What is a panic attack?
As I walk through the crowded and noisy shopping center, I notice my heart begins to beat faster and my palms begin to sweat. My friend’s voice begins to slowly fade into the background. I suddenly feel terrified, but I have no idea why. The thoughts are racing through my head like a pinball machine and I can’t seem to focus on anything. My breath becomes shallow and fast and my chest becomes painfully heavy. Everything closes in around me and the voices of the strangers next to me begin to amplify. Am I having a heart attack? Am I going to die? Where’s the exit?
Have you ever experienced the above scenario? If you have, then you know how scary a panic attack can be. It’s a moment of feeling you have lost complete control. A panic attack is defined as, “a brief episode of intense anxiety, which causes the physical sensations of fear” (www.betterhealth.vic.gov.au). A panic attack can last a few minutes to half an hour while the physical and emotional effects of the attack may linger for a few hours.
The Diagnostic Statistic Manual (DSM 5) is written by the American Psychiatric Association (APA) and is used to describe and diagnose mental health disorders. The DSM 5 describes a panic attack as being characterised by four or more of the following symptoms:
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- A feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Feelings of unreality (derealization) or being detached from oneself (depersonalization)
- Fear of losing control or going crazy
- Fear of dying
- Numbness or tingling sensations (paraesthesia)
- Chills or hot flushes
Healthy Ways to Manage Panic Attacks
1. Breathing
There are two components to the autonomic nervous system; the sympathetic nervous system and parasympathetic nervous system. The Sympathetic Nervous System functions like a gas pedal in the car and triggers the fight-or-flight response. The Parasympathetic Nervous System acts like the brakes in a car and promotes the “rest and digest” response that helps calm and regulate the body. Slow deep breathing is the best window into the Parasynthetic Nervous System.
A very basic breathing technique that can be utilised regardless of where you are is to gently place your hand on your stomach. Breathe in for 4, hold for 7 and out for 8. This is known as the 4-7-8 breathing sequence. When you are panicking and hyperventilating, this is confirming to your body that there is a threat. Hence, slower breathing is key so your body can receive the message that you are safe and ok. For my younger ones, I explain this as “pretend fear” or a “false alarm”. Your body is doing the right thing (trying to protect you) but at the wrong time (as there is no danger present).
2. Grounding
Grounding is a technique that helps bring you back to the present, helps to reorient you and can help you regain a sense of focus and control. A common grounding technique is:
Look around you and identify:
5 things you see (Some people benefit from choosing a colour and finding items that match that colour)
4 things you feel (By this, I do not mean, I feel anxious. I am referring to examples such as feeling the warmth of the sun on your skin, the softness of the chair beneath you, the feeling of your cold watch resting on your arm.)
3 things you hear
2 things you smell
1 thing you taste
3. Change your environment
It is ok to utilise an exit, whether this means leaving the classroom or a business meeting. For many people, the feeling of being trapped becomes overwhelming so I suggest reminding your brain and body that you are capable of leaving should you choose. Go to the toilet, grab a drink of water or sit on a bench outside. Give yourself time to calm and then return to what needs to be done.
4. Engage in physical activity
If are you able to notice anxiety building, it can be very beneficial to get your body moving. This can be simple stretches in your lounge room, grabbing your runners and walking/jogging outside or even doing star jumps in place. Research has demonstrated several benefits to exercising including reduction in stress hormones, a decreased sensitivity to anxiety and an increase in endorphins which help boost mood. I know you aren’t going to start exercising during a panic attack, but I include this on the list as a fantastic preventative measure to panic and anxiety in general.
5. Connect with a trusted and supportive person
When we reach for someone and open up about our experience, it can help us sort though our feelings, gain perspective and realise that we are not alone. Whether the anxiety is building, the panic is happening currently or the panic attack has passed, sometimes just having someone listen to us, calm us and soothe us can be massively helpful.
6. Self-Talk
While a panic attack can feel scary and the physical experience can be extremely uncomfortable, self-talk can be helpful. Simple and brief statements that can be repeated such as:
I am safe
I am not trapped here
I know a panic attack cannot harm me
These feelings will pass
This is my body’s false alarm
I would choose a statement that resonates with you and have it prepared for repeating.
7. Self-Compassion
Once the panic attack has passed and the body is calmed, many people start engaging in self-deprecating thoughts and judging themselves as weak or crazy. Many people I have worked with have also described holding a sense of embarrassment, humiliation or shame. I want to say now very clearly, having a panic attack doesn’t make you weak or crazy. Be kind to yourself about it. You are strong for surviving it and resourceful for trying creative ways to manage it. Thinking “What would I say to a friend right now” and channeling some self-compassion can decrease shame but can also allow you to let go of the experience and proceed with your day.
8. See a therapist
I know accessing support can feel quite vulnerable but if your panic attacks are frequent and you feel you are not managing, seeing a therapist can be useful. Therapists can help provide you with further psychoeducation (information about what’s happening to your body and why), strategies and tools to manage this, engage you in various cognitive, relational and behavioural interventions and support you to make necessary lifestyle changes.
Summary
In summary, I would recommend taking a photo on your phone of the below suggestions, so you can utilise them when needed. If you are interested in pursuing therapy with one of our Green Life Psychology clinicians, please feel free to call and speak with our friendly reception staff.
- Slow deep breathing by inhaling, holding and exhaling (counting sequence 4-7-8)
- Practice Grounding
- Change your environment- go to the toilet, get a drink of water, sit outside
- Engage in physical activity
- Connect with a trusted and supportive person
- Self-Talk
- Self-Compassion- What would I say to a friend in my position?
- See a therapist
I hope this has been helpful. Please feel free to leave a comment below or visit us on Facebook and Instagram.