Panic attacks (part 4)

How to cope with panic attacks

The good news is that panic attacks are very treatable. By the time you are reading this final part of my four-month series on panic, you may have found that your panic attacks have already started to reduce because you have begun to understand and accept that they will not harm you.

Panic affects your body, your mind and your behaviour, so it makes sense to try to deal with panic from all of these angles.  You may find some techniques more helpful than others – different strategies work better for different people.  Also, if you have been having panic attacks for a while, it may take some time for these techniques to work.  Don’t expect miracles straight away, but keep at it and you should see the benefits soon, when you’ve found the techniques that work best for you.

Your Body

There are at least two things you can do to help with the physical symptoms of anxiety:

1. Relaxation

2. Controlled breathing

These techniques are helpful for a number of reasons:

• Panic attacks often start in periods of stress.  These techniques can help you to deal with stressful situations better, and reduce overall levels of anxiety.
• They can nip the problem in the bud, stopping the cycle that leads to full blown panic, by reducing anxiety symptoms and preventing hyperventilation.
• They can be used when avoidance is being cut down, to help you cope with situations you fear.
• Being relaxed and breathing calmly is the opposite of panic.  It is impossible to be completely relaxed and highly anxious at the same time.

To begin with, practise relaxation and diaphragmatic breathing techniques when you are not anxious.

Relaxation

People relax in many different ways.  It might be that looking at your lifestyle would be helpful.  What do you do to relax?  Write down six things you do, or could do to relax.  For example, swimming, reading, walking, taking a bath, singing along to favourite music…  As well as finding everyday ways of relaxing, there are special relaxation techniques which can help with the specific symptoms of panic.  We have already seen that one of the things that happens when you panic is that your muscles tense up.  To help yourself you should try to relax your muscles whenever you start to feel anxious.  Relaxing in this sense is different from the everyday ways of relaxing like putting your feet up and having a cup of tea (although that is just as important).  It is a skill, to be learned and practised.  Listening to a relaxation tape is good (try the free download on my site here). Relaxation tapes teach you to go through the main muscle groups in your body, tensing and relaxing them in turn.  BUT remember, relaxation can help to reduce symptoms of anxiety and panic, but it is not preventing something terrible happening – because nothing terrible is going to happen, whether you relax or not.

Controlled Breathing

When you become frightened you start to breathe more quickly, so that oxygen is pumped more quickly round the body.  However, breathing too fast, deeply or irregularly can lead to more symptoms of panic, such as faintness, tingling and dizziness.  If breathing can be controlled during panic, these symptoms may be reduced and so the vicious circle described earlier can be broken.  You must breathe more calmly slowly.  Do this for at least 3 minutes and your internal alarm bell should stop ringing.  However, this is not as easy as it sounds because in the middle of a panic attack, focusing on breathing can be difficult.  One of the effects of over-breathing is that you feel you need more air, so it is difficult to do something which makes you feel as though you are getting less!

Again, practise while you are not panicking to begin with.  This technique will only work if you have practised and if it is used for at least three minutes.  It works much better in the very early stages of panic.  Practise the following as often as you can.

Fill your lungs with air.  Imagine you are filling up a balloon attached to you navel, so that your diaphragm expands fully and you chest pushes out, filling from the very bottom up.  Your stomach should push out too.
Keep your breathing nice and slow and calm.  Breathe in through your nose and out through your mouth. Breathe in slowly, saying to yourself: 1 elephant, 2 elephant, 3 elephant, 4.  Then let the breath out slowly to six: 4 elephant, 5 elephant, 6.

Keep doing this until you feel calm.  BUT remember – even if you didn’t control your breathing, nothing awful is going to happen.

Your Mind

There are several ways to help deal with the way your mind fuels a panic attack:

1. Stop focusing on your body looking for problems

2. Distract yourself away from frightening thoughts because ‘nothing bad is going to happen’

3. Question and argue yourself out of your frightening thoughts

4. Try to work out whether something else is making you tense

5. Stop yourself from getting over-vigilant. Try to notice whether you are focusing on your symptoms, or scanning your body for something wrong.  There really is no need to do this and it makes the problem far worse.  It may be helpful to use the next technique to help you stop the habit.  In particular, focus on what is going on outside rather than inside you.

Distraction

This is a very simple but effective technique.  Again, you need to keep distracting yourself for at least three minutes for the symptoms to reduce.  There are lots of ways you can distract yourself.  For example, look at other people, and try to think what they do for a job.  Count the number of red cars you see on the way home.  Listen very carefully to someone talking.  You can also try thinking of a pleasant scene in your mind, or an object, like a flower or your favourite car.  Really concentrate on it.  You can try doing sums in your mind, or singing a song.  The important thing is that your attention is taken off your body and on to something else.  Use what works best for you.

