5.11 | What is a panic attack? How to deal with them.

[elphaba]

I had done some research online and put this together about a week or so ago... .just hadn't had the time to really put it in posting format.  I have suffered from panic attacks for years, they come and go depending on my stress level... .they are at a point now of only coming on occasionally and I'm working on breathing techniques, etc. to get through them.

I am (of course) not a medical proffesional, and each person is different, in how the attacks come on and how controlable they are.  But, here is some info and some tips that may help others who are dealing with them.



What is a panic attack?

A panic attack is the fight or flight response. This is the body’s response to a dangerous situation, it prepares itself to fight the foe or run away from it as quickly as possible. Hence all these strange symptoms you feel when you have a panic attack. In the body’s preparations the following things happen:

   • The heart rate quickens

   • Adrenalin is pumped into your system

   • Blood is directed towards your legs rather than your internal organs

   • Your breathing quickens

   • Your digestive system may well decide to get rid of any food it happens to be processing as fast as possible

   • The same may happen to your bladder.

All this happens so that you can fight or flee from your situation as well as possible.

Unfortunately when you do suffer a panic attack it is unlikely to be because wolves or killer rabbits are chasing you, but it may well happen when you are eating a meal, or catching a bus or any other seemingly normal operation. You may well feel the following symptoms:

   • You become very aware of your heartbeat, you can hear it quite clearly

   • You become very hot and start sweating and feel uncomfortable in your skin

   • Your hands/legs become shaky and your body tenses

   • It becomes difficult to control your breathing which seems very fast

   • Your whole digestive tract becomes uncomfortable and you feel nauseous

   • You desperately need to go to the bathroom.

This is an incredibly frightening situation to be in because you feel you have no control over your body. The fear you have of the situation makes everything worse and the whole thing seems inescapable. By this stage it seems the only way of stopping the feelings will be by doing something drastic like running from the room, throwing up or bursting into tears.

Why me?

No one seems quite sure on this one. It has been suggested that it has something to so with the way your body processes serotonin. It could be genetic or it could be lifestyle. Maybe there is no definite answer. Those of us who have survived extreme stress may be more likely to suffer from these attacks, especially those who have had the misfortune of dealing with a person with BPD in our lives... .I know I spent alot, alot, ALOT of time in a state of hyper alertness (waiting for the next BPD rage)

How to survive a Panic Attack

Firstly learn to recognize the panic attack before it overpowers you. Notice your heart beating faster and your breathing quickening. Now back away from whatever it is that you think is making you feel like this (you may not know what it is yet, but go with your instinct on this one).

Now turn on the television or start reading a magazine or start talking about your favorite subject, whilst you do this to distract your brain try breathing slower and more regularly.

Breathing into a paper bag can help as it increases the amount of carbon dioxide you are breathing in. Your body wants oxygen for its ‘fight or flight’ response, but the increased oxygen will make the panic symptoms worse.

It may take a while to calm down fully. Persevere with the breathing and keep your brain occupied. This is only a short-term solution, but it may help prevent a full-blown attack and makes you feel more confident about beating the problem.


Panic is all encompassing and throws the body into upheaval. Panic follows no logic or time table, and no one is immune to its disease. The Webster's New World Medical Dictionary (2007) defines this panic as, "a sudden strong feeling of fear that prevents reasonable thought or action."

Most importantly, panic is a wake-up call. Panic attacks are a symbol of disconnect, and signal a breakdown in the way stress and emotions are supervised. In the long term, psychological therapy and behavior modification are in order. In the long term, drug therapy - with the assistance of a medical doctor - may be necessary. In the long term, severe life changes are recommended. However, in the short term, panic is an albatross, a cross to bear, and the day-to-day struggle to overcome its sudden effects can be tiresome and disheartening. Mismanaged panic attacks can destroy lives, careers and families. Below is the seven step technique I used to combat my panic issues. It worked for me. I hope it works for you.

Step 1 - Stop. When a panic attack arrives, you are literally no longer in control of your emotional or physical self. You can possibly hide shaking hands and disjointed breathing patterns, but the major symptoms - dizziness, fainting, chest pains akin to heart attacks - refuse camouflaging. This can be disastrous, particularly if you are handling heavy machinery or driving. Stop whatever you are doing immediately, sit down wherever you are, cross your arms in an X over your chest, and grip your shoulders with both hands. This anchors you, and adds a feeling of weight to the body along with the illusion of control. The first step is to acknowledge what is happening to you so that you can begin to deal with what happens next. You may need to skip out on a business meeting, etc, but panic signals that you are not prioritizing the self. So take care of yourself, make your excuses, and walk out of the room….Seriously.

