What To Do In A Panic Attack: 4 Great Ways To Cope
4 great ways to cope during a panic attack
Deep breathing
Progressive muscle relaxation
Distraction
Medication
These are great for “Managing and Minimizing” the symptoms of a panic attack as it's happening but they may not put an end to future panic attacks.
These strategies are great during a panic attack as they focus on alleviating the symptoms.
Just like taking NyQuil to relieve the sore throat, headache, and fever of strep throat. It is very helpful. But NyQuil does not treat the underlying cause of these symptoms. Antibiotics will treat the streptococcus bacteria and as a result the symptoms will end too.
You want your panic attacks to stop fast. You want to feel in control and no longer fear the symptoms of a panic attack. You want to prevent future panic attacks.
Don’t get me wrong. I want to minimize uncomfortable symptoms while I treat the main cause too.
Read to the bottom to "What will put an end to your panic attacks?" to learn 2 strategies to end a panic attack and prevent future panic attacks.
What is a Panic Attack?
A panic attack is the body’s evolutionary response to a perceived external threat.
The fight, flight, or freeze response is helpful if we encounter a wild animal poised to eat us. The adrenaline that begins flowing through our bodies aids in our escape and survival. When the external threat is defeated or evaded, the symptoms disappear.
For most people today, however, there is no wild animal. It’s a false alarm that signals an internal threat or danger. It’s a misperception of danger.
After experiencing a first panic attack, the fear becomes about experiencing another one.
What are the symptoms of a Panic Attack?
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, or faint
Chills or heat sensations
Numbness or tingling sensations
De-realization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or “going crazy”
Fear of dying
What Causes a Panic Attack?
Beyond other anxiety disorders, fears, and worry there are physical and mental processes responsible for panic attacks and anxiety.
They are evolutionary biological processes that are meant to help us in times of danger but often become a nuisance when there is no danger.
Catastrophic thinking
Catastrophic thinking causes the amygdala to turn on the body's fight or flight or freeze stress response and triggers the vicious cycle of panic.
The Vicious Cycle of Panic
The Trigger can be a thought or a situation
You then Perceive Danger. The thought or situation can be of an internal (Physical) or external (Phobic) threat. An example of an unhelpful thought for an internal threat is “My heart feels like it is beating fast. I must be having a heart attack.” An example of an unhelpful thought for an external threat is, “This plane that I’m on could crash.”
This sends a message to your amygdala to sound the alarm and causes more Fear and apprehension of the perceived danger.
The sympathetic nervous system automatically kicks in and increases physical Body Sensations (pounding heart, sweating, shaking).
You Label the Sensations as Catastrophic, you have a panic attack, and this confirms the danger.
Your Perceived Danger increases and the cycle continues. This becomes a vicious cycle of panic. Avoiding the situation or running away also falsely confirms that the danger is real and gives more power to future panic attacks.
Sympathetic nervous system
The sympathetic nervous system is responsible for the “Stress Response” also called the “Fight or Flight or Freeze Response” in order to provide us with the internal resources to deal with a real threat or danger.
Just remember that the sympathetic nervous system "Sympathizes" with you in times of danger.
It is fast, automatic, and is activated mostly without your conscious control. It is responsible for the physical sensations of panic or the fight, flight, and freeze stress response.
Amygdala
During times of stress or danger, your senses send messages to your amygdala in the brain.
The small almond shaped amygdala is your emotional center and is responsible for causing the emotional feeling of fear.
When your amygdala gets the message that there is danger, it sounds the alarm for your sympathetic nervous system to release adrenaline to help you react to the danger. This causes the symptoms you feel during a panic attack.
The thinking part of your brain also gets this message so that you can determine if the danger is real or not. If you have the thought or belief that the danger is real, then your amygdala will get that message from your thoughts and it will continue to sound the alarm.
What To Do In a Panic Attack
1. Deep Breathing
Deep breathing, also known as diaphragmatic breathing, by far is the most helpful strategy to manage and minimize the symptoms of a panic attack.
It is extremely helpful when used alongside strategies that target the root cause of a panic attack.
