Panic attacks can be sudden and overpowering. They can affect anyone and may be caused by general anxiety, panic disorder, or depression (Medical news today).
You’re probably reading this because you’ve experienced or you’re still having anxiety/panic attacks. I know when I was suffering from them, I tried absolutely anything I could think of because I was so desperate.
I couldn’t sleep for days on end because of the panic attacks. I experienced most of the common physical symptoms of anxiety: muscle tension, headaches, backaches, a clenched jaw, feeling keyed up, restless, and “on edge”, as well as difficulty concentrating. These symptoms are a side effect of our body’s attempts to protect us; blood moves around our body and brain, into our large muscles, like our arms, legs, back, and neck, to get us ready to ”fight” or to “flee.”
Eventually I became psychotic (you may want to read about it here) . After only three or four nights without sleep, anyone can start to hallucinate (a psychosis or a psychotic episode is not schizophrenia).
When we experience anxiety/panic, the first thing that happens is our senses observe our environment, and we feel that rush of cortisol in our brain as the fight-or-flight mentality begins to set in. This is something humans have evolved to do to be able to sense danger and respond quickly, which is why it all happens in a matter of seconds (Sal Raichbach, Ambrosia Treatment Centre). This means we need to feel some kind of anxiety in response to danger i.e. if a car was thundering towards you, you’d feel anxious and try to get out of its way.
We obviously realise we are panicking and that’s all we can think of in that moment. We don’t automatically think OMG, why am I panicking, do we? We just think OMG I’m panicking. Let’s have a look first at the onset of anyone’s anxiety/panic attack. Something happens, something causes the panic attack to start.
Only you will know how your anxiety/panic attack starts, though you may not even be aware of it – yet. So now we’ll learn the mechanics of how a panic attack begins. It might start with:
(1) negative thoughts i.e. “I’ll fail all my exams”, “I’m always going to have panic attacks”, “I shouldn’t have shouted at the kids this morning, I’m such a bad mum/dad” or “I’ll get thrown out of my home cos I can’t pay the rent” etc.
(2) negative physical feeling i;e. stomach churning, heart palpitating, sweating, dry mouth, shaking, nausea, vomiting.
(3) negative emotional feelings i.e. sadness, fear, disgust, shame.
(4) negative behaviour i.e. stealing your friends medication, isolating yourself, turn to alcohol or illicit drugs.
So, let’s clarify – a panic attack could start after -thoughts, -physical feelings, -emotional feelings or -behaviours
Let’s take a look at the following diagram, used in Cognitive Behavioural Therapy (CBT), which is the psychological treatment of choice recommended for a variety of mental health problems by the National Institute for Health and Clinical Excellence (NICE).
Look at how our thoughts, feelings and behaviours all interact with each other.
For example: the -behaviour was to overeat, stop dieting or eat unplanned food which evoked -thoughts i.e. I’m so weak willed and this led to -feelings i.e. depressed, ashamed which, in turn perpetuated the -behaviour i.e. continue to overeat because you’ve blown the diet anyway.
Still looking at the diagram, see how you can turn this on it’s head and you may have the -feelings first i.e. depressed which led to your -behaviour of overeating, after which you had -thoughts i.e. I’m such a pig, I can’t even stick to a diet.
I’ve only used the above as an example. However, it doesn’t matter what the issue is, this CBT model can be used for all negative thoughts, feelings and behaviours. Let’s take a look at another issue:
We’re still looking at the links between -thoughts, -feelings and -behaviours; it’s just the issue itself, example above, will be different and personal to you.
I’m going to share a little known fact with you here. Just have a think for a moment. What has previously or what would make you feel really excited (and I don’t need to know)? Don’t read any further until you’ve got that thought!
Now, you might absolutely love or hate roller coaster rides and, depending on how you feel about them, your thoughts or feelings might have started to kick in when you saw the photo. If you hate them, you might be thinking “yuk, I hate roller coasters” (-thought) or your stomach may have turned over at the sight of the picture (-feeling). If ever I saw a spider, even on a page – it made me anxious and I had to turn the page quickly (-behaviour).
While I’ve just made you think about whether you like roller coasters or not – that wasn’t really my whole intention. I wanted to distract you from reading any further until you’d thought of what has or would excite you. I hope you’ve been able to think of at least one event, occasion, gift or …………
Do you remember what it felt like to be so excited? Think about that for a few seconds………
Did you ever get that butterflies feeling in your stomach? Have you ever felt shaky and tearful when someone gave you a lovely surprise? Did your heart ever pound with excitement pre-Christmas or your birthday party? I really hope you did – because I would feel really sad for anyone who had never experienced any of these sensations.
Here’s the little known fact -both excitement and panic/anxiety involve the same chemical process in the brain. That’s because anxiety and excitement are both aroused emotions. In both, the heart beats faster, cortisol surges, and the body prepares for action. In other words, they’re “arousal congruent.” The only difference is that excitement is a positive emotion‚ focused on all the ways something could go well (Alison Wood Brooks, a professor at Harvard Business School).
When we feel anxious/panicky, we’re most likely to tell ourselves to just relax or calm down. But this might be precisely the wrong advice, Brooks said. Instead, the slogan should be more like, “Get Amped and Don’t Screw Up.” In other words, it’s so much easier to convince yourself to be excited rather than calm when you’re anxious.