Step 2 - Breathe. A no-brainer for living is breathing, but rationality disappears when dealing with panic. The survival instinct is to pull in air as fast as possible, but you must, must, must resist. I know this has been a problem for me... .I start breathing in short quick breaths and once in full blown attack cannot seem to "remember" how to breathe normally... .Fast breathing equals more panic, so take it slow. Count - one, two, breathe in - three, four, breathe out. Regulate the breathing, everything else will follow. It may help to rock back and forth, as this is a protective measure to simulate comfort. Go with the feeling.

Step 3 - Distract. This can be achieved two ways: focus on an object or think of something else. I usually pick a point in the room and chant, either out loud or in my head, "focus, focus, focus."  or any phrase that helps to distract from the attack and focus your mind on something else, anything... .Physically, this could help the dizziness, and psychologically it serves to redirect the attention from what is happening inside of you to the outside world. Panic occurs when we unknowingly put our attention towards mental distress. You must, must get out of your own head. If this does not work, pick a happy place (the beach usually works) and imagine the sand between your toes and the water lapping at your ankles. Do not think about what is immediately occurring - this only serves to ratchet the panic level. Re-focus in order to recover.

Step 4 - Call. Most people who do not suffer from panic will not understand panic. This makes it difficult to find people to lean on in extreme situations. However, panic is unpredictable, and attacks can vary from very mild to very unsettling. If you notice the panic level is absurdly high, reach out to someone. Find an anchor. Mothers are obligated to care, so start there.

Step 5 - Hold. When all else fails, ride the wave and embrace the moment. Give yourself permission to fall apart, if only for a few minutes. Panic, like life and the ocean, ebbs and flows. It will come to an end, I promise. Stop. Breathe. Re-focus. Anchor. Hold on.

Step 6 - Prevent. This is actually pre-step #1. Some panic attacks telegraph their arrival, and it is your job to notice. Do no ignore what you feel. When the first flutters begin, immediately commence with step number #1. Follow the ritual to the end. Repeat if necessary.

Step 7 - Heal. You are dripping wet; your breathing is just now under control; your hands have finally stopped shaking. Get help, find the root cause(s) of your problem, and do the work it takes to get well. It is now time to focus on the long term.

If you cannot seem to control the feelings of panic and you are getting attacks fairly often, please, do yourself a favor and go see a doctor.  There are medications that can help quickly difuse the attack and help to calm you, just be careful... .don't depend so much on medication that you then have another problem on your hands, make every effort to learn to control your body/mind and calm your nerves... .

[duet_4-8]

   • It becomes difficult to control your breathing which seems very fast

Great information here, thanks.  I just wanted to add that there can also be a feeling that you cannot breathe.  That's how panic attacks affect me.  I become very conscious of my breathing and feel like I need to breathe very deeply.  The harder I try to do that, the more difficult it becomes which feeds the feelings of fear, which causes the breathing to be more difficult, which feeds the feelings of fear... .etc etc

[Grace]

Thanks so much for this information.  My d has suffered from panic attacks for years and they are exactly as described.  The first time she had one I thought she was going to die - she started breathing so fast that she was unable to stop.  Sometimes the attack would last for an hour or so before she was able to get her breathing in control.  At times she would have to pass out to come out of the attack.  The really scary thing for her dad and I was that she pretty much would remember none of it afterwards.   She was taught some breathing exercises by her T which will stop some attacks but not all.Grace

[methinkso]

This is a great read.

Having suffered panic attacks in my twenties, the advice I read here that I think should really be noted, is that it IS ok to remove yourself from what is causing them. It is nothing to be ashamed of ~ where I then thought it was.

I 'healed' by avoidance. And by allowing myself the freedom to avoid (I'd always been pressured and controlled into the things that caused my panic attacks), I then became comfortable doing these things when I was in control of them. NOT because somebody else was forcing me through guilt, shame, or manipulation.

