Coping With Panic Attacks

Anyone who's had a panic attack will tell you how horrible they can be. They're one of the most treatable psychological issues though. This article will cover some ways to cope with them.

Description of a panic attack

If you're already familiar with what a panic attack is feel free to skip this part. Sometimes people will have panic attacks, but they'll be unaware of the concept and call them something else such as an anxiety attack, a freak out, or a breakdown. I'll describe the full-on version below, but less severe types are possible too.

Panic attacks are bouts of intense anxiety. They come on quickly, sometimes seemingly out of nowhere, but at other times in response to a stressful event or the thought that something unavoidable and bad is going to happen in the future. There's an understandable urge to flee from the scene. They usually don't last more than half an hour, but the person who just had one may feel drained and jittery for hours afterward.

The main psychological symptoms are intense fear, and feelings that something terrible is going to happen, or that you're going to die, faint, lose control, or go crazy. Your mind will also have a tendency to think over your problems in a frantic way and jump to the worst possible scenarios. You'll generally be thinking about how screwed or trapped or in trouble you are.

The physical sensations are just as bad and feed into how nerve-racking the experience is. Some of the big ones are rapid breathing, a pounding heartbeat, shaking, nausea/vomiting, tightness in the throat, chest pain, headache, dizziness, and hot flashes. The key thing about panic attacks is they're really frightening and uncomfortable when they're happening. They can be hard to come down from as well.

The first panic attacks vs. subsequent ones

A person's experience of their first panic attack, or first few panic attacks, tends to play out differently from the ones that come after. The first time someone has a panic attack it often catches them completely off guard. It's not uncommon for people to interpret their symptoms as a sign they're having a heart attack, seriously ill some other way, or that they're going crazy. It's also not that rare for a person to go to the hospital because of it.

Even if someone knows that what they're going through is a panic attack, and that they're not in any danger of dying, they're still often thrown for a loop by how scary and unpleasant one actually is. They may still worry that they're going to have a nervous breakdown or lose their mind. Basically, during the first panic attack or two people often take the experience at face value and are scared in the moment by what they think it means.

What tends to happen with subsequent episodes is that the fear shifts to having another panic attack itself. People develop a fear of fear. After the first attack or so a person will probably learn what it is that actually happened to them, and realize they weren't having a heart attack or whatnot. Still, the experience was horrible and now they're on edge out about it happening again.

They may become very anxious when they're put in the situation where they first had a panic attack. Whenever they get nervous they start to wonder if another attack is imminent. They may start to steer clear of situations where they'd be 'trapped' or embarrassed if they panicked (e.g., subways, crowded movie theaters, certain social situations). They begin to pay really close attention to their bodily sensations. If their heart beats a little bit fast or they feel out of breath for a few seconds they may worry if another attack is starting.

The vicious cycle at the heart of panic attacks

Panic attacks start with some initial physical symptoms. For the attack to progress the person has to interpret those initial symptoms as a very bad thing. When they do this they get even more scared, which makes their symptoms even worse, which makes them more anxious. Things spiral out of control until full panic is achieved.

Again, the process to happen differently for first vs. subsequent panic attacks. The first time the person may feel how nervous they are or how fast their heart is beating and think, "I'm going crazy" or "I'm going to have a heart attack and die." That's what sets the cycle off. For subsequent attacks as soon as someone feels anxious enough or has a bodily sensation that's panic-related they may think, "Oh crap, oh crap, oh crap! I'm going to have a panic attack again!" That's the thought that freaks them out and sets the cascade in motion.

Coping with panic attacks

Like I said, panic attacks are very treatable. That's not to say that if someone is having them because they're anxious about something going on in their lives, then they suddenly have no reason to be nervous. However, it's very possible to get to a point where you may still worry about your real concerns, but don't full-on panic in response to them. Everyone gets nervous, but panic attacks are an unnecessary overreaction to a worrisome situation, and they can be cut down.

Many of the ideas below appear in this article on more general attitudes towards handling anxiety. Normally I try not to repeat myself too much across different articles, but in this case I think it's okay.

Realize that the symptoms of a panic attack are harmless

Panic attacks feel terrible. There's no debating that. Although as messed up as your body or mind feels, none of what happens during them is harmful. Knowing this is a huge part of dealing with them. It disrupts that initial "This is very bad" thought that kicks off the process towards full-on panic.