Deep breathing gives you a sense of control over your body when feeling out of control during a panic attack, especially if you are hyperventilating or feeling dizzy.
When we are anxious we tend to breathe faster. We take in more oxygen and breathe out carbon dioxide. But if we are not actively running away from or fighting the misperceived danger, then our bodies don’t use up all of the oxygen.
This causes an imbalance with too much oxygen and too little carbon dioxide in our blood. This condition is called respiratory alkalosis. The extra oxygen can cause us to feel light-headed and feel tingling in our fingers and toes.
Deep breathing helps correct the oxygen and carbon dioxide levels during panic attacks.
Deep breathing works to activate the parasympathetic nervous system which is responsible for producing a calm and relaxed feeling.
The parasympathetic nervous system is also called the “Rest and Digest” response.
The parasympathetic (Rest and Digest) system is also very slow compared to the sympathetic nervous system.
This is why deep breathing will not stop a panic attack quickly but will only slowly replace the symptoms of panic with a feeling of calm.
Since both the sympathetic and parasympathetic systems cannot be fully active at the same time, deep breathing causes the parasympathetic nervous system to slowly over-ride the sympathetic system.
Deep breathing alone, however, may not stop the symptoms of a panic attack quickly and may not prevent future panic attacks.
The root cause of a panic attack is within the sympathetic nervous system (aka the fight, flight, or freeze response).
So deep breathing does not turn off the sympathetic nervous system to stop a panic attack. Deep breathing works to replace panic with a calm and relaxed state.
Deep Breathing Exercise
Inhale through your nose slowly by expanding from your belly first then fill your upper lungs for a count of 5
Hold your breath for a count of 2
Exhale slowly and forcefully through pursed lips for a count of 10
Repeat this 5 to 10 times or do it for at least 1 minute
2. Progressive Muscle Relaxation
Progressive muscle relaxation is often used in conjunction with deep breathing to overcome the fight or flight stress response of the sympathetic nervous system by activating the parasympathetic, rest and digest, system.
As you tense and then release a muscle, it has to relax.
Tensing each muscle group and then relaxing causes your muscles to become more relaxed than they were before tensing.
As a result the heart slows down because relaxed muscles don’t need as much oxygen. Breathing and blood pressure also slow down.
Progressive muscle relaxation works to turn on the parasympathetic nervous system but doesn’t fix the problem with the sympathetic nervous system.
Progressive Muscle Relaxation
From a seated position begin by tensing your legs and buttocks for a count of 5, then relax
Tense your abdomen for a count of 5, then relax for a count of 5
Tense your arms for a count of 5, then relax for a count of 5
Shrug your shoulders to your ears and tense for a count of 5, then relax for a count of 5
Press your tongue to the roof of your mount for a count of 5, then relax for a count of 5
Tips: Let all of the tension release and flow out or your muscles. Exhale as you release the tension and relax. You should feel the muscles become loose and limp. Focus on the difference between the tension and relaxation as this is the most important part of the exercise.
3. Distraction
Distraction is helpful in providing temporary relief from the mental symptoms of a panic attack.
It causes you to stop focusing on the physical symptoms of a panic attack and the fearful thoughts that just add more fuel to a panic attack.
Distraction shifts your brain from the cycle of panic feedback loop by pulling your attention out of your head and outside of your body.
You stop analyzing your symptoms and you start analyzing something else in your environment, like how many colors there are in a picture on the wall.
The symptoms of a panic attack begin to decrease because you are moving away from the danger of focusing on the uncomfortable symptoms and repeating something like “OMG, OMG, I’m going to die.”
But the relief is only temporary. Your mind will return to the scary thoughts that trigger your panic attacks again later.
Distraction is actually a form of mental avoidance.
Avoidance is the major way that you feed the fear and maintain panic attacks. This is why you don’t get better and why the panic attacks keep coming back.
Distracting yourself from the symptoms and triggers of a panic attack and focusing on something else can be helpful in the moment and avoid a panic attack.
It works.
But notice that you are only avoiding a panic attack. You might not have a panic attack but you have also reinforced that whatever you just avoided is dangerous.