Distraction really does work.  Have you ever been in the middle of a panic attack when something happened that totally took over your attention, for example the phone ringing, or a child falling over?  Remember – distraction breaks the vicious circle, but it is important to remember that it is not preventing something terrible from happening.  In fact, as distraction works, this is evidence that nothing awful was going to happen after all.  For example, could the fact that the phone rang really have prevented a heart attack?

Question your thoughts

Sometimes, rather than distracting yourself from your anxious thoughts it is more helpful to challenge them.  In the long run, it is most helpful to challenge your worrying thoughts, so that you no longer believe them.  For thought challenging you need to do two things:  1. Work out what your anxious thoughts and worst fears are.  Everyone’s are different, you should already have a good idea from the work done so far. 2. Start to challenge these thoughts and come up with more realistic and            helpful thoughts.

Once you are aware of your thoughts and pictures in your mind, ask yourself:

• What is the evidence for and against them?
• How many times have you had these thoughts and has your worst fear ever happened?
• Do your experiences fit more with panic or with something more serious. For example, if thinking about panic brings a panic attack on, is it likely that a stroke or heart attack could be caused in this way?

If you can come up with more realistic helpful thoughts, write them down and keep them with you.  It is often much more difficult to come up with these thoughts when you are actually panicking.

Some examples of unrealistic and unhelpful thoughts, with more realistic alternatives are given below.

I am having a heart attack vs  I have had this feeling many times and am still here.

I am going to faint vs People having panic attacks are unlikely to faint.  I have not fainted before.

I am going mad vs The feelings I am experiencing are panic – they are nothing like going mad.

I will make a fool of myself vs I have panicked before and no-one has particularly noticed.

Whilst it is really useful to challenge thoughts in this way, probably the best way is to challenge the thoughts through the things we do, which is the next section.  Before looking at how we can alter our behaviour to help reduce panic, it is useful to look at one other way in which your mind may be contributing to panic.  Not through unhelpful anxious thoughts, but because there may be other things bothering you, as mentioned earlier.  Remember that panic can arise as a result of difficult feelings not being dealt with.  It may be helpful to work out whether anything like that is bothering you.  Is there anything from your past that you haven’t sorted out that is preying on your mind?  Are there difficulties in your relationship?  Do you feel angry or sad?  Has someone or something upset you or is something troubling you?  Panic is less likely to happen if you face up to emotional difficulties, either through talking to a friend or a professional counsellor.

Behaviour

Finally, challenging what you do is probably the most helpful way of overcoming panic.  We have already talked about how avoidance, escape and safety behaviours keep panic going.  It makes sense then that to reduce panic you need to reduce these behaviours.

Put simply, what you need to do now is test out the situations you fear most to prove to yourself that what is written here is true:   a panic attack cannot harm you.  This is best done, not all at once, but in a planned way. It’s probably best to start off with a small experiment.  It’s difficult to believe something just by reading it, what you really need to do little by little is to prove to yourself what is really going on.

It is important to remember that whatever you do or don’t do, the panic attack will stop.  Just like any other alarm would.

First of all, work out what behaviours you need to tackle:

Avoidance – For example, if you are frightened of being alone, or visiting a supermarket, try gradually spending a little bit more time on your own, or going to a small shop.  Does your feared disaster actually happen?  Now you have some evidence that you didn’t die/go mad/faint.  The next step is to spend a bit longer, more often.  You will probably feel anxious to begin with, as you have learnt to be anxious in certain situations, and you may have been avoiding them for some time.

Escape – First of all, note which situations you are escaping from.  Do you stop eating a meal half way through in case you are sick? Or leave the supermarket without your shopping?  Try staying in the situation until your panic starts to go down.  What will you have learnt?

Safety behaviours – Try to notice all the things you do to keep yourself safe, big and small and gradually cut them out.  Do you stand absolutely still to stop yourself having a heart attack. Walk about instead.  If you normally sit down to stop yourself fainting, try staying upright.  What happened? What did you learn?

By testing out your fears in this way, and finding out that your worst fear never happens you will gradually become more and more confident.  Your panic attacks should become fewer and fewer and less strong when they do come.

Summary: Coping with Panic. 

• Practise relaxation, slow breathing, distraction and thought challenging when not anxious until you have learned the techniques.
• Remind yourself during a panic that you have panicked many times before and nothing awful is going to happen.
• Use distraction, relaxation and slow breathing to help you get the panic to go away.
• Challenge your unrealistic thoughts during a panic, using some more realistic thoughts you have written down.
• Try not to avoid, escape or use safety behaviours, instead test out what really happens.
• Try to sort out any worries or troubles that you have by talking them through with a counsellor