I teach my teen and kid clients about the purpose of Anxiety. The amygdala is a part of the brain that sets anxiety in motion. It’s actually an Ancient Warrior trying to protect you.￼ Sometimes it becomes overly protective and gives you a turbo boost. This is fuel that is meant to keep you strong, fast, and powerful in case you need to take action.￼ Sometimes you need it, and sometimes just in case. We can work together on that ‘just in case’ part. ￼
A panic disorder is characterized by recurring panic attacks. These attacks are best described as moments of intense fear. Panic attacks differ from a typical fear response because there’s often no actual threat involved in the immediate vicinity. The body may be saying there’s danger, when in reality there may not be any threat present in the moment. For the person having a panic attack, the danger feels no less than if a predator is literally about to pounce on them. It feels REAL.
There are many panic attack warning signs to look out for, including some of the most common physical signs. Many people experience dizziness, body tension, gastrointestinal distress, shortness of breath, sweating or chills, ￼a rapid heartbeat, and trembling, during a panic attack.
A looming fear of death is another familiar feeling. While having a panic attack, many people feel like they’re not going to be able to make it through. ￼ Panic attack triggers aren’t always easy to identify, so people who have one attack often worry about having more, especially in public. Recurring panic attacks may lead to isolation and loneliness. Often, it may be difficult to leave the house.
What to do :
You Might Need to Get Help
If an individual requires emergency assistance, get help. Panic attack symptoms can be similar to heart attack symptoms. If they are experiencing chest pain and hasn’t had a panic attack before, you should call 911. While most panic attacks are short, some of them can last hours. One panic attack can lead to another.
Recognize the Symptoms
If you haven’t already, take some time to familiarize yourself with the early signs of a potential panic attack.
Panic attacks commonly begin with:
a feeling of terror or dread
hyperventilation or shortness of breath
feelings of choking
a pounding heart
dizziness and shaking
Panic attacks can be confusing as well as scary. People generally can’t predict them and there’s often no clear cause. They can happen in stressful situations but also during calm moments or even during sleep. Your ability to offer empathy and recognize their distress as real and significant is important.
Validate their distress
People often have a hard time sharing their experiences with mental health issues, including panic attacks. Some avoid talking about mental health issues because they believe others won’t understand what they’re going through. Others worry about being judged or told what they experience isn’t a big deal. But the response is real, and the person experiencing the attack can’t control it. An empathic response can be as simple as, “That sounds really tough. Let me know what I can do to support you.”
-reassuring them you won’t leave
-reminding them the attack won’t last
-telling them they’re safe
Stay Calm Yourself
People with anxiety are experiencing very intense feelings and symptoms during a panic attack. One easy way to help ground them through that experience is to remain calm. While you might feel scared yourself, showing that you’re afraid can worsen the person’s panic attack. Remaining steady by their side can help them stay present and know that they can get through what they’re feeling. They’ll feel protected knowing someone is there to emotionally hold them through this experience.
Help them stay grounded
Grounding techniques can have benefit for a range of anxiety issues, including panic attacks. These techniques help the person focus on what’s actually happening, not their fear of the attack. Remember that grounding can be highly personal for each person. Some people prefer to pace or move; others want to hunker down, often in a corner or curled up in a ball; some want to be outside, others don’t want to leave the room. I always tell patients to listen to what their body wants to do in that moment; it has wisdom.
Quick grounding tips
To help someone ground themselves, you can try:
-physical touch, like holding their hand (if they’re okay with it)
-giving them a textured object to feel
-encouraging them to stretch or move
-encouraging them to repeat a soothing or helpful phrase, like “this feels awful, but it’s not going to hurt me”
-talking slowly and calmly about familiar places or activities
-have them lie on the ground, floor, or grass; being close to the earth can be reassuring
After the panic attack
When someone chooses to tell you about their panic attacks, take this as a sign of trust. Many people feel embarrassed and vulnerable after a panic attack. ￼ It’s pretty common to worry about having a panic attack, especially in front of strangers, or believe the attack might annoy or inconvenience friends or loved ones.
To show respect for their experience and honor this trust:
-Respond with compassion. Be mindful of your words and actions, during an attack and at any other time. You might have all the best intentions, but it’s entirely possible to make someone feel bad without realizing you’re doing so.
