Panic attacks are intense episodes of fear that come on suddenly and can involve frightening physical symptoms like a pounding heart, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, feelings of detachment, fear of dying, tingling sensations, chills, or hot flushes. People experiencing a panic attack might feel as though they are having a heart attack or stroke, or are losing control or “going crazy”. A panic attack can happen when someone encounters a feared object or situation, but they can also occur seemingly out of nowhere. While incredibly distressing, panic attacks are temporary and usually subside within 10 to 30 minutes. They are often described as one of the most alarming experiences a person can have. Dealing with panic attacks can feel overwhelming, but there are approaches and techniques that can help.
One key aspect of dealing with panic attacks is understanding their nature. They are often an exaggeration of a normal bodily reaction to stress or an extreme reaction resulting from the amygdala activating the sympathetic nervous system and triggering the release of adrenaline. The physical sensations are part of the fight, flight, or freeze response, which is normally a lifesaving reaction, but can be triggered inappropriately when there is no logical reason for fear.
Instead of trying to fight or eliminate panic attacks entirely, approaches to dealing with panic attacks often focus on changing your relationship with the intense feelings and sensations, or managing the physical responses in the moment.
Here are some techniques and tools for dealing with panic attacks:
- Understanding the Symptoms: Gaining knowledge about what panic symptoms are and why they happen can provide relief. Recognising that the physical sensations are related to the body’s fight-or-flight response and are not harmful can make them less frightening. Understanding that you are not powerless in these moments is important.
- How to use: This involves learning about the physiological processes involved in panic. Resources like books or information provided by a therapist can explain the connection between the amygdala, the fight-or-flight response, adrenaline, and physical symptoms.
- Self-help vs. Professional: This foundational understanding can be gained through self-help resources like books, but a therapist can also provide this education and help clients process the information.
- Acceptance and Willingness: A significant part of dealing with panic attacks involves developing a willingness to experience the intense feelings, sensations, and thoughts without trying to escape or control them. Efforts to control or avoid anxiety, including panic, can paradoxically make things worse and restrict life. Learning to experience anxiety fully, without trying to change it, is part of acceptance. It’s about making a choice to experience what is there. Accepting the reality of the adrenaline response, even seeing it as a potential source of power, can be a helpful perspective.
- How to use: This involves shifting your mindset from fighting panic to allowing it to be present. Exercises might involve mindfully observing physical sensations or thoughts associated with panic without reacting to them or trying to push them away. It requires a conscious choice to be willing to have the experience.
- Self-help vs. Professional: While self-help resources can introduce the concept of acceptance and provide exercises, therapists can guide clients through this process, especially when intense feelings trigger strong avoidance habits.
- Mindfulness and Present Moment Focus: Paying attention to the present moment is a core skill for dealing with panic attacks. Mindfulness helps you observe physical sensations, emotions, and thoughts without getting caught up in them. It can help pull the mind away from racing, panicky thoughts.
- How to use: Mindfulness practices involve intentionally focusing attention on the present experience, such as bodily sensations, sounds, or breathing. Simple exercises like the 5-4-3-2-1 technique can help ground you in the present moment. Observing thoughts and feelings without judgment is key. Consistent practice is important.
- Self-help vs. Professional: Basic mindfulness skills can be learned and practised through self-help resources, apps, or online tutorials. A therapist can also teach mindfulness as a skill and help integrate it into dealing with panic attacks.
- Changing the Relationship with Thoughts: Panicky thoughts often involve catastrophic predictions like believing you are dying, going crazy, or looking foolish. Dealing with panic attacks involves learning to relate differently to these thoughts, rather than being ruled by them. This involves loosening the hold that thoughts have over behaviour. Questioning your thoughts, their usefulness, or whether they are false alarms can also be helpful. Conscious questioning can help organise the information anxiety provides.
- How to use: Techniques involve observing thoughts as just thoughts, not necessarily facts. This can involve labelling thoughts (e.g., “thinking”), using metaphors, or using exercises that help you see thoughts from a distance. Questioning techniques can involve asking what is causing the anxiety, evaluating if it’s a false alarm, or what the worst possible outcome is, and what can actually be done. Writing things down can help organise thoughts and make anxiety feel less burdened.
- Self-help vs. Professional: These techniques can be practised using self-help guides or workbooks. Therapists are skilled at teaching these processes and helping clients apply them to their specific anxious thoughts. Questioning techniques are also part of therapeutic models like the NLP Meta Model.
