What are Panic Attacks and How to Effectively Manage them

Signs and Symptoms A panic attack is a sudden surge of a mounting physiological arousal that suddenly occurs with no warning or in response to thinking about a phobic situation. The bodily sensations that occur with the onset of an attack can include heart palpitations, shortness of breath, tightening in the chest, choking sensations, dizziness, sweating, shaking, and/or tingling in the hands and feet, faintness, chills, hot flashes, and sweating. Psychological sensations that may accompany these sensations are feelings of intense fear dying, unreality, desire to run away, and a sense of impending doom or danger.  Anyone who has experienced these intense attacks know how uncomfortable and scary they can be. Your first attack can be traumatic and can leave you feeling fearful with the anticipation of another one leaving you feeling helpless. Unfortunately, for some these attacks do come back and can repeat. Panic attacks can happen once, a couple of times a year or for some can become chronic.  However, the good news is that there are ways to help manage and decrease your panic attacks so they no longer impair your life.  Strategies for managing symptoms The following are some strategies that have been shown to be effective:

• Eliminating stimulants: Caffeine and tobacco are two of the most widely used stimulants in our society. Caffeine and Nicotine can aggravate and trigger anxiety and panic attacks because it produces the same physiological response as when you are in stressful situations. In addition, nicotine, increases vasoconstriction and makes the heart work harder. Some research also shows that smokers are more anxious than non-smokers. For many, reducing the consumption of caffeine  related drinks and foods helps them feel calmer and sleep better. For those of you who smoke here’s another good reason to quit. 

• Regular practice of deep relaxation: Deep relaxation practice helps too slow your heart rate, slower your breathing and blood pressure and relaxes your muscles while increasing blood flow. In addition, it helps to increase focus,  energy, heightens problems solving, relieves aches and pains and overall well being.  Here are some to try today:
  • Deep Breathing:  Find a calming place where you won’t be disturbed and focus on your breathing. Breath from your abdomen slowing inhaling for one…two…three…four… and five as you inhale, pause and repeat on the exhale. Continue this cycle for 3-5 minutes. During the exercise try to keep your breathing smooth and avoiding forcing your breaths. 
  • Visualization:  This is best used in a calm state and can be used after your deep breathing exercise. Allow yourself to visualize a place that is peaceful and serene allowing you a place to relax and free yourself from anxious thoughts. First take some breaths and use soothing self-talk. I am safe and calm right not. Next, visualize in your mind a place where you feel most calm and comfortable. This place is one that you can create or it can be one that is familiar to you. Allow yourself to use all your senses to visualize yourself in this place. Below is a script to help envision a safe and peaceful scene.
    • • You are calm and safe right here, right now. You are sitting along the edge of a waterfall. You are barefoot and you can feel the coolness of the water slowly flowing over your feet as the warmth of the sun warms your shoulders and legs. You can hear the sound of the water as it hits the rocks along its path. The sound is hypnotic and relaxing your body more and more. The milky white water pours down along the black smooth rocks as fizzling sounds calm you into deeper and deeper relaxation. With each breath you draw in the scent of fresh, crisp air with a hint of wet grass. You feel a slight breeze as it whispers against your face and rustles your hair. As you sit and soak in the whole scene you feel a sense of calmness and deep relaxation. Allow yourself to take another breath in an out before you end this practice. 
  • Calming music:  Music has many benefits to your health due to its stress reducing effects as well as overall happiness. When using music as a tool to manage anxiety it is important to use music that makes you relaxed and feel good. Be selective in the pieces that are genuinely relaxing and make you feel good as rather than one’s that evoke you emotionally or are too stimulating. 

• Regular exercise: Regular exercise helps anxiety due to it’s natural releasing of “feel-good” endorphins or brain chemicals that enhance an overall sense of well-being. Exercise decreases tension, improves sleep, elevates and stabilizes your mood, and improve self-esteem in as little as 10-15 minutes three to five times a week. Regular exercise also gets you out in your community increasing socialization, is a good distraction, and builds self-confidence. Exercise includes a wide range of activities from gardening to running. In addition, you can break it up throughout the day so that you can enjoy many different activities.