-Don’t compare normal stress and fear to panic
-You might even have anxiety yourself. Avoid trying to draw comparisons between your different experiences.
-If you have experienced extreme fear, let that memory inform you. Remind yourself they aren’t just afraid or stressed. They may also feel helpless, unable to manage what’s happening, out of control, physical pain or discomfort. You might not intend to make your friend feel ashamed, but denying the reality of their distress can certainly have that effect.
-Avoid saying things like:
“Just relax. There’s nothing to be afraid of.”
“You’re upset over that?”
“What’s wrong with you?”
“Are you sick?”
“Did you forget your meds?”
-Don’t give advice
Not every coping technique works for everyone. Deep breathing and other relaxation techniques can have benefit, but they often help most when practiced regularly, not just during a panic attack. ￼ When these techniques are only utilized during moments of panic, they may wind up backfiring. Deep breathing can turn into hyperventilating and the mind may become too overwhelmed to focus.
In short, avoid telling someone how to manage symptoms.
Sure, you may have heard yoga, meditation, or giving up caffeine can help. But you don’t know what the person has already tried unless they’ve told you.
Listening and holding space with the power of your presence can go a long way.
Also see Ways to Stop a Panic Attack.
Equipoise. It refers to a balance of interests or forces. It doesn’t diminish the importance or impact of the other. These are just a few examples of how you can actively hold and honor opposing emotional experiences with therapeutic effects.
- Loneliness: Video call or meet with someone that you love and care about.
- Unneeded: Care for your companion animal. With affection, massage them, groom them, validate how special they are to you.
- Unwanted: Spend an evening or a full day nurturing yourself. Make yourself something nourishing to eat, curl up in your softest pajamas, watch a movie that brings you joy. See On The Power of the Self-hug.
- Anxious: Do mindful breathing to self-soothe, visual imagery, and progressive muscle relaxation. See our Anxiety Toolkit for more info.
- Not good enough: Remind yourself of your strengths. Coming soon – The Self Resume: The CV that Counts.
- Down/Blue: The Reboot: Call it a night. Or day. Sleep, watch your favorite movie or show, unplug. If you have to do something, focus on a mindless chore. Fighting our feelings is exhausting. Replenish first and come back to fight another day.
Equipoise, a momentary counterbalance with cumulative effects.
When you feel a wave of anxiety, these are tools that you can use wherever you are.
Your breath is your friend.
- Acknowledge to yourself that anxiety is occurring.
- Remember that you’ve dealt with this before, and you made it through.
- EXHALE a long breath. Yes, exhale. You’re letting it out first.
- Give yourself a self statement. I’ve done this before, and I will be OK.
- Breathe in deeply.
- Exhale. Repeat.
- Place your hand on your belly. Feel the air going in and out. You are solidly being there for yourself.
Deep breathing lowers your heart rate, reduces stress hormones, and lowers your blood pressure.
Your breath and you: Allies.
Also see: The Anxiety Toolkit.
- Make a list.
- Take a walk.
- Seek connection.
- Plan and prepare.
- Prioritize: conserve your energy.
- Take a nap; reboot.
- When you take out your trash, do a visualization: you are taking out the mental and emotional detritus of the week.
- Schedule worry time; put off worrying until ‘the worry hour.’
- Put together a playlist of songs that empower you. Only play it when you need a boost.￼ Music creates neural pathways.
- Meditate. Our breath is a natural anxiety reducer.
- Make post-its. Line them up. One row for immediate, one row for secondary. Throw them away as you finish a task.
Anxiety and exhaustion go hand-in-hand.
Anxiety is a feeling of fear, dread, or apprehension. It can be brought on by a stressful event or by the way you think about an event. Sometimes people feel anxious even when there doesn’t seem to be an external trigger at all.
When you perceive a threat, your hypothalamus, pituitary, and adrenal glands release a torrent of hormones to prepare you to fight, flee, or freeze. In response, you might feel any or all of these physical symptoms:
- quickened heart rate
- fast, shallow breathing
- dry mouth
- muscle tension
Reasons for Anxiety Fatigue
- Post-Anxiety Crash
One reason has to do with the crash you feel after your adrenaline runs out. The name for this phenomenon is adrenal fatigue. Anxiety is like being on high alert. Your body is preparing you to fight or flee; and so it is flooded with energy so that you can respond to a threat. Then, when that adrenaline runs its course, your body goes through a crash that can leave you feeling drained.