So, if you could retrain your mindset, rather than saying/thinking “OMG I feel anxious about my driving test”, try saying “I feel excited about my driving test”. It boils down to telling yourself that you feel excited whenever you feel nervous. It sounds stupidly simple, but it’s proven effective in a variety of studies and settings. Try it.
The excitement reappraisal won’t actually make you less anxious, nor will it lower your heart rate. That’s because your underlying anxiety is the same—it’s just reframed as excitement.
The way this works, Brooks said, is by putting people in an “opportunity mindset,” with a focus on all the good things that can happen if you do well, as opposed to a “threat mindset,” which dwells on all the consequences of performing poorly.
Okay. We’ve looked at anxiety and panic attacks so, what can we do about them? Right at the start, when you have the initial -thought i.e. when you wake up and you think “Oh, no. I feel yuk about today’s presentation” or you have a -feeling i.e your heart starts to race:
Stop. Take stock of the situation. Try “Oh, I’m excited about today’s presentation”, “I’m excited that my driving test is today”or “I’m excited about my interview today”.
Accept and recognise: You might have experienced panic attacks in the past. During an attack, it can help to remember that it will pass and cause no physical harm, though they are unpleasant. Acknowledge that the attack is a brief period of concentrated anxiety and that it will end (Medical news today).
Learn what triggers your anxiety/panic attack: it may be crowds or small spaces etc.
Do an evidence-based breathing technique like Slow Diaphragmatic Breathing:
- Sit comfortably in a chair with your feet on the floor. You can lie down if you wish.
- Fold your hands on your belly.
- Breathe in slowly and calmly. Fill up the belly with a normal breath. Try not to breathe in too heavily. The hands should move up when you breathe in, as if you are filling up a balloon. Avoid lifting the shoulders as you inhale; rather, breathe into the stomach.
- Breathe out slowly to the count of “5”. Try to slow down the rate of the exhale. After the exhale, hold for 2-3 seconds before inhaling again.
- Work to continue to slow down the pace of the breath.
- Practice this for about 10 minutes.
This works best if you practice this two times each day for 10 minutes each time. Try to find a regular time to practice this each day. The more you practice, the easier you’ll find it to use when you most need it.
Try Relaxation; this happens when the body stops trying to protect us, which helps us feel more calm and at ease. Relaxation skills are like exercise! Imagine a friend of yours telling you that she is planning to train for a 10K race. Despite the fact that she has never run a race before and does not jog regularly, she tells you her training will consist singularly of practicing running the full 10 kilometers on the day before the race. What would you think about this?
We know that the body needs time to learn how to run for long distances and build strength. She would need to practice at least a few times per week for a number of weeks to be ready. Relaxation skills are developed just like exercise: in order to see significant results, we must use them regularly over long periods of time. This is not a one shot deal (medicine.umich.edu). Each person is different as we all relax in different ways:
- Find a relaxation exercise that you can practice daily or multiple times per week.
- Increase awareness of tension in your body and improve awareness of the difference between tension and relaxation – remember, your body can’t be tense and relaxed at the same time. Choose relaxed over tense. Let your shoulders drop down, away from your ears, unclench your jaw by doing a few facial exercises and breathe.
- Progressive muscle relaxation, yoga, mindfulness, and deep breathing.
- Adjust your lifestyle to make it less busy, hectic, and rushed.
- Take part in activities that give you pleasure, make you feel competent, or give you a chance to take a break from other, more stressful activities.
Try sniffing Lavender which has long since to relieve anxiety and evoke calmness.
Limit stimuli i.e. switch the tv off, perhaps close the curtains to reduce outside noise and distractions.
Try Mindfulness – there are a variety of exercises (not just breathing) you could try.
I know Mindfulness isn’t for everyone but many people benefit from it, myself included. So much so that I attended certificated courses and am now able to teach Mindfulness. I have to admit, I don’t practice it as much as I did in the beginning and my son reminds me to use these techniques more often.
See your GP. Some people avoid getting needed medical assistance because they fret that the GP will think they are silly or petty if they report anxiety. If anxiety regularly impacts your life, contact your doctor. Medication might be needed initially, but this doesn’t have to be long-term. Speak with your GP.
Panic attacks can be frightening and disorienting, especially the first time. Symptoms can be similar to those of other health conditions. Seek medical advice if:
- a panic attack lasts longer than usual — most last between 5 and 20 minutes
- a panic attack is noticeably worse than usual
- panic attacks are inhibiting your life, possibly by stopping you from engaging with others, socialising or working
Cognitive Behaviour Therapy, is a talking therapy which is clinically proven to help treat a wide range of emotional difficulties. This form of therapy is centered on identifying and changing inaccurate or distorted thinking patterns, emotional responses, and behaviors. Speak to your GP and ask for a referral to a CBT practitioner. There’s often a lengthy wait so, in the meantime, you may want to try some of the other suggestions mentioned.
Anxiety and panic attacks are very real and they tend to get worse over time, particularly if you don’t do anything to alleviate the symptoms. You wouldn’t be able to drive a car without practice so please understand that you need to practice the techniques regularly.
You might find another post of mine “Strategies to help relieve your stress” helpful too. Click here.
Have you learnt anything you didn’t know previously? Have I missed anything?