Manage Anxiety and Panic Disorder

Panic disorder is a condition characterized by a specific anxiety: anxiety over when your next panic attack will occur. On top of that, you may need to deal with the anxiety that triggered the initial panic attacks. It is possible to manage panic disorder with the help mental health professional — you should not attempt to tackle treatment on your own. It is important to seek help as soon as possible, as anxiety and panic disorder can affect your relationships, job, education, and can even lead to agoraphobia.

Steps

Identifying Panic Disorder

1. Learn the symptoms of panic disorder. Panic disorder affects roughly 6 million adults in the United States and is more commonly experienced by women. The attacks associated with panic disorder generally last only a few minutes, but can reoccur for hours at a time.Some of the symptoms of panic disorder include:
   • Sudden and repeated attacks of fear.
   • Feeling out of control during an attack.
   • Experiencing a fear or terror that is almost paralyzing.
   • Fear or anxiety about when the next attack might occur.
   • Avoiding places where previous attacks have occurred .
   • Feeling that you are going crazy or are about to die.
   • Physical symptoms during an attack may include a pounding or racing heart, sweating, difficulty breathing, weakness or dizziness, feeling hot or a cold chill, tingly or numb hands, chest pain, choking, or stomach pain.
2. Know what differentiates panic disorder. Experiencing general feelings of anxiety or one or two panic attacks, while frightening, does not mean you have panic disorder. The defining characteristic of the disorder is the persistent fear of having future panic attacks. If you have had four or more panic attacks and are fearful of when your next attack will occur, locate a mental health professional who specializes in panic or anxiety disorders.
   • People with panic disorder are more afraid of when and where their next attack will occur than they are of particular objects or events.
   • Remember that everyone experiences anxiety — it's a normal reaction to stress. Feeling anxious does not mean you have a disorder. Normal anxiety usually occurs because of something specific, like an upcoming presentation or a big game. For a person with an anxiety disorder, the anxiety is constant and can appear to have no source.
3. Be aware of the side effects of panic disorder. When left untreated, panic disorder can have serious side effects. One of the most severe consequences of panic disorder is the development of phobias. If, for instance, you had an attack while riding in a elevator, you may begin have serious anxiety about elevators; you may begin to avoid them and may develop a phobia. You may give up a great apartment or job because you would have to use an elevator to access it, or you may avoid a hospital to get care, or a shopping center where you would normally shop and see a movie, and so on, all because you are avoiding elevators. Those who suffer from panic disorder may eventually develop agoraphobia, or fear of going outdoors, because they are so afraid of having another panic attack outside of their home. Other possible side effects include:
   • Increased likelihood of alcohol and drug abuse
   • Increased risk of suicide
   • Depression
   • Spending less time on hobbies, sports, and other satisfying activities
   • Fear of traveling more than a few miles from home
   • Economic effects (giving up well-paid jobs that would require travel, losing employment, becoming financially dependent on others)