And I remember how strange it was for me to 'let go' and not care if I satisfied other's wants or not. It felt a little unacceptable at first, but it soon grew into some pretty darned good feelings of freedom. My 'good' T said I was a late bloomer. And when he first said I needed to grow up, I could not fathom. After all, I was responsible, even perfectionistic. I learned that he meant 'take my control back'. Perfectionism IS for others.

So that is why I want others to not skim over that part because for some others it might be the very thing that helps tremendously.

I agree with the breathing and distracting, too.

Hugs to all who have panic attacks. I had come to fear them so much that I was living in an inner hell.

[theomorphic]

According to Pastor Henry Wright w/Pleasant Valley Church who heals thoses in this situation.

It is a thought!  This thought is projected into the future repeatedly and it is not real it is a projection, and when it is done enough times it is believed as real.  HOLD EVERY THOUGHT CAPTIVE!  We must not engage with certain thoughts as they trigger this and other problems such as trauma and psychosis.

[Moving On]

As someone who has experienced anxiety attacks (one step lower than a panic attack), I agree with the strategies to deal with it once it starts happening.  I'll add:  Don't drink anything with caffeine.  Actually, milk is a good think to drink, as is water.  And if the situation fits, and you're so inclined, a shot or two of your favorite booze can help.  There's advice that you probably won't get from your family doctor! 

Also - these have a tendency to happen to me while driving.  I start thinking (it's one of my places where I am alone with my thoughts), and I develop strategies to deal with my situation.  While this is healthy, it ends up being too much at one time.  If you find yourself getting lightheaded or even slightly dizzy, pull off to the side of the road, get some fresh air.  Sit on the hood of the car or a fence or something - basically, relax.  Get your heart rate down.  Focus on a point really far away or fairly close, whichever seems to work better for you.   If you feel like throwing up, go ahead and try.  It may help.  But if you're like me, the feeling that you need to throw up isn't really caused by a need to, and trying to suppress it simply makes the feeling worse.

All of that being said - anxiety attacks and panic attacks are so much like a heart attack in their symptoms that you may want to see emergency medical help just in case.  However, once you've done this one or twice (or 4 times, in my case), you'll eventually be able to identify it as a anxiety/panic attack.  That, in and of itself, is something that'll help.  I know that each of my anxiety attacks built up stronger because I started thinking that it was a heart attack; I started worrying about that possibility, and that just caused it to escalate.  Knowing that your heart is strong, and that previous attacks weren't heart related is useful.

I'm going to address how to avoid them a bit.  Anxiety/Panic attacks, as stated, are brought on by your thoughts running loose, getting yourself more and more worked up, nervous, afraid.  One method that works GREAT for me is to sing loudly along with the radio.  Pick songs that have long running phrases, where you have to have good breath control in order to get through the phrase.  For me, this works great, because I listen to music that is theme appropriate (anger at my stbx, concern for my kids, whatever), and my favorite music tells a story, and this causes nice and long breath intervals, and still allows me to dwell on my problems without getting worked up about them in a way that leads to a anxiety/panic attack.  Note that this strategy has never worked for me while in the throes of a anxiety attack, though - I just don't feel like I have the breath in me to sing.  But once I start feel it first coming on, it has helped me get rid of it.

When you find yourself in a situation where you might have a anxiety/panic attack, caffeine is another no-no.  Having said that, I violate that recommendation.

[Moving On]

I had another thought.  When I've had an anxiety attack, the stomach issues caused me as much upset as anything, and during my last one I bought some anti-nausea syrup stuff, and it did help.  It might be something worth trying.  That and aspirin - besides, if it really IS a heart attack coming on, the aspirin is good (I try to dismiss that mentally while in the throes of an anxiety attack, because they checked me out a couple of times already, and said my heart was as healthy as could be).

[Deborah A. Galaska]

I agree with the advice to get medical issues ruled out.

The keys for most effective deep breathing are:

       -practice a few minutes at a time (I recommend 4x/day) when you are not having a panic attack

       -make your exhalations longer than your inhalations (this will kick in your parasympathetic nervous system, which is the one that relaxes you) - blow out like you are blowing on a soup spoon to cool soup

       -drop your shoulders away from your ears and bring your breaths down into your abdomen

       -pause at the top and bottom of each breath so you aren't hyperventilating

Some other suggestions I have found helpful for my clients with panic attacks:

     - "5-4-3-2-1": find 5 things you see, 4 things you hear, 3 things you feel, 2 things you smell, 1 thing you taste

     - a sharp sensation: hold an ice cube, splash cold water on your face, put your face in front of the car air conditioner vent, bite a chili pepper, stomp your feet

Many clients benefit from EMDR (eye movement desensitization and reprocessing), hypnotherapy, autogenic training, and/or cognitive behavioral therapy.