This knowledge helps in the sense of reassuring people that they're not going to have a heart attack or go nuts. That's the first type of worry that can progress to full panic. It also helps when someone has a fear of panicking for its own sake. If they can move from an attitude of "These sensations are terrible, I'll do anything to prevent them!" to "These sensations don't feel great but they don't actually do anything" then they'll be a lot less likely to spook when they initially start to experience them.

Why panic attack symptoms are harmless

Knowing exactly why there's nothing to worry about can help ease people's minds. There are two main factors behind panic attack symptoms. The first is adrenaline. Your body releases it to prepare your body to fight off or flee from danger. Of course, in the case of panic attacks the danger is imaginary or abstract and the adrenaline isn't necessary.

Adrenaline causes the sensations like shakiness, a rapid heartbeat, fast breathing, and an upset stomach. They're all side effects of gearing you up to perform physically. It also has the mental effect of making you hyper alert for signs of danger, and for giving you an urge to get up and bolt to somewhere safer.

The other factor is hyperventilation. When we get nervous we tend to breath in a rapid, shallow way. This changes the proportion of carbon dioxide in our bloodstream, which can cause symptoms such as dizziness, breathlessness, or sudden feelings of hotness on your skin.

Sometimes someone becomes anxious enough that it triggers a release of adrenaline or leads to rapid breathing. This brings on all the above-mentioned unpleasant sensations, which can trigger that 'This is bad!' interpretation that really gets things going. At other times someone may experience some milder feelings in their body. Maybe their heart is beating fast because they had too much coffee. They'll interpret that lesser experience as bad/scary, and that then will lead to hyperventilation and an adrenaline release. Then they think, "Oh no, what are these sensations?!? This is not good!" and again the cycle towards full panic begins.

Because they're side effects of normal bodily processes, none of the sensations that adrenaline or hyperventilation cause are dangerous. Your heart can beat rapidly for days without any real damage occurring. Your stomach can similarly be upset for quite a long time. You can't faint while you're panicking because a rapid heartbeat causes your blood pressure to go up. It needs to drop for you to pass out. When people actually 'go crazy', it's not by suddenly snapping due to nervousness. They slowly succumb to a longstanding mental illness like schizophrenia.

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Face your fear of experiencing panicky sensations

As long as you're scared of having panicky feelings in your body, the attacks will always have the ability to frighten and control you. One step in getting over them is to let yourself feel the sensations and learn over time that you can handle them. You could do this in the moment whenever an attack comes on. Instead of getting worked up, resolve to just sit there and observe what's going on in your body in a detached way. If you feel bad, just try to stay with it and see where things go. If you do this enough you'll likely start to see that while the sensations don't feel great, you can put up with them until they pass on their own.

Another effective treatment is to purposely bring on the panicky sensations so you can expose yourself to them. I'm not going to lie, this isn't an especially fun thing to put yourself through, but it has been shown to work. Some people choose to do this under the guidance of a therapist. You can also do it on your own. You can bring on various panicky feelings by spinning in place, holding your breath, doing some jumping jacks on the spot, or by breathing rapidly to make yourself hyperventilated (breathing through a small straw works too). Once the sensations have arrived you can then try being with them. If you do this alone, you'll want to ease into things gradually.

Work to develop a mentality where you mostly don't care whether you have panic attacks

Panic attacks have such a powerful ability to shape our lives because they're so uncomfortable that we'll go out of our way to avoid them. We can also fear that if we have a panic attack around other people then we'll horribly embarrass ourselves. A huge step you can make towards overcoming them is to change your attitude.

It's simpler to read about than to do, but if you decide that you're not going to care if you have a panic attack, that can actually make them less likely to appear, because you're no longer anxious about whether one will happen or not. Not caring means you don't care if you feel bad, and you don't care if you do something like tremble or get an upset stomach around other people. You're going to be comfortable with the fact that you get worked up and nervous sometimes.

Of course, if you do embarrass yourself somehow it probably still will bother you. What I mean by 'don't care' is that you're making a choice not to let your fear of panicking push you around anymore, and that you'll always choose to do something you know you need to do, with the possibility of panicking that brings, rather than re-arranging your life to avoid it.

