Immediate Actions:
- Acknowledge and accept the panic. Understand that your brain is reacting to a perceived threat, and that it is a normal bodily reaction to stress. Don’t fight or resist the feelings, as this can make things worse. Remind yourself that the panic attack is temporary and will pass without your interference.
- Stop what you’re doing. You may need to stop your current activity to focus on being non-reactive to your thoughts and sensations. If you are driving, pull over.
- Breathe, but don’t over-breathe. Avoid trying to take deep breaths through an open mouth, as this can worsen symptoms. Instead, close your mouth and allow your body to breathe naturally. Some sources suggest slow, deep breathing exercises, but it is important not to force it and to be gentle. If you are comfortable with breathing techniques and find them helpful, you can use them, but not during the panic attack itself.
- Ground yourself in the present moment by focusing on your senses. Name five things you can see, four things you can hear, three things you can touch, two things you can smell, and one thing you can taste. You can also focus on the sensations of sitting.
- Shift your focus outwards. Describe your surroundings in neutral terms. Focus on what you need to do or want to do rather than evaluating how well you are doing them.
- If you can, remain in the situation. Although you may feel a strong urge to flee, resisting this can help you gain control over your reactions. Escaping the situation may reinforce the panic in the long term.
Body and Muscle Relaxation:
- Release physical tension. Relax tense muscles in your forehead, jaw, neck, shoulders, and hands. Let go of clenching fists. Allow your arms to relax.
- Try a body scan meditation, which involves focusing on relaxing different parts of your body.
- Pace or exercise if you are able. This can help burn off excess adrenaline.
Mental and Emotional Strategies:
- Challenge negative thoughts. Question the causes of your anxiety. Ask yourself if you are underestimating your ability to cope, or if it is a false alarm.
- Use positive affirmations. Repeat supportive and positive statements out loud, such as “I am getting better and better at handling whatever I am feeling”. Tell yourself “I know I can” instead of “I don’t know if I can do this,” and “I am confident” instead of “I hope he or she doesn’t judge me”.
- Distract yourself. Think about something other than panicking. You may need to find ways to occupy your mind.
- Practice self-compassion. Remind yourself that you are not “crazy” and that you are simply experiencing a normal response to scary symptoms. Treat yourself with kindness and take care of yourself.
- Accept your feelings. Understand that what you are feeling is okay, and do not be ashamed of your feelings.
Longer-Term Strategies:
- Identify triggers. Try to recall what triggered the panic attack. Consider if your anxiety is related to specific situations, such as social interactions, or certain places, or whether it comes out of the blue.
- Reduce overall anxiety levels. When you reduce your overall stress and anxiety, your panic attacks will reduce. Focus on creating solutions to everyday problems rather than dwelling on why the problems exist.
- Challenge negative beliefs. Identify and dispute the negative beliefs that fuel your panic.
- Practice relaxation techniques regularly. This will help your body respond with calm rather than stress. These may include meditation, yoga, and muscle relaxation.
- Consider therapy. Acceptance and commitment therapy (ACT) and exposure therapy can help you understand how your thoughts trigger feelings and learn to manage your reactions. Acceptance and Commitment Therapy (ACT) helps you accept your feelings and move forward with your values.
- Explore body based therapies if you have access to mental healthcare, such as Somatic Experiencing, or sensorimotor psychotherapy, which can help with the physical aspects of panic.
- Keep a journal. Track your panic attacks, triggers, thoughts, and coping strategies.
- Reduce stimulants. Be mindful of caffeine, alcohol and nicotine which can increase anxiety.
- Take care of yourself by eating well, trying to be active and sleeping as well as you can.
Things to Avoid:
- Don’t fight or resist the feelings.
- Don’t try to over-breathe.
- Don’t leave the situation.
- Don’t focus on panic attacks or worry about when the next one will come.
- Don’t ask “why” you are feeling bad. Focus instead on solutions and how you would like things to be.
It is important to understand that what works for one person may not work for another, so it is helpful to try a variety of techniques and strategies to find what is most effective for you. Be patient with yourself and know that you can learn to manage panic attacks. Remember, “Panic attacks are unpleasant but will not harm you”.