Debye

[elphaba]

Thanks for the bump JK... .

I know that for me, sometimes just acnowledging that I am having a panic attack can help... .saying it outloud and letting it simply be what it is rather than trying to surpress it.

[justhere]

Thank you JoannaK for bumping this thread up again as I've had and continue to have issues around panic and anxiety. It seems I experience these attacks differently at times or maybe there are different things going on.  Sometimes I just have the chest pain with very few other symptoms as it comes on suddenly for no apparent reason and I can try Ativan to see if that helps or I also have Nitro but most of the time, the Ativan stops the chest pain. I've had this for a while and I can usually recognize when I'm in trouble and need to get to Emergency but first I get myself somewhere safe, like stop driving or pull over, sit down etc, take the Ativan or Nitro and call 911 just the same. 

I've also found that smoking and drinking caffeinated coffee or tea, and to also have issues with 'high pulse rate' and/or 'high blood pressure' it doesn't take much if you are doing these things in combination to just add a stressful situation to start the heart palpitations and get the pulse and blood pressure soaring.  My Dr told me that any situation where you are experiencing heart palpitations, a pounding, visible and/or irregular pulse and any pulse over 130/min needs medical attention immediately.

Then I have these panic attacks where it is more about my breathing.  If I even try to concentrate on my breathing though like to breath deeper or slower, it gets worse and I panic more and then I feel like I can get air in or even if I'm aware that I'm breathing, I feel that I'm not.

The only thing that seems to work for me is to get up if I was in bed and distract myself, phone someone and not talk about my breathing, or walk or watch tv or anything that takes my mind off my breathing.  Lately I've been trying to do yoga for relaxation and meditation but once I start the deep breathing I start to feel the panic and have to stop.

I know I've been stressed out more lately and I've noticed my breathing because its more shallow and I take a couple of deep breaths and distract myself. 

I think that I'm going to have to see my Dr about this though as it is becoming more problematic this last while as my panic seems to be there, just under the surface as even thinking about this now is a little distressing.

[scrabble]

This may be something different, but I had my first anxiety/panic attack giving a brief presentation in a meeting of about 25 people a few years ago.

Out of nowhere, couldn't breathe, started sweating, feeling lightheaded, studdering due to the lack of breath and the sensation of a wave coming over me. It was pretty overwhelming. I thought everyone would notice, but no one mentioned a thing.

Since then, I've spent a fair amount of time trying to get over this, because I have to speak in public on a regular basis. Here's some things that have helped me:

No caffeine

No tobacco

Good sleep

Deep breathing my T taught me. I also get the feeling of lack of breath and the normal deep breaths seem to make it worse. Like I can't get enough air in. Breathe deeply, but hold it for a second or two, then let it out taking 4 times as long as you let it in. Repeat a few times.

Reframing. You cannot control a panic attack, but you can manage your way through it. Ride the wave, let it happen. Notice the physical sensation and detach from it a bit. Takes practice, but it can be done.

Visualization and self hypnosis. My T and I worked through some visualization/hypnosis and a physical trigger, rubbing my thumb and forefinger together, as a trigger to relax and reconnect with my body. Not sure how well it works, but since a part of the panic is a perception that we cannot control our physical reactions, reconnecting to ourselves physically does seem to help.

My T once said that panic attacks are or can be caused by unexpressed anger. Hmmm. Some of that around here.

Once heard Sarah Silverman say that whatever the first panic attack is about, the rest are about the first one (paraphasing).

I realize that "stage fright" is a different angle on a panic attack, but here's where I've gotten using all that and some practice.  Was giving a 20 minute presentation, with slides, in front of every senior exec in my company recently. Felt the physical reaction coming on and was able to intentionally short circuit it. Still felt like I could feel the stress hormones raging through my body afterwards, but no one noticed a thing.

Looking back, I think what caused them for me was:

1) Stressful work situation and history

2) An SO with BPD who had undermined my confidence over many years

3) Unexpressed anger around 1 & 2

Scrabble