Tag Archives: panic attack

Panic attacks are not cool.

Panic attacks are not cool. Feelings can range from not being able to leave the house to believing you might die. From electric tingles, sweating, shortness of breath, flushing, heavy limbs, feeling like you might pass out, nausea, to a heartbeat that just will not settle down. The hardest part is the ‘no predictability factor’. It can sneak up on you.  People sometimes tell me, “there was nothing bad happening in the moment, it just hit me.”
No matter what, it feels absolutely terrible.

Wanting to know why is part of our nature as frontal lobe driven creatures. We don’t like unpredictability. What the heck is going on and what can we do to control it? What I always suggest is that Therapy has three parts: the crisis mode, the strategy building, and the fine tuning (editing and revising).

Being the pragmatic beings that we are, we often only respond to the urgency of the first part. The second one is really important. We build our skills and toolkits for WHEN bad stuff happens. Learning cannot happen as easily in crisis mode. Pack your tool kit to the brim.

Also see How to Help Someone Having a Panic Attack. 

How to help someone having a panic attack

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.”

Key Points
-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.

Ways to Stop a Panic Attack

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.

Embolden Psychology

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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