- Breathing and Relaxation Techniques: While trying to take deep, open-mouthed breaths during a panic attack can sometimes worsen symptoms like hyperventilation, practising proper, slow, deep breathing regularly when not in a state of panic can make it the default when under pressure. Diaphragmatic breathing, breathing slowly and deeply with the belly, can be taught as an exercise. Muscle relaxation is another technique that can help calm the body. It is suggested that a relaxed body state signals the brain to exit panic mode.
- How to use: Regular practice of slow, controlled breathing techniques is key, even when calm. When panic arises, the focus is often on slow exhales or simply closing the mouth and letting the body breathe naturally rather than forcing it. Muscle relaxation involves tensing and releasing different muscle groups or focusing on releasing tension throughout the body.
- Self-help vs. Professional: Basic breathing and relaxation exercises are widely available in self-help resources. Therapists can teach these techniques, ensuring they are performed correctly, especially the nuances around breathing during a panic attack.
- Facing Feared Symptoms and Situations (Exposure): A core strategy for overcoming panic is facing the feared physical symptoms or situations that trigger panic, without using avoidance or safety behaviours. This practice, sometimes called exposure, involves intentionally encountering the feared sensations or situations to learn that they are not harmful and can be tolerated. This process helps rewire the brain. Taking action towards a valued life, even with anxiety present, is a form of committed action that underlies this process.
- How to use: Exposure can involve intentionally bringing on feared physical sensations (e.g., spinning to induce dizziness) or entering situations that trigger panic (e.g., a crowded place). The key is to stay in the situation and allow the panic to peak and subside without escaping or using safety behaviours.
- Self-help vs. Professional: While self-help guides may introduce exposure-like exercises, undertaking exposure, particularly for intense or complex panic, is often recommended with the guidance of a therapist. A therapist can help create a planned hierarchy of exposures and provide support.
- Identifying Triggers: Understanding what situations, internal states, or even physical activities (like caffeine or intense exercise) can precede a panic attack can be helpful in managing them. Tracking these can reveal patterns.
- How to use: Keeping a journal or list of when panic attacks occur and what was happening immediately before (thoughts, feelings, location, activities, substances consumed) can help identify triggers.
- Self-help vs. Professional: Identifying triggers through journaling is primarily a self-help activity. A therapist can help interpret the patterns and develop a plan based on the identified triggers.
- Focusing Productively / Shifting Attention: When experiencing panic or intense anxiety, the mind often races or focuses on catastrophic thoughts. Learning to shift your focus productively is a key skill. This can involve ignoring the negative and intentionally listing positive or neutral experiences in the moment.
- How to use: Practising shifting attention during daily life (e.g., focusing on the breath, sounds, or sights) can build this skill. When feeling panic, consciously redirecting attention to a different focus or identifying positive/neutral aspects of the present moment.
- Self-help vs. Professional: Learning focus skills is often part of mindfulness practice, which can be learned through self-help. A therapist can guide this process and help apply it specifically to anxiety-provoking situations.
- Identifying Protective Factors and Coping Skills: Knowing what resources and strategies you have can help when anxiety is intense. This includes identifying coping skills you can rely on (like walking, listening to music, or self-soothing practices) and outside support (friends, family, support groups). Creating a list of helpful strategies can be useful in the moment.
- How to use: This involves reflecting on what has helped in the past or what resources are available. Making a physical list of these protective factors and coping skills can make them more accessible when needed.
- Self-help vs. Professional: Identifying and listing these factors is a self-help exercise. A therapist can assist in this process and help develop or strengthen these resources.
Dealing with panic attacks effectively involves a combination of understanding the underlying processes, developing skills to manage intense internal experiences, and gradually facing feared situations without avoidance.
Summary: Dealing with panic attacks involves understanding their nature as intense, temporary episodes of fear often linked to the fight-or-flight response. Rather than seeking to eliminate them, effective strategies focus on changing your relationship with the panic, learning to manage intense physical sensations and thoughts, and facing feared situations. Key techniques include understanding the physiological basis of panic symptoms, practising acceptance and willingness to experience intense feelings, using mindfulness to stay present, changing the relationship with catastrophic thoughts through techniques like questioning or defusion, learning and practising proper breathing and relaxation techniques outside of panic, gradually exposing yourself to feared symptoms and situations without avoidance, identifying personal triggers, productively shifting focus away from panic, and identifying protective factors and coping skills. While some foundational learning and skill practice can be done independently through self-help resources, working with a therapist is often recommended for implementing exposure strategies and navigating more challenging aspects of dealing with panic attacks. The goal is to gain more control over your response to panic, allowing you to live a fuller life.