- Muscle Tension
Anxiety causes profound muscle tension throughout the day, and this often results in a similar drained feeling: your body feels tired. Many people who are anxious clench their jaw in their sleep, waking with headaches and facial pain.
- Mental Tiredness
Some of that tiredness is mental simply because your brain can run out of strength. Anxiety is linked to ongoing, stressful thoughts and an overactive brain. It taxes your cognitive capacities, leading to a drain on your ability to think and react. It also increases your emotional load, which means you can end up emotionally and mentally drained.
Becoming tired is sometimes a coping mechanism that your body uses to prevent you from experiencing severe stress. Tiredness motivates you to take a break and rest rather than exposing yourself to more anxiety, which could become even more overwhelming. Fatigue is an attempt by the body to reset itself.
Napping can help you overcome fatigue and reduce anxiety, making it a useful habit in many ways. But too much napping makes it harder to sleep at night, which in turn may increase your anxiety. Naps should ideally last less than 20-30 minutes to avoid sleep difficulties at night.
- Sleep Issues
Many people with stress and anxiety also develop serious problems sleeping, for instance, difficulty falling asleep, nocturnal waking, and reduced quality of sleep. All of this contributes to an overall lack of sleep, which causes tiredness.
Finally, anxiety can cause depression. Depression is linked to a huge loss of energy; and that makes it extremely hard to stay alert throughout the day.
- See also: Seven Subtle Signs of an Anxiety Disorder.
How to Manage Anxiety Fatigue
Protect your sleep fiercely: a cool, quiet, dark sleeping space, a regular bedtime, limited naps, and relaxation techniques are key, along with curbing your caffeine and powering down your screens an hour before bed. Even if you don’t get the ‘ideal’ amount of sleep each night, keep it consistent. Go to bed and wake up around the same time each day.
- Get regular exercise
Exercise reduces anxiety sensitivity and promotes healthy and restorative sleep.
Relaxation techniques like meditation and mindfulness can help quiet your mind, regulate your breathing, and lower the amount of stress hormones in your bloodstream.
Balance and allocate energy to the highest priority tasks can help cope with limited energy. Learning to pace ourselves and to manage our energy can be frustrating; it’s difficult when we don’t have the energy to do the things that we want or need to do. But it is an essential part of managing anxiety without burning out.
Whole, unprocessed foods, such as lean proteins, fruits and veggies, legumes, nuts, seeds, and complex carbs, can give you sustained energy. Foods high in saturated fat and sugar are associated with higher anxiety levels.
A psychologist or counselor may be able to help you identify your anxiety triggers and develop coping skills that lead to less anxiety and greater relaxation.
Talk to your healthcare provider or mental health counselor about whether symptoms may benefit from treatment with anti-anxiety medication.
Wake up at 7 AM.
Check day planner or calendar to mentally set the day.
Brush teeth and wash face.
Take care of companion animals and younger children.
Respond to important overnight texts.
Make bed, tidy room.
Eat healthy breakfast.
Write or journal.
Go for a twenty minute walk. Even just on your street.
Shower and get dressed.
The foundation holds up the house.
I’ve heard numerous comments recently that people are having trouble breathing, racing heartbeat, and deep fearfulness. Even without symptoms that we fear are from virus, these are very significant in their level of distress. Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms. Often people end up at the emergency room or going to their primary doctor because the experience can be very frightening. I am urging my patients to stay at home, or contact their therapist, rather than trying to go to the hospital.
Many people with panic attacks may have difficulty breathing, sweat profusely, tremble, and feel their hearts pounding. Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they make think they’re having a heart attack. Others have reported feeling like they are having a stroke. Other patients have told me of feeling electric currents in their body. Panic attacks can be very scary and may hit you quickly. People can often start feeling that they might have a panic attack and it makes them even more afraid. Anxiety is contagion.
Here are strategies you can use to try to stop a panic attack when you’re having one or when you feel one coming on:
1. Use deep breathing
While hyperventilating is a symptom of panic attacks that can increase fear, deep breathing can reduce symptoms of panic during an attack. If you’re able to control your breathing, you’re less likely to experience the hyperventilating that can make other symptoms and the panic attack itself actually worse. Focus on taking deep breaths in and out through your mouth, feeling the air slowly fill your chest and belly and then slowly leave them again. Breathe in for a count of four, hold for a second, and then breathe out for a count of four. Repeat.