This confirms the perceived danger of a panic attack, increases the fear of a panic attack, and puts you at risk of having another panic attack the next time you begin to experience those same sensations and thoughts that trigger a panic attack.
4. Medication
Medication can also be very helpful if used appropriately and strategically.
Medication can help reduce the level of anxiety during certain situations that trigger panic attacks such as during phobic situations.
Other situations such as avoiding school and work due to anxiety can be helped with medication. However, medication also may not help you to stop and end panic attacks.
People begin to attribute a reduction in panic attacks to the medication and then are fearful that the panic attacks will come back if they stop the medication.
Medication can also be considered a form of chemical avoidance.
Most research indicates that a combination of medication and cognitive behavioral strategies works best.
If you are taking medication, work closely with your physician and never abruptly stop or discontinue without the checking with your doctor first.
Discontinuing from medication creates a rebound effect. A rebound effect temporarily causes an increase of anxiety that is greater than what was experienced before the medication. This usually occurs two to three days after stopping the medication abruptly without gradually tapering off the dosage.
What will put an end to your panic attacks?
1. Changing the way you communicate with your amygdala
Your amygdala will believe whatever you tell it. If you continue to react with thoughts that you are in danger, then your amygdala will continue to sound the alarm.
If you react by running away and avoiding, your amygdala will sense danger and sound the alarm, causing a panic attack.
Start responding with more accurate and helpful thoughts about what is happening.
Don’t run away from a panic attack. Don’t distract yourself from the sensations.
Stand your ground, confront the panic symptoms, and tell yourself that you know you are not in any danger because you know what a panic attack is.
Challenge your inaccurate and unhelpful thoughts. Ask yourself:
1. What do I think is happening during a panic attack?
“I feel light headed and I think I will faint.”
2. What facts or experiences suggest that this thought is not true?
“I learned that fainting only occurs when blood pressure is low and there is a lack of oxygen to the brain, and during a panic attack, blood pressure is actually high and there is more oxygen in the brain. Also I have never fainted before. So I will not faint.”
2. Give up Control to Get Control over Your Panic Attack
This is where you change your behavior and face your fear
In order to free yourself from panic attacks, you need to know that you can defeat and stop them.
For this to happen, you need to have the experience of actually lessening the symptoms of a panic attack, stopping it, or not having one at all.
This means staying in a panic situation or approaching a feared situation, and being able to apply these strategies at the first sign of a panic attack.
So basically you will need to be in a situation to have a panic attack.
If you have been dealing with panic attacks regularly then you will definitely get your chance to use these techniques during a panic attack.
When it comes to anxiety and panic, the more controlling you are by physically or mentally escaping, the more out of control you will feel.
By increasing your level of control when anxious, you communicate to your amygdala that you are in danger, and then your amygdala sounds the alarm to dump more adrenaline into your blood stream.
Decide to give up control and allow yourself to feel the anxiety without mentally or physically escaping or avoiding.
Say “Hello anxiety and panic, come on in.”
This sends the message to your amygdala that there is no danger and that you can actually tolerate what you are feeling.
Steps to giving up control:
1. Say “Hello anxiety, welcome. I am going to sit here with you.”
2. Use your helpful balanced thoughts, “I know what this is, it’s just anxiety and there really is no danger. I can exercise some control by doing deep breathing.”
3. Begin diaphragmatic breathing;
Inhale through your nose slowly by expanding from your belly first then fill your upper lungs for a count of 5
Hold your breath for a count of 2
Exhale slowly and forcefully through pursed lips for a count of 10
Repeat this 5 to 10 times or do it for at least 1 minute
4. Continue to monitor your thinking and continue with deep breathing as the anxiety diminishes.
5. Feel proud of yourself for staying with it, tolerating the discomfort, and actually reducing the symptoms.
Realize that you just gained control by giving up control.
The book “Attacking Panic: The Power to Be Calm” has more in depth cognitive and behavioral techniques on how to stop panic attacks quickly. The book shows you how to go beyond just giving up control and allowing yourself to experience a panic attack. The book has more of my secret strategies that will short-circuit your fight or flight system, stop a panic attack very quickly, and even prevent a panic attack from occurring.
Please contact me by email if you have any questions or need some advice.
