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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Other topics you may be interested in:

13 Beliefs to Disbelieve 
   
The downward spiral: the fastest way down!
     
Staying motivated when depressed. 5 ways to fight the sludge of depression/anxiety!

Sleep, Insomnia and Anxiety  




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 

Driving Anxiety: How to cope when you're going over 100km/h!

We all know driving is dangerous, but we casually get into our cars and drive everyday without thinking more than once about safety - putting on our seatbelts, checking mirrors, and we're off to work, or school, etc.

Until you feel that sense of uneasiness welling up from your stomach, or the fog and pressure building in your head.... Maybe you feel too hot, or cold.... Maybe your vision starts blurring and you start sensing the worst.... And then you end up in a full-blown panic attack, speeding down the highway in a giant metal weapon.

Having panic attacks is extremely rough and having them while in control of a vehicle is monumentally worse.

I have some tips for those of you conquering this issue in your life right now:

1) Deep-breathing techniques

If you perform some deep-breathing you might find that your physiological response tones down enough that you can actually reduce the panic feeling and retreat from the edge of the full-blown panic attack.
If not, at least you will be able to calm yourself sufficiently to pull over.

2) Distracting yourself:
-by adding numbers on license plates you see
-really focusing on what other people in their cars are doing
-talking to yourself, or using a hands-free device to call your friends or parents (or if you are secretive about your panic, your local crisis line). Sometimes just talking with someone, about anything or your particular situation, is extremely helpful for distracting you from the physical or mental stimulation that was pushing your anxiety.

3) Have some snacks and water on hand. Eating a few bites of apple or some popcorn or veggies might help you to refocus yourself, while giving you a bit of nutrition.

4) Track your panic - see if you can find a root cause or causes. If it happens around the same time of day or on the same stretch of road, try to prepare yourself by knowing that it will likely be rough but because you have made it through before, you will again, and again. Gradually, through exposure, and pure Conqueror-spirit, you will be able to drive through those tough spots.

5) Are there other things in your life that you are ignoring or repressing? Relationship or school/work issues? These may be making themselves known in the form of panic attacks in stressful (ie: driving) situations. If you haven't already, talk to a close friend or relative about what's going on for you. If that doesn't help, or doesn't help sufficiently enough to reduce your anxiety, see your doctor or a local counselor.

6) Finally, if these practical approach tips aren't working for you, speak with a local counselor or your doctor about other ways you can manage your anxiety while driving. It may be helpful for you to try some herbal or pharmaceutical anti-anxiety medications.

While you are working out what methods will work the best for you, you can always take the bus on days when it just absolutely won't work for you to drive. Try to find a carpool for your work or school; this will allow you to be more productive on the way to and from work, as well.

Note: I do not advocate avoiding anxiety-triggers, as that will only compound the problem; however, I do advocate remaining safe while figuring out what is best for yourself in these hard times.
If it is for you to carpool or bus while you practice driving at night or on the weekends, then do so.

Be safe, stay calm and Conquer on!



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The nervous system

 Our nervous system has two major divisions: the voluntary and autonomic (involuntary) branches. The autonomic is comprised of the sympathetic and para-sympathetic nervous systems. These systems modulate the heart rate, digestive processes, and blood pressure. Either one or the other system is active most of the time, as they are antagonist systems. This means they can’t function at the same time.

Because the sympathetic nervous system is concerned with survival, its activation takes precedence.

The sympathetic nervous system is triggered during states of panic or anxiety, we get a rush of adrenaline into our body and an entire cascade of events occurs to prep your body to fight or flee for survival.

This includes shunting of blood from the digestive organs to the muscles and brain. Both heart rate and blood pressure increase. We may also notice an increase in perspiration.

All of these changes would assist us in a situation where we have to fight or run away from danger. It’s an extremely impressive evolutionary adaptation that serves us well in emergencies, however, when the “emergency” you are facing is not life-threatening, or not even dangerous (like shopping in a crowded grocery store), then it is no longer a positive reaction in your life. This is also the system involved when we find ourselves in a panic attack.  

            What many sufferers of chronic anxiety may experience is a persistent fatigue or tiredness. If the sympathetic nervous system is activated for extended periods of time, the adrenal glands can become stressed, overworked. Also, other organs involved in the process can become tired and our bodies enter a state of ‘depression’. So it’s not uncommon to find people who suffer from anxiety eventually find themselves coping too, with depression.