You can often function when you're panicky and keyed up

When you're panicking it feels like there's a storm going on inside your body. You imagine you must look like you're totally losing it, and that you couldn't possibly do anything or interact with anyone. Maybe in extreme cases this is possible, but most of the time a person having a panic attack doesn't look that unusual. People can often function much more than they think they can. Sure, ideally you wouldn't care how you come across to people (see above), but still, just knowing you're likely not going to humiliate yourself as much as you think can be a relief and take away more of the anxiety's coercive power.

Accept you may just panic at times

Some people stress themselves out trying to completely control their panic attacks. It is very possible to experience significant relief from them, but it's always possible you may panic again at some point in the future. Maybe a perfect storm of stressors and unlucky life events will put you in a state where that will happen. It doesn't mean you've failed, or that you're weak for not being able to master your own mind and body. Sometimes our nerves get the best of us.

If you start to panic, relax and ride the symptoms out

If you start to feel a rush of anxiety coming on, it can actually make things worse if you grit your teeth and think, "Urgh, here it comes! I have to hold on for dear life and fight my way through this!" If instead of struggling you think, "Well if I'm going to panic, I'm going to panic. I'll just relax and let it run its course" that will often make it go away more quickly. If you don't dump any more gas on the fire the symptoms will fade in about fifteen minutes.

When it comes to this piece of advice, there are two common analogies. One I mentioned in another article, which compares anxiety to a big wave that appears while you're swimming away from shore. If you stay calm and tread water it will pass under you. Another way to think of it is like a Chinese finger trap. The way those work is that the more you pull against them the tighter they hang on. The way to release them is to relax your fingers, and then pull them out when the trap has fully loosened.

Don't be too quick to react whenever you have an odd bodily sensation

People who suffer from panic attacks become hyper aware of any changes going on in their body. When they do feel something out of the norm, they're too quick to get nervous about it and fear it's a sign they're going to panic again. It's a total self-fulfilling prophecy. Our bodies experience all kinds of odd feelings and most of them don't mean much of anything. However, if you're watching for every little change you'll have an endless variety of things to potentially freak out about. Also, as I mention at the end of this article, if we somehow start to feel a bodily sensation associated with an emotion, even if comes on for a totally unrelated reason, our mind will often make us feel the mood that goes with the physical feeling.

The next time you feel an odd bodily sensation, slow yourself down and ask yourself what may have caused it. If you can find a reasonable explanation for what brought it on, your mind won't have to jump to, "I'm starting to panic!" Is your heart beating a bit fast because you took the stairs? Do you feel hot because the heat is on too high? Is your stomach upset because you ate too much for lunch? Are you feeling a bit shaky and light-headed because you haven't eaten in a while?

Use other strategies to cope with panic in the moment

The article below lists some strategies for coping with anxiety once it has come on. Most of the ideas are applicable to feeling panicky too. As the article says right off the bat, the idea is to use these coping strategies to mop up bouts of anxiety once they begin. Overall though you should adopt a more general attitude where you don't fear your anxiety and try to control it at every turn.

Coping With Anxiety In The Moment

Make lifestyle changes to reduce your anxiety at its source

We're more likely to have panic attacks when our baseline level of anxiety is high. This article talks about lifestyle changes you can make to lower it:

Lifestyle Changes That Can Improve Mood

Face or handle the fears that your panic attacks are associated with

Sometimes panic attacks seem to come out of nowhere, and any fear associated with them is simply of having another one. Sometimes they're brought on by something a person is worried enough about that they panic. Often these fears involve an element of feeling something will trap you or have an irreversible effect on your life. A fairly common example is how members of a couple may freak out after they've committed to moving in together or getting married. Even if they want to do it and know it's the right choice, they may still panic over how final it all seems, and how they might be making a mistake. Another example may be someone who's convinced themselves that if they fail an exam, they will literally never get the kind of job they want. In the situations where you have an actual worry, it can obviously help to take steps to address or resolve it.

The panic attacks may also be associated with a fear or phobia someone has. In this case the best long-term solution is to face that fear. Actually the person would be facing two connected fears at once. They'd be confronting the thing or situation that scares them, but also their fear of panicking.