Coping With Panic Attacks

Anyone who's had a panic attack will tell you how horrible they can be. Luckily they're actually one of the more treatable mental health issues. This article will cover some ways to understand and cope with them.

Description of a panic attack

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.

Panic attacks are bouts of extreme anxiety. They come on quickly, sometimes seemingly out of nowhere, but at other times in response to a stressful event or a particularly scary fear about the future. They usually don't last more than fifteen minutes, but you may feel jittery and drained for hours afterward.

The main psychological symptoms are intense fear, and a feeling that something vaguely terrible is going to happen, or that you're going to die, lose control, or go crazy. Your mind tends to think over your problems in a frantic way and jump to the worst possible scenarios. You'll generally dwell on how screwed, 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 main ones are rapid breathing, a pounding heartbeat, shaking, nausea/vomiting, tightness in the throat, chest pain, headache, dizziness, and hot flashes. Some people also got a freaky sense of everything being unreal or dream-like.

In terms of behavior, if you're at home or somewhere else that feels "safe" you'll just stop everything and focus on the anxiety. You may pace around or crumple into a ball. If you're out somewhere when the attack comes on, like a party or movie theater, you'll want to flee the scene.

All in all, panic attacks are 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

Someone'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 they have a panic attack it often catches them off guard. It's not uncommon for people to interpret their symptoms as a sign they're having a heart attack, seriously ill in some other way, or that they're going to completely mentally snap. It's pretty common for people to go to the emergency room 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 feels. They may still worry they're going to have a nervous breakdown or lose their mind. Basically, during the first panic attack or two people often take what's happening at face value and are afraid in the moment of what they think it all 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 two people usually learn what it is that actually happened to them, and realize they weren't having a heart attack or whatnot. Still, the episode felt horrible and now they're on edge out about it happening again.

They may become very anxious when they're in the situation where they first had a panic attack. Whenever they get nervous they start to wonder if another attack is right around the corner. They may start to steer clear of settings where they'd be "trapped" or embarrassed if they panicked (e.g., subways, crowded restaurants, driving in heavy traffic). 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 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 someone has to interpret those early sensations as concerning and dangerous. When they do this they get even more scared, which makes their symptoms even worse, which makes them more anxious. Things quickly spiral out of control until full panic kicks in.

Again, the process happens differently for first vs. subsequent panic attacks. The first time someone 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 they feel anxious enough or have 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! Not now! I can't do this!" 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. It's not a fun or easy process, but it can be done. There are many people who once felt debilitated by frequent panic attacks, but are now free of them.

That's not to say that if you're panicking because you're anxious about something going on in your life, then they'll suddenly have no reason to be stressed. 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, and they can be cut down.

Many of the ideas below also appear in this article on more general attitudes toward handling anxiety.

Realize that the symptoms of a panic attack are harmless

Panic attacks feel absolutely 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 really, really bad" thought that kicks off the process toward total 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 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 may help ease your mind. 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 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 amount of carbon dioxide in our bloodstream, which can cause symptoms such as dizziness, breathlessness, or a sudden feeling of heat on your skin.

Sometimes someone becomes anxious enough that it triggers a release of adrenaline or leads to rapid breathing from the get go. This brings on all the above-mentioned unpleasant sensations, which can trigger that "Oh no, this is terrible!" 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 awful and scary, and then that 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 toward 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. When people actually "go crazy", it's not by suddenly snapping due to nervousness. They slowly succumb to a longstanding mental illness like schizophrenia.

If you start to panic, try to 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. It's uncomfortable, but it won't kill me. I'll do my best to quietly 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. I know having this mindset is much easier said than done, but you can get there.

When it comes to this suggestion, there are two common analogies. One compares anxiety to a big wave that appears while you're swimming far 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 arms, and then pull your fingers out when the trap has fully loosened.

Use anxiety calming techniques, in moderation

Above everything else you want to try to accept you're panicking and be willing to sit with it until it dissipates. While you're waiting it's fine to try to actively calm yourself, as long as it's coming from a place where you're okay with your nerves, but wouldn't mind if they settled a bit. Again, when you try to forcibly relax with a struggling, fighting, non-accepting mentality, that can backfire.