The other part of the autonomic system is the parasympathetic nervous system. It is in command of relaxation responses and processes (like decreasing heart rate and respiration rate; and promoting digestion and repair of tissues). Just as this system automatically takes over during periods of relaxation, we can trigger its presence during stressful periods by practicing mindful, deep breathing.

Conquer on!

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Other topics you may be interested in:

13 Beliefs to Disbelieve 
   
The downward spiral: the fastest way down!
     
Staying motivated when depressed. 5 ways to fight the sludge of depression/anxiety!

Sleep, Insomnia and Anxiety 

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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Sleep, Insomnia and Anxiety

            Insomnia is defined as: trouble falling asleep or staying asleep through the night¹. Its time-frame may be episodic (comes and goes), short-term (3ish weeks) or chronic (long-lasting).   There are many potential reasons to experience insomnia, but many relate to anxiety. It can take someone the better part of a few years to get their night-time anxiety under control. For some, their anxiety peaks in the morning, when the body’s level of cortisol is highest. For others, while they may experience this cortisol-peak physiologically, their anxiety isn’t affected by it nearly as much as the thoughts regarding falling BACK to sleep later that evening...

          

        It’s a vicious circle.

           
             The problem with anxiety-caused insomnia is that it’s not only the thoughts about potential important events, or maybe even about the insomnia itself, it’s about environmental triggers that you have unwittingly conditioned your body to react to. Your bed, for one, is a very powerful physical trigger – ever notice that as soon as you lie in it you are likely to start feeling drowsy? That’s because your body knows this is where you sleep. The problem comes when your body and your brain knows that this is where you do most of your “freaking-out”...

            Another physical conditioning effect that many parents try to instill in their children is a nighttime routine, also known as “sleep-hygiene”. In order to ensure you have the best sleep possible, there are a few general rules to follow. At this very moment, I am violating one of the main rules of good sleep hygiene: I am working in my bedroom, lying on my bed. That’s a sleep no-no.

            Your bed should be for sleep and sex. That’s it. Take your homework to the table. There is so much power in physical conditioning that your sleep-quality is affected, even if you don’t have insomnia. Another thing is that around an hour before you are planning to lie down for the evening you should begin to wind down your mind. Turn off the TV, computer or any electronics (music is okay), and write in your journal, do some stretches (nothing vigorous, you are going to sleep soon), and maybe read a little bit of a book (nothing too exciting, you don’t want to get your brain fired up). The idea here is to get a routine established. Usually about an hour to wind-down before bed works for me, when I do practice good hygiene.

            The most important thing is to establish good sleep-hygiene as a routine - it will serve you well. You will definitely begin to notice your sleep-quality decreasing the less you maintain your nightly habits.

            There are a few ways to get yourself ready for bed in addition to drinking a glass of warm milk or having a nice, hot herbal-tea.

            Melatonin is a hormone in the brain that signals it’s time to sleep. Our bodies make it naturally (the pineal gland in the brain), and it is triggered by darkness. It can be obtained in pill-form, kind of like a “vitamin” from most grocery stores, and virtually all pharmacies. There are varying doses, but 3mg is fairly standard. If you are thinking about trying melatonin for your sleeplessness I would suggest reading the information available on the packet before-hand and definitely consulting your doctor. There are potential allergic reactions, and side-effects that you will need to be aware of.

            Deep, abdominal breathing is a great way to relax your body as you prepare to sleep. It begins with inhaling slowly and intentionally from your belly. Don’t let your chest rise while doing so, and exhale through your nostrils. Focus on making your belly rise and fall with each breath. You can count your breaths, from 1 to 10, and then start again back at 1 with each breath. The idea here is to focus the mind on something other than what you are thinking, and because this deep-breathing slows your heart rate (it’s a physiological reaction) it actually calms your nervous system down so that over time your anxiety should decrease, and with it, your thoughts should clear a bit. Of course, however, like all things, this takes practice to master. So while you may not feel relief the first time you try the deep-breathing, if you are consistent in your nightly routine, you will start noticing the calming effects. I will write more, detailed descriptions of deep-breathing and provide some exercises and visualizations in an upcoming article.

Thank you for reading.

                                         Conquer on!

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