Treating Panic Disorder

1. Find a mental health professional who specializes in anxiety disorders. The key to managing the anxiety that occurs with panic disorder and leading a normal life is seeking professional treatment. The good news is that this disorder is highly treatable; the unfortunate news is that it can often be misdiagnosed. Talk to your doctor about what is going on so she can rule out another physical issue that may be causing your attacks, then ask for a referral to a mental health professional who deals specifically with anxiety and panic disorders. Types of therapy that may help include:
   • Cognitive behavioral therapy (CBT). This is particularly helpful in treating panic disorder and is the preferred method of treatment. CBT is directed at identifying deeply rooted thought and behavioral patterns that affect your anxiety and teaching you more adaptive ways of viewing the world and coping with stress.
   • Exposure therapy. Your therapist will guide you in identifying the source of your fears and developing a gradual plan to gain exposure to the source.
   • Acceptance and commitment therapy. This form of therapy uses methods of acceptance and mindfulness to overcome anxiety and cope with stress.
   • Dialectical behavior therapy. This treatment approach is derived from principles in Eastern medicine. Through a combination of mindfulness, emotional regulation and distress tolerance strategies as well as interpersonal skills training, patients become better equipped to handle anxiety.
2. Talk to your doctor about medication. In some cases, medication may be appropriate, especially if you are experiencing a side effect like depression. Antidepressants and anti-anxiety medications are the most commonly prescribed for panic disorder.
   • Side effects of antidepressants may include headache, nausea, or difficulty sleeping. Talk to your doctor if you experience any side effects.
   • The first line of treatment for most people lies with selective serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or venlafaxine.
   • Antidepressants can sometimes cause suicidal thoughts or even suicide attempts, especially in children and teenagers. It is important to closely monitor anyone taking antidepressants, especially when they first begin treatment.
   • Though uncommon, your doctor may also prescribe beta-blockers, which may help control physical symptoms.
   • Regardless of the drug prescribed, psychiatrists still suggest dual treatment with cognitive-behavioral interventions.
3. Identify your triggers. Panic attacks often arrive suddenly, and seemingly from out of nowhere — they can even occur while you are asleep. Experiencing panic attacks may eventually lead to the development of panic disorder, where you fear the attack itself rather than whatever may have initially caused your panic attacks. These are known as triggers, and the simple act of identifying them and realizing they are independent of the panic attack can cause them to lose their power. Your therapist can help you identify your triggers.
   • Things that may trigger your initial anxiety attacks include:
     • Financial problems
     • Work
     • Health concerns
     • Tumultuous relationships
     • Big decisions
     • Bad news
     • Anxious thoughts or memories
     • Loneliness
     • Places or people that represent traumatic events
   • Things that may trigger an anxiety attack related to panic disorder include:
     • Chronic stress
     • Separation or loss
     • Places where you have had a previous attack
     • Increased heartbeat or other symptoms that are physically reminiscent of what happens to your body during an attack
4. Expose yourself to your fears. With the help of your therapist, you can begin to challenge your triggers, including physical triggers. There are different types of exposure therapy your therapist may wish to try.
   • With interoceptive exposure, your therapist can guide you through the symptoms of an attack in a safe, controlled setting. You will learn that these symptoms (like increased heart rate, sweating, etc.) do not mean an attack is imminent or unavoidable. For instance, you may be instructed to run in place to elevate your heart rate to demonstrate that this is a harmless physical sensation that occurs independent of a panic attack.
   • In vivo exposure breaks fearful situations down into small, manageable steps and, beginning with the least-threatening scenario, you face those situations one at a time.
5. Recognize and challenge cognitive distortions. Your thinking may be at the root of your anxiety. Your therapist will help you identify cognitive distortions at play in your everyday thinking. Then, examine what evidence there is for or against this way of thinking. When you learn to pinpoint these thoughts, try to replace them with healthier, more realistic ways of thinking. Cognitive distortions associated with anxiety are:
   • Black and white thinking (also known as all-or-nothing thinking): "If I my child does not make good grades and excel in school, I am a failure as a mother."
   • Over-generalization: "Peter is upset with me because I didn't return his call. He'll never talk to me again."
   • Catastrophizing: "My anxiety is flaring up. Oh, no! The whole room is going to stare at me! I'm going to be so embarrassed! I'll never be able to show my face here again!"
   • Jumping to conclusions: "Jessica didn't speak to me in the restaurant. She must hate me."
   • Emotional reasoning: "I feel like a loser because I don't have a job, so I must be one."
6. Repeat a mantra throughout the day. Mantras are sounds or phrases that create positive reverberations in your spirit, according to Sanskrit. This phrase is spoken aloud onto the universe and, when you say it, the goal is to focus on fully becoming what the words imply. To successfully replace negative thoughts with positive thinking, you must first do the work of challenging negative thinking and discovering your triggers, as described above. Disproving your negative thoughts can chip away at those negative beliefs, giving you space to start believing positive messages about yourself.
   • You can wake up each morning and repeat this phrase as you prepare for the day or as you look at yourself in the mirror. Whenever you feel stress mounting, count on your mantra to calm and center you.
   • Try something like: Anxiety is not dangerous. It is only uncomfortable.

