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.￼