2. Recognize that you’re having a panic attack
By recognizing that you’re having a panic attack instead of a heart attack, you can remind yourself that this is temporary, it will pass, and that you’re OK. Take away the fear that you may be dying or that impending doom is looming, both symptoms of panic attacks. This can allow you to focus on other techniques to reduce your symptoms. I have people create self-statement index cards to remind themselves that they survived panic in the past and they will get through this.
3. Close your eyes
Some panic attacks come from triggers that overwhelm you. If you’re in an environment with a lot of stimuli, this can feed your panic attack. Stimuli includes TV news, social media, and being around other stressed out people. ￼To reduce the stimuli, close your eyes during your panic attack. This can block out any extra stimuli and make it easier to focus on your breathing.
4. Practice mindfulness
Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening. Focus on the physical sensations you are familiar with, like digging your feet into the ground, or feeling the texture of your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to focus on. Some people have to go outside, and get some fresh air or walk around.
5. Find a focus object
Some people find it helpful to find a single object to focus all of their attention on during a panic attack. Pick one object in clear sight and consciously note everything about it possible. For example, you may notice how the hand on the clock jerks when it ticks, and that it’s slightly lopsided. Describe the patterns, color, shapes, and size of the object to yourself. Sometimes, I recommend finding a picture frame and counting the corners while you do your breath work. No matter where you are, there are objects on the wall that you can use to focus your gaze and your breath. Focus all of your energy on this object, and help your panic symptoms subside.
6. Use muscle relaxation techniques
Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible. Consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body. Muscle relaxation techniques will be most effective when you’ve practiced them beforehand. Progressive muscle relaxation or PMR is an important behavioral strategy that can be learned and practiced.
7. Picture your happy place
What’s the most relaxing place in the world that you can think of? A sunny beach with gently rolling waves? A cabin in the mountains? For me, it’s running on the beach with my dogs, breaking bread with my best friends, sitting by a bonfire or fire pit. Picture yourself there, and try to focus on the details as much as possible. Imagine digging your toes into the warm sand, or smelling the sharp scent of pine trees. This place should be quiet, calm, and relaxing. One client told me that he pictures himself in his mother’s very large clothes closet, because everything in it has her scent, and it soothes him.
8. Engage in light exercise
Endorphins keep the blood pumping in exactly the right away. It can help flood our body with endorphins, which can improve our mood. Because you’re stressed, choose light exercise that’s gentle on the body, like walking or stretching. The exception to this is if you’re hyperventilating or struggling to breathe. Do what you can to catch your breath first.
9. Keep lavender and sage on hand
Lavender is known for being soothing and stress-relieving. It can help your body relax. If you know you’re prone to panic attacks, keep on hand and put some on your forearms when you experience a panic attack. Breathe in the scent. You can also try drinking lavender or chamomile tea. Both are relaxing and soothing. Smudging using sage or Palo Santo can be very healing and calming. Nutmeg, in tiny amount helps promote sleep. Note: Lavender should not be combined with benzodiazepines. This combination can cause intense drowsiness.
10. Repeat a mantra internally
Repeating a mantra internally can be relaxing and reassuring, and it can give you something to grasp onto during a panic attack. Whether it’s simply “This too shall pass,” or a mantra that speaks to you personally, repeat it on loop in your head until you feel the panic attack start to subside.
11. Take benzodiazepines
Benzodiazepines may help treat panic attacks if you take one as soon as you feel an attack coming on. While other approaches to the treatment of panic may be preferential, the field of psychiatry has acknowledged that there is a handful of people who will neither respond fully (or at all in some cases) to the other approaches listed in above, and as such, will be dependent on pharmacological approaches to therapy. There is no shame in seeing your primary care doctor or psychiatrist, if you continue to struggle. Because benzodiazepines are a prescription medication, you’ll likely need a panic disorder diagnosis in order to have the medication on hand. They should only be used sparingly and in cases of extreme need.
12. Have an emotional coach buddy.
Somebody that you can call during a hard time who will literally talk you down.￼ It’s like a sponsor for your emotions.￼
People with abandonment issues may experience problems in relationships because they fear that the other person will leave them.
