Coping with panic attacks - What to do to help yourself or a loved one calm down

Your heart is pounding, your vision is blurring and your breathing is rapid... You feel like you are dying...

If you've ever had a panic attack, you know how terrifying they can be. If you have never had the experience, consider yourself lucky.

Panic attacks typically are self-limiting and short in duration. The usually develop and peak suddenly, their intensity reaching the highest level within ten minutes and then abating. Someone experiencing a panic attack may feel their heart bouncing around in their chest (palpitations); may feel sweaty or shaky; might feel like they are choking or can't breathe; and may feel disoriented or dizzy as well as an intense amount of fear¹.

Today a friend of mine had a panic attack unexpectedly (as they usually are "out-of-the-blue") and I happened to catch it and help them calm down. I want to offer some tips to those of you who experience panic attacks or have loved ones who do.

Generally the first thing you want to do is control your breathing, as calming your physical self down will help to short-circuit any of the "fight-or-flight" responses occurring in your body. If you are having a panic attack (or your friend or family member is), get into a comfortable position and relax the body and focus on proper breathing. I quickly knelt by my friend and got them to a chair. I told them to focus on their breathing and breathe in through their nose and out their mouth using only their belly. I kept eye contact with them and held their hand and breathed with them.  It is hard to think during a panic attack so if you can be the guide for breathing, it is much easier for the other person to follow; also, if you are helping someone else, it is important to keep calm yourself.

If you are alone when panicking, it may help you to call a friend/family member to help you breathe or talk through what you are feeling while focusing on breathing (but be safe! If you are panicking while driving, pull over and make the call or use a hands-free device). If you can't call anyone find a comfortable spot and begin your breathing exercise. Distraction works well in this case - video games, movie, music, writing. Anything to get your mind off the feeling of fear or the physical symptoms you're experiencing. If you continue to breathe correctly your anxiety should subside. If it doesn't, there are help-lines to call and the operators will be able to assist you.

Once you've regained control of your breathing and are in a safe place to relax, you can work on progressive muscle relaxation (PMR) exercises (especially if you are prone to panicking before bedtime). This will bring the anxiety level down even farther. The slow and controlled breathing is an important first step and might help you come completely out of an attack or might just bring you back to a manageable level of anxiety; but the PMR exercises can really help you get centered again, especially after a panic attack. It all depends on your base-line anxiety levels.

If you are noticing that you are having many anxiety attacks in a short period of time or that they are getting worse or your work/school/relationships are suffering you should speak with your doctor. There are many helpful therapy programs (CBT especially) as well as medications that can help you manage your anxiety. It is not a weakness to reach out for help when you need it.


List of crisis lines*:

https://www.lifeline.org.au/  (Australia)
http://suicideprevention.ca/thinking-about-suicide/find-a-crisis-centre/ (Canada)
National Suicide Prevention Lifeline toll-free at 800-273-8255. (USA)

*if your country is not listed, a quick Google search should help you find one in your area.




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¹  Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE: The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication.
Arch Gen Psychiatry 2006, 63:415-424. PubMed Abstract | Publisher Full Text | PubMed Central Full Text 

Progressive muscle relaxation

Many of you may have heard of this before, and many of you may be completely new to this subject.

Progressive muscle relaxation (PMR) is a technique involving the tensing and relaxing of various muscle groups as a way to relieve stress and induce relaxation. PMR was developed in the 1920’s by Edmund Jacobson.

The theory behind the practice is that because muscular tension accompanies mental anxiety and stress, then the opposite (loose, relaxed muscles) will induce relaxation.

In order to properly begin a PMR session – find a comfortable sitting or lying position where you will be undisturbed for 20-30 minutes. It is also nice if you have some soft instrumental music playing (nothing too exciting, just something relaxing).

As with the deep-breathing exercise, I want you to close your eyes.

You may start the breathing exercise as a warm-up for the PMR. Ideally, if you can maintain your breathing during the PMR you will find the most benefit, but in the beginning, do not be discouraged if you find yourself unable to maintain your breathing patterns. This will come with practice.

As you lie or sit there with your eyes closed I want you to feel your body. This may be frightening, as you might be feeling very anxious and focusing on the feeling of your body may exacerbate this, but bear with me.

Next, tighten up all the muscles in all parts of your body and hold for 10 seconds, maintaining your deep-breathing, in and out.

Then release all the muscles of your body, focusing on the warmth and heaviness of them as they relax from the tension. Feel the stress releasing as you relax your muscles.

Do this body-tensing 2 or 3 three times.

Next, after the last relaxing, tense only the muscles in your toes, then your ankles and calves, then your thighs, your hips and butt, your hands, forearms, upper arms, stomach chest and face muscles. Hold this tension for 5-10 seconds. Then slowly release all of those muscles in the backwards order – face first, chest, stomach, hands and arms, then finally thighs and lower legs.

Do this 3 or so times. Finish again with 2-3 full body tenses and relaxes.

Focus on your breathing for another 5-10 minutes, practicing deep, belly-breaths.

The key here is not to rush the tension and relaxing. Slower is better.

You should feel more relaxed after this exercise, but if you are new to breathing or relaxation exercises, you might not feel much different. However, with practice, relaxation will be attainable. You will find yourself eventually doing these tension and relaxation exercises subconsciously in stressful periods.

If you would like to read more about mindfulness and relaxation read this article on thought-monitoring and this one on practicing mindfulness as ways to centre yourself during stressful periods!

Conquer on!

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Breathing

Most people never pay any attention to their breathing. It just happens.

"I’m still alive so there I go..."

But breathing is so much more important that many people realize, and breathing properly is something that has to be re-learned as adults a lot of times because we pick up bad breathing habits like shallow, chest-breathing instead of deep, belly-breathing.

I know this sounds bizarre, but trust me. Breathing is very important in order to attain and maintain a relaxed state.

It is especially effective when combined with progressive muscle relaxation.

In order to breathe “properly”, choose a quiet spot – preferably one where you can lie down. If you cannot lie down, sit comfortably in a chair of your choice.

Place one hand on your belly near your navel, and one on your chest near your sternum.

Close your eyes and inhale through your nose by expanding your belly, ensuring your chest doesn’t also rise – you can tell by whether your chest-hand moves up at all.

Exhale slowly out of your mouth, letting the air find its way out – do not force it out, just let your belly fall.

Concentrate on keeping your breaths even and slow – focus on the air moving through your nose and into your lungs, feel it energizing and calming your body, and feel the stress or anger flowing out with it as you exhale.

Practicing deep-breathing is important for calming yourselves during anxiety and panic, as well as re-energizing and relaxing after a long day. It is also helpful for centering oneself when spiraling into depression. It may not lift your mood but you will at least feel more centered after a breathing exercise.

I have underscored the importance of proper breathing a few times already without ever really explaining the mechanism behind why this is such a powerful tool to be using to reset ourselves during anxious periods. Please read the information in this article for more details about the systems behind why breathing helps calm us down during times of stress and anxiety.

Conquer on!

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