of a panic attack at night and during the day is an anxiety attack, combined with a wide range of somatic abnormalities, fears and disorders of the nervous system.
After the onset of a panic attack, there is a whole range of characteristic symptomatic manifestations: difficulty breathing, severe headaches, dry mouth, dizziness and nausea, chills, general weakness, increased heart rate (tachycardia), a feeling of doom, approaching death, control over one's own actions is lost, the unreality of everything that happens around is felt. nine0003
Due to the unpredictability of the appearance of the condition, it can overtake a person at any time of the day, as well as anywhere: at home, at work, on a trip, while communicating with friends, etc.
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Panic attacks - how to cope
Every person suffering from this condition should know how to deal with panic attacks - this will allow you to control your own actions in moments of maximum stress . nine0003
If you don't have medication prescribed by a mental health professional during a panic attack, you can manage your anxiety with a few simple rules:
- Sit comfortably, close your eyes, and lean back in your seat;
- Ensure uniformity of respiratory movements - there should be no sudden inhalations and exhalations;
- Concentrate on some pleasant memories, for example, how you spent your holidays with your loved ones or imagine a calm atmosphere: a sea sunset or the sound of the surf; nine0044
- Try to relax, imagine that you are trying to fall asleep in the evening.
Now you know what to do in case of a panic attack. In the absence of drugs, use the above rules.
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Panic attack treatment - how to get rid of panic attacks
There are two main methods of treating panic attacks: cognitive behavioral therapy and drug therapy. The optimal method of treating the problem is determined by the psychotherapist based on the initial examination, test data and the physiological characteristics of the body of a particular patient.
As a rule, for mild symptoms, conservative cognitive-behavioral therapy is used - it allows you to avoid medication. With severe symptoms, when there is a high risk of suicidal ideation, drug therapy is recommended, which is carried out against the background of phono-behavioral therapy.