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 

Give yourself a break! 10 signs it's time to put your feet up!

Photo credit to Conquer The Clouds (Trees of the Cloud Forest, Oaxaca, Mexico)

Sometimes you don't know when it's time to stop and relax. Take a small break to recharge. You all have an inner feeling about when things are too much, or overwhelming, but some of you just ignore these feelings and press on. The problem with forcing yourselves to go on even though you feel your emotional resolve weakening is that it makes you vulnerable to anxiety and depression. Letting yourselves take a break from your daily routines, a challenging project or task is healthy and will let you return with more vigor afterwards.

Here are 10 signs you may be exhibiting that signal it's time for a break (even just a little one). 
 
1. You're drawing blanks.

You can't seem to think straight, everything seems like a blur and you're frustrated. You have too many things on the go, and piling more on or pushing forward might be detrimental to your end goals. This is a definite sign you are overwhelmed and nearing a breaking point.

2. You're not scheduling sleep into your life. 

Cliché but, even Rome wasn't built in a day. You need to sleep in order to have energy to do the things you want. Sleep is the most basic restorative state you can enter. Denying yourself enough time to sleep and recharge your body is setting you up to fail as your energy wanes. If you aren't getting enough sleep because of insomnia then it could be a sign that you are overworking yourself.

3. Friends are something other people have.

I posted a while back about the power of friends as a buffer for low moods. These friends won't help you stay out of the gutter if you don't make time to see them. It's not a threat, just a reality. This is a sign that your life is out of balance and you need a break to re-connect with the people you care about. Even a quick coffee or lunch can make a big difference in your mood and energy levels.

4. You aren't taking the time to eat or nourish yourself.

If most of the crumbs from your daily meals are landing in places like your computer keyboard or between your car seats, or you find you don't even have time to eat, then you know it's time to slow down. Savouring a healthy meal and taking the time to appreciate the flavours goes a long way to preventing burnout. I'm not saying you should sit at the table, then proceed to shovel food into your mouths and then run off again, but actually taking thoughtful bites of each food and being present in the moment.

5.  You're not scheduling FUN into your life.

This one is a hard one to swallow... FUN is a nasty three-lettered word for overachievers and work-aholics. The very thought of spending time doing something enjoyable can feel scary to some who aren't used to taking a step back, taking a few deep-breaths and enjoying life. But if your life has gotten to the point where fun is being omitted on a regular basis, there is going to be a problem. This also goes for people suffering depression. In depression, the "fun-button" gets worn out and doesn't work anymore, things are really bleak and negative. But fun won't happen if you don't schedule something "fun" into your life. You may not have fun, but the trick is to just get into the habit of scheduling enjoyable activities in your life. Eventually you will start to feel a semblance of pleasure, and then start looking forward to those activities.

6. You aren't making time for exercise and fresh-air.

 Your schedule is so packed you go from one place to the next until you come home exhausted, fall into bed, all without ever going outside for a walk or a run or whatever sports you might enjoy. Combine this with number 4 and you have a recipe for disaster. We are animals and we need to move. Getting outside for even just a short brisk walk is enough to reap the benefits of our naturally-occurring feel-good chemicals: endorphins!

 7. Your body is starting to fall apart.

Your muscles are tense and painful, you're getting headaches frequently, or your stomach is constantly in knots. These are real physical signs that you're pushing too hard and need to slow down. If your days are plagued with physical ailments that are likely resulting from your hectic lifestyle, you definitely need a break it may be time to speak with your doctor about the effect of your stress on your body.

8. Your friends are telling you you're too busy.

Our friends and family often see situations more objectively than we do. If you are noticing that friends and family are saying things like "we never see you anymore" or "you're always too busy", then it's likely they're expressing true concern. Take note of their comments and re-assess your priorities.

9. You miss bill payments.

Your home office (or your kitchen counter!) is starting to look like a paper-version of Jenga... only with much more at stake than just a messy floor. Your bills are piling up and you haven't made time to sit down with them, crunch the numbers and get your finances in line. This is a costly side-effect of being too busy and not taking the time for all our obligations. It's also likely that your feelings of being overwhelmed make it hard to think about starting this task as well.

10. You're wishing for a snow-day.

The alarm goes off and the last thing you want to do is leave the bed. It could be the middle of July, but you're lying there wishing for a snow-day. Your brain is overwhelmed, you're dreaming of staying home, cuddling up on the couch to watch a movie, or clean your bathroom and have a tea. Whatever it is that you're dreaming of, it's a sign you need to take that well-deserved break.

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Other topics you may be interested in:

Progressive Muscle Relaxation

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Motivating and encouraging statements - Help yourself stay above the water!

Staying Motivated When Depressed; 5 Ways to Fight the Sludge of Depression/Anxiety!

 

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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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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