Managing Symptoms and Treating Your Body Well

1. Learn deep breathing exercises. Deep, diaphragmatic breathing practiced daily can help you alleviate stress and anxiety. Plus, engaging in deep breathing during a panic attack can keep you grounded and help you to overcome the symptoms faster. Hyperventilating, or taking quick, short breaths, is common in a panic attack. Doing diaphragmatic breathing exercises can help you to manage the feeling until panic passes, and may even help prevent future attacks.
   • Sit upright in a comfortable chair. Place your hand on your belly. Take a long, slow breath for four counts in through your nose. You should feel your abdomen expanding. Hold the breath for two counts. Then, release the breath through your mouth for four counts. Notice your abdomen deflating beneath your hand.
   • Perform this exercise twice a day for five to 10 minutes for greater stress relief.
2. Try mindfulness techniques. Mindfulness relates to the here and now, or the present moment. Frequently with anxiety, you are caught up in either the past or future. Mindfulness allows you to manage stress by emphasizing present-focused awareness. You can engage in mindful meditation, breathing, and other practices to combat anxiety.
   • Mindfulness meditation involves sitting in a quiet room and engaging in deep breathing. Meanwhile, you might consider all the sensations in the present moment: sight, sound, smells, touch, and taste. Whenever you notice your thought wandering to either the past or the future, return them to the present moment.
   • Mindfulness breathing involves attempting to clear your mind of any thoughts but remaining focused on your breath. Practice deep breathing and as thoughts come into your mind, acknowledge, then repel them and continue to concentrate on your breath.
3. Stay active. In addition to being essential for long-term health and well-being, exercise is paramount when it comes to stress-relief. Because stress can make you more susceptible to experiencing a panic attack, lowering your stress and knowing how to deal with it in a healthy way may decrease your likelihood to suffer an attack. Exercise produces a positive mood state and delivers natural painkillers known as endorphins. Physical activity has been known to improve self-esteem and sleep quality, too.
   • Try out a number of different activities before settling on a few that you enjoy. Keep in mind, that you probably will not commit to activities that you find particularly grueling or tedious. Choose an activity that you like, and find ways of doing it with others to boost your stress management.
   • One thing to keep in mind is that some people are triggered by things like sweating or an elevated heart rate — physical changes that mirror what happens to your body during a panic attack. If this may be one of your triggers, speak with your therapist before beginning to exercise.
4. Sleep regularly. Sleep and anxiety exist in a vicious cycle. Failing to sleep can cause a decreased stress response, and more stress can be detrimental to sleep. It seems that chronic worriers are even more affected by a lack of sleep. Research has demonstrated that individuals with anxiety and panic disorder may experience a decrease in symptoms if sleep quality is restored.
   • Aim for seven to nine hours of sleep per night. Develop an winding down routine in which you participate in relaxing activities like reading, doing a crossword puzzle, or drinking decaffeinated tea.
   • Try to go to sleep and wake up at a regular time each day to create a routine.
   • Refrain from drinking alcohol and caffeine. People often drink alcohol to get to sleep. While it may initially cause you to pass out, high doses of alcohol disturbs the later stages of sleep. So you may fall asleep faster, but the quality of your sleep is severely compromised. Caffeine can exacerbate the symptoms of anxiety, and, if consumed too late in the day, prevent sleep.
5. Consider refining your diet to relieve anxiety. It's important to eat well-balanced meals that are rich in vitamins and nutrients. Strive to eat real, unprocessed foods such as lean meat and protein, complex carbohydrates like fruits, vegetables and whole grains, and fat-free or low-fat dairy. Find out if you have any food sensitivities such as gluten or dairy, and avoid these foods to minimize negative reactions that may worsen anxiety.
   • Eat complex carbohydrates, such a whole grains, fruits, and vegetables. Ingesting these may encourage the body to create serotonin, which can lower stress.
   • Also, include foods high in Vitamin C such as citrus fruits, and foods rich in magnesium like leafy greens and soybeans. Vitamin C is thought to reduce cortisol, a stress hormone.
   • Stay hydrated and drink 8 (8 oz.) glasses of water or more per day.

Seeking Additional Help

1. Turn to a friend. Simply speaking our worries or concerns aloud to someone else can be cathartic and gratifying. Anxious thoughts so often run on a loop in our heads that we believe them to be fact. Speaking to a close friend or relative who can impartially give you advice might help. Stating your concerns aloud might help you to view them as unlikely or silly, or your friend might help you to see that these concerns are not warranted.
2. Participate in an anxiety support group. Support groups can be found locally through mental health and religious organizations. You can also join support groups online or by telephone. Participating in such groups reduces the burden of managing anxiety or panic disorder on your own. You can learn helpful strategies to cope with symptoms from individuals who have been in your shoes. What's more, support groups offer invaluable encouragement and foster the development of lasting friendships.
   • Studies reveal that anxiety sufferers benefit from the social support offered in a group setting. Friends or family members may not be able to relate to what you are going through, but others like you can empathize with your situation and offer hope.

Tips

• Maintain your toolbox of resources to manage your anxiety. Over time you will find that managing your symptoms becomes easier.

Warnings

• None of the above suggestions should replace the recommendations of a physician or mental health provider. Follow your prescribed treatment plan if you have one.
• Do not attempt to work through panic disorder on your own. Your treatments must be outlined and prescribed by a psychologist or psychiatrist.

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Sources and Citations

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