The article below lists some strategies for coping with anxiety once it has come on, like deep breathing or distracting yourself. Of course, you have to practice and get the hang of some of these techniques beforehand. It won't do you much good to try a breathing exercise for the first time when you're terrified.

Coping With Anxiety In The Moment

Try not to engage with your worried thoughts

Some panic attacks feel horrible on a purely physical level. Often there's also an element of feeling like your life is going to fall apart too. When you're not creating images of how your future will go catastrophically wrong, you can want to think everything through and try to figure out a solution.

It's not always possible, but do your best not to get sucked into this anxious thinking. Remind yourself you're hyper-anxious and unable to think straight. There are times when it's helpful to counter your irrational thoughts with logic, but not when you're extremely nervous and unable to take in a rational perspective. Focus on quietly riding out the experience. Make a plan to consider your problems in more detail later when you've calmed down.

Remember no matter what you do the panic attack will end one way or another

If everything goes well the panic attack will be over in around fifteen minutes. Though even if it goes longer, and you do a bunch of things to accidentally extend it, know it will stop eventually. No one's ever had an unending panic attack. Your body can't physically maintain a state of high anxiety forever. It sucks when you're in the middle of an extended panic episode, but it be comforting to know it has to end at some point.

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

Longer term, work to develop a mentality where you don't care whether you have panic attacks

Panic attacks have so much power to shape our lives because they feel so awful we'll go out of our way to avoid them. We can also fear that if we have a panic attack around other people we'll horribly embarrass ourselves. A huge step you can make toward overcoming them is to change your attitude.

It's much simpler to read about than to do, but if you get to a headspace where you don't care if you have a panic attack, that can make them less likely to appear, because you're no longer anxious about whether one will happen or not. That means you don't mind if you feel physically unsettled, and you're okay with doing something like trembling or getting an upset stomach around people. You're generally at peace 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 on one level. 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 value and know you need to do, with the possibility of panic that goes along with it, rather than rearranging your life to avoid ever being anxious.

Accept you may just panic at times

Some people tie themselves in knots trying to completely control their panic attacks. It is very possible to experience significant relief from them, but there's always a chance 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.

Know 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 accomplish anything or interact with anyone. Extreme panic attacks can shut you down, but most of the time someone having one doesn't look that unusual. People can often function much more than they think they can. For example, sometimes they'll panic in the middle of a speech, but still finish it, with the audience none the wiser. Sure, ideally you don't care how you come across to everyone (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 influence.

Try not to 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 bodies. 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 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 can 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 lightheaded because you haven't eaten in a while?

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 can do this in the moment whenever an attack comes on. Instead of doing what you normally do, resolve to just sit there and observe what's going on in your body in a detached way. However it is 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 certainly don't feel great, you can put up with them until they pass on their own.

Another treatment, called Interoceptive Exposure, is to purposely bring on specific panicky sensations so you can practice getting used to them. Many people choose to do this under the guidance of a therapist. If you think you can handle it, you can also do it by yourself. You can bring on various panicky feelings, for example by spinning in place to make yourself dizzy, or breathing rapidly to make yourself hyperventilate. Once the sensations kick in you can then try being with them. If you do this alone, you'll want to ease into things gradually. That's just an overview, but more detailed instructions for this type of exposure are just a bit of research away.

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 you're worried enough about that you 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 specific fear or phobia. In this case a reliable long-term solution is to face it. You sometimes have to face two connected fears at once, the original thing or situation that scares you, and also your fear of panicking around it.

Possibly process any upsetting memories related to your panic attacks

When we go through an intensely scary, overwhelming event the memory of that experience can get seared into our mind. Later reminders of it can call up all the distressing feelings and beliefs we felt in that moment. When we've snapped back into the past and are replaying those emotions we temporarily lose access to our level-headed adult self. Panic attacks can most certainly be traumatic in this way. Even if you've used a mix of approaches to combat them, they may not fully resolve if you haven't dealt with the original trauma response they created. You can know on paper panic attacks are no big deal, but it won't help much if you're cut off from that knowledge in the middle of a low-grade flashback to the evening you were convinced you were going to drop dead because your heart was beating so fast. You can process the memories of your worst panic attacks and drain them of their tripwire emotional charge. You can do this with a trauma therapist if the thought of attempting it alone seems too intimidating.