Signs and symptoms of abandonment issues in adults include:
- always wanting to please others (being a “people pleaser”)
- giving too much in relationships
- an inability to trust others
- pushing others away to avoid rejection
- feeling insecure in romantic partnerships and friendships
- a need for continual reassurance that others love them and will stay with them
- the need to control others
- persisting with unhealthy relationships
- the inability to maintain relationships
- moving quickly from one relationship to another
- sabotaging relationships
- lack of emotional intimacy
Individuals who experienced abandonment in childhood may find themselves drawn to people who will treat them poorly and eventually leave them. When this occurs, it reinforces their fears and distrust of others.
Signs and symptoms in children
In children, some degree of worry about caregivers leaving them alone is common. Separation anxiety is a normal part of development in infants and very young children. It typically peaks between 10 and 18 months and ends by the age of 3 years.
Separation anxiety and abandonment issues become a concern when the symptoms are severe or continue for a long time. In children, a fear of abandonment may manifest itself in the following ways:
- constant worry about being abandoned
- anxiety or panic when a parent or caregiver drops them at school or day care
- fear of being alone, including at bedtime
- frequent illness, which often has no apparent physical cause
- low self-esteem
- In severe cases, such as those in which a child has experienced the loss of a parent or caregiver, they
- may develop unhealthy ways of coping, such as:
- disordered eating
- lashing out at others, either physically or verbally
- sleep problems
When you feel abandonment anxiety rising, say this:
- They are busy
- They did not leave
- Space is healthy
- They do not always have to respond
- I did not do anything wrong
- It is OK
Also see the The Anxiety Toolkit.
Black and white thinking – also known as all-or-nothing thinking – splits your world neatly into one category or another. If you’re experiencing depression, it’s common to fall into black-and-white thinking. You might focus a lot on your perceived failings, what you should have done differently in a situation and not surprisingly you end up feeling low. Black-and-white thinking also plays a role if you’re experiencing anxiety. A panic attack can make you think about a situation as either completely safe or completely unsafe.
Why Thinking in the Gray is Important
- Black and white thinking can negatively impact your relationships
Your partner is the most wonderful person in the world — until they’re the worst. This cycle of love/hate, down/up, good/bad can be seriously stressful for any relationship. In some cases, these wild lows and highs can be a sign of something more serious, such as mental health problems. In family relationships and friendships, quickly changing from thinking a loved one is perfect to feeling they’re awful can erode intimacy and trust. By seeing your loved one as either all good or all bad, you’re not letting yourself see them for what they are: a normal, fallible human. See also How Mental Flexibility Helps Romantic and Family Relationships.
- Binary Thinking Leads to Poor Decisions
According to psychological research, thinking in binary terms can actually change the way we perceive the world, effectively conditioning us to miss nuance. In a 2016 study, Pomona College researchers found that participants’ perceptions of how someone was feeling changed depending on whether they were given black and white, or more fluid categories, to understand emotion. By conditioning a person to see things in more binary terms, black and white thinking can become a self-fulfilling prophecy, making it even harder to perceive nuance.
- It can signal a deeper problem
While everyone experiences black and white thinking to some extent, extreme black and white thinking can also be a symptom of mental illness. People with Borderline Personality Disorder, for example, experience intense black and white thinking, which can in turn affect their perceptions of their relationships with others and with themselves.
How to challenge black and white thinking
Shifting your thinking can be difficult but with the right support, you can learn some helpful strategies. Cognitive BehavioralTherapy (CBT) and Mindfulness based therapy are effective ways to address black and white thinking. It is a process where you are encouraged to replace unhealthy patterns of thinking and behaving with more helpful approaches. It certainly doesn’t happen overnight but with time and professional help, it is a very effective treatment.
How to Be In The Gray
Reframe your thinking. Catch yourself in the middle of a thought and challenge whether it is true or not. Are you really a terrible partner? Does your boss really hate you? Is your best friend actually ignoring you? ￼Is it more accurate to think: ‘I might not have been at my best today, but my partner loves me and I can work to communicate better.’ Or ‘My boss doesn’t need to constantly reassure me, they will tell me if there’s an issue.’
Words like ‘never’ and ‘every’ are not helping you. Catch yourself using ‘absolute’ words and rethink them as ‘sometimes,’ maybe,’ or ‘every now and again’. Acknowledge and accept that life is filled with uncertainty. You don’t have all the answers all of the time. It’s completely fine to say, ‘I don’t know, I need to think about that more.’