• Noticing and challenging anxiety inducing self-talk: People who suffer from anxiety or panic are often prone to negative self-talk. Panic and anxiety sufferers often have the “what if’s” type of thinking which directly increases anxiety and panic. Negative self-talk is often automatic and subtle which can make it difficult to notice and although it is irrational it feels true. This type of self-talk also perpetuates avoidance, initiates or aggravates a panic attack and becomes a habit. Cognitive distortions are negative statements that our mind will use to convince us that something isn’t true. The good news is that negative self-talk can be replaced with healthier ways of thinking. However, this is not always east and will take persistence and work to replace these unhealthy thinking patterns with more positive and supportive thoughts. The following are strategies to begin healthier ways of thinking.
  • Writing: Write down you thoughts to find out what thoughts are coming up for you. You may be surprised at how often this type of thinking is happening. This insight can help you better understand how persistent you will need to be. Writing your thoughts down will help identify common negative thought patterns you are struggling with. The following is a list of cognitive or irrational thought patterns that may be perpetuating your symptoms. 
  • Cognitive Distortions:  
    1. 1. Magnification and Minimization: Exaggerating or minimizing the importance of events. One might believe their own achievements are unimportant, or that their mistakes are excessively important
       2. Catastrophizing: Seeing only the worst possible outcomes of a situation. “ I’ll never get the job”, “I will always have anxiety”
       3. Overgeneralization: Making broad interpretations from a single or few events. “I felt awkward during my interview, I am always so awkward”
       4. Magical Thinking: The belief that acts will influence unrelated situations. “I am a good person-bad things shouldn’t happen to me. “
       5. Personalization: The belief that one is responsible for events outside of their own control. “My husband is always upset. He would be fine if I did more to help him” 
       6. Jumping to Conclusions: Interpreting the meaning of a situation with little or no evidence. 
       7. Mind Reading: Interpreting the thoughts and beliefs of others without adequate evidence. “She would not go on a date with me. She probably thinks I’m ugly.” 
       8. Fortune Telling: The expectation that a situation will turn out badly without adequate evidence. “What if I have a panic attack”, What if I panic during the interview”. 
       9. Emotional Reasoning: The assumption that emotions reflect the way things really are. “I feel like a spouse/friend/parent, therefore I must be” 
       10. Disqualifying the Positive: Recognizing only the negative aspects of a situation while ignoring the positive. One might receive many compliments on an evaluation, but focus on the single piece of negative feedback. 
       11. “Should” Statements: The belief that things should be a certain way. “I should always be friendly to others.” 
       12. All-or-Nothing Thinking: Thinking in absolutes such as “always”, “never”, or “every”. “I never do a good enough job on anything.” 
  • Challenging  and replace negative thoughts: An effective way to change your thinking is to challenge the cognitive distortions that are perpetuating your anxiety and fears. The following is a list of questions to help challenge those thoughts and replace them with more realistic ones. 
    1. 1. What evidence do you have that these thoughts are true?
       2. Is there evidence that disproves these thoughts?
       3. What would a friend think about this situation?
       4. Is there a more neutral or positive way of looking at this situation?

• Learning to express and talk about your feelings: Feelings are an important part of our lives as they involve a total body reaction, influence our thoughts and perceptions and can be both simple and complex. Suppression of your feelings can lead to an increase in anxiety, depression, phobias and other issues that can manifest in physical and psychological forms. The following are exercises to start today.
  • Tune into your body:  Allow yourself to tune into your body and ask yourself, “what am I feeling right now?” Feel whatever you are feeling without judgement.
  • Express your feelings: If you are not feeling ready to talk them out with someone start by journaling what you feel and work up to talking about your feelings with someone you trust. 
  • Managing strong feelings: Sometimes our feelings can be intense and hard to manage so it is important that you find effective ways to manage them such as exercise, deep relaxation methods as decribed above,  writing them out or allowing yourself a good cry.

• Medication: For some, medications can be used to temporarily reduce symptoms of the disorder. You and your doctor can determine if this is an option for you. 

Panic attacks can also be related to medical conditions so it is important to see your physician to rule out any medical conditions first.