A panic attack is a sudden and intense experience of fear or terror that can feel overwhelming and frightening. It is characterised by a range of physical and emotional symptoms, that can vary in intensity, but generally reach their peak within minutes. Panic attacks are not dangerous, but they can be incredibly distressing, and understanding how they happen and what can help can significantly reduce their impact.
What Happens in the Brain During a Panic Attack
- Amygdala Activation: The amygdala is a part of the brain responsible for processing emotions, particularly fear. During a panic attack, the amygdala overreacts as though there is an extreme threat, triggering the body’s fight-or-flight response. This response is meant to prepare the body to deal with danger, but during a panic attack it is activated when there is no real threat.
- Fight, Flight, or Freeze: The amygdala initiates the fight, flight, or freeze response. This can manifest as a desire to attack, an urge to escape, or a feeling of being immobilised. These responses are caused by the activation of the sympathetic nervous system and a release of adrenaline.
- Physical Symptoms: The release of adrenaline triggers a range of physical symptoms. These may include a racing or pounding heart, sweating, trembling, shortness of breath, dizziness, nausea, chest pain, numbness or tingling, and hot flushes or chills. It can feel like having a heart attack or losing control.
- Cortical Influence: Whilst the cortex, the thinking part of the brain, does not cause panic attacks, it can make them worse by misinterpreting the physical symptoms. If the cortex interprets these symptoms as a sign of danger, it can intensify the panic. It is important to recognise that a panic attack is a biological reality and that attempting to reason your way out of it won’t help.
Tools and Techniques to Manage a Panic Attack
It can be helpful to understand that different tools and techniques can address different aspects of the panic response.
- During an Attack
- Do Nothing: When confronted with high anxiety or panic, one of the best things you can do is nothing. Doing nothing is faster than doing something.
- Close Your Mouth: When experiencing a panic attack, close your mouth and don’t interfere with your body’s breathing. Trying to breathe deeply through the mouth can increase the panic.
- Slow Breathing: Focus on slow, deep breaths, mostly with your belly, inhaling slowly, holding briefly, and exhaling slowly. This helps reduce hyperventilation and the over activation in the amygdala.
- Physical Relaxation: Tensing muscles can intensify a panic attack, so consciously relax your muscles. Muscle tension can increase amygdala activation and relaxing muscles can help shorten the duration of the panic attack.
- Diaphragmatic Breathing: Breathe slowly and deeply, mostly with your belly, taking 5 seconds to inhale, then holding it for 2 seconds, then 5 seconds to exhale, and 2 more seconds to hold your exhalation. Repeat for 10 breaths.
- Exertion: Exercise or movement can help burn off excess adrenaline that is released during a panic attack. Pace or exercise.
- Heartmath: Use heart focused breathing to breathe a positive feeling in through your heart and out through your solar plexus and down into your feet. Hold steady in the heart and say to yourself, “I can handle this. I know where this is going to go and it’s not worth it. I’m not going there this time.” Hold to that steady knowingness that you can handle it by going to your heart.
- Sensory Techniques: Use sensory input to shift the brain state, including touch, movement, sound or smell. Use havening techniques to create delta waves in the brain.
- After an Attack
- Self-Compassion: Be kind to yourself and recognize that a panic attack is a normal response to a perceived threat, not a sign of weakness. Treat your emotions as a normal part of your intelligence and cognition.
- Reframe: Change negative thinking patterns that exacerbate panic, and develop an attitude that things will go better than expected.
- Acceptance: Accept and allow the panic to run its course, rather than trying to fight it or suppress it. Accept that your body knows how to self correct.
- Focus Outward: Keep the focus outward, and engage in activities that are important to you.
- Problem-Solving: Switch focus from why you have the problem to how you can create solutions.
- Positive Reframing: When experiencing anxiety or panic, it is natural to shift your resources in that direction momentarily. What you do after that initial shift determines how successful you will be at managing it. Focus on what is positive or neutral in your present experience.
- Exaggeration: Write or talk about your fear and exaggerate it as much as you can.
- Distraction: Distract yourself from thinking by doing an activity you enjoy such as watching a film or doing a puzzle.
- Exposure: Expose yourself to your feared symptoms and situations in order to reduce the fear around them. Practice your feared symptoms until you are no longer afraid of them.
- Mindful Body Awareness: By using mindful body awareness, you can pull your mind out of the racing thoughts and spiraling emotions you experience during a panic attack.
- Relaxation: Practice relaxation techniques regularly, including meditation, yoga, or muscle relaxation, to promote a sense of calm. Create a relaxing routine that includes a bath, reading or a healthy drink.
- Identify Triggers: By understanding the common triggers and patterns of your panic attacks, you can be better prepared to manage them. Keep a record of your panic attacks to help identify triggers and gain more control over your emotional and physical reactions. This can include writing down what happens when you get anxious and when it happens.
- Healthy Lifestyle: Avoid stimulants like alcohol and caffeine that can increase sensitivity to panic attacks. Ensure you are eating well, sleeping well and are not sedentary.
Key points to remember
- Panic attacks are temporary: Panic attacks usually last from one to thirty minutes and will pass. They will subside without your interference.
- They are not dangerous: Although panic attacks feel frightening, they won’t physically harm you. They do not mean that you are dying, going crazy, or losing control.
- Avoid fighting it: Do not attempt to fight or control the panic attack.
- Avoidance is unhelpful: Resisting the urge to flee the situation and staying in it will help reduce the power of the attacks in the long run.
Summary
Panic attacks are an intense and frightening experience that originate in the over activation of the amygdala in the brain. This is the source of a strong stress response, leading to fight, flight or freeze reactions, as well as many physical and emotional symptoms. A range of techniques can help to deal with panic attacks during and afterwards, including deep and mindful breathing, physical relaxation, exercise, self-compassion, accepting the experience and identifying triggers. The core principle is to understand that panic attacks are not dangerous and will pass, and that by reducing avoidance and embracing self-compassion, it is possible to gain more control of the experience.