Stop Panic Attacks

A panic attack is a very sudden and frightening experience that can feel like you are having a heart attack, dying, or losing control. Many adults experience only 1 or 2 attacks in a lifetime, but others have recurrent attacks, which may be an indication of an underlying condition called panic disorder. A panic attack is an abrupt onset of intense fear for no apparent reason, accompanied by very real physical changes, such as a rapid and pounding heart rate, sweating, and rapid breathing. Steps can be taken to stop a panic attack, and to help prevent further attacks from happening.

Steps

Getting Immediate Relief

  1. Recognize the physical symptoms. During a panic attack, your body goes into a natural fight-or-flight response, just as if you were in a truly terrifying and dangerous situation, only no dangerous situation is actually occurring.[1] Symptoms that are commonly experienced during a panic attack include:
    • Chest pain or discomfort
    • Dizziness or faintness
    • Fear of dying
    • Fear of losing control or impending doom
    • Feeling of choking
    • Feeling of detachment
    • Feeling of unreality
    • Nausea or upset stomach
    • Numbness or tingling in the hands, feet, or face
    • Palpitations, fast heart rate, or pounding heart
    • Sweating, chills, or hot flashes
    • Trembling or shaking
  2. Control your breathing. Most panic attacks cause rapid and shallow breathing which fuels the attack, causing the symptoms to linger. By controlling your breathing, you can help to return your heart rate to normal, lower your blood pressure, slow the sweating, and re-establish a feeling of being in control.[2]
    • One method to slow your breathing is to take a deep breath and hold it for as long as you can. This balances levels of oxygen and carbon dioxide and reduces the feeling that you cannot breathe.[3]
    • After holding your breath, then begin deep, diaphragmatic breathing. Breathe in slowly and deeply, then exhale even more slowly.[3]
    • To practice diaphragmatic breathing, try sitting in a chair with 1 hand on your chest and the other a little below your rib cage. Sit comfortably with bent knees, and relaxed shoulders and neck.[4]
    • Next breathe in slowly through your nose and let your stomach expand, keeping your upper chest as still as possible. Slowly exhale, tightening your stomach muscles, and keep your upper chest still. The hand on your stomach area should move out as you inhale, then back in as you exhale, with the hand on your upper chest remaining as still as possible.[4]
    • Another method is the 5-2-5 method. Inhale with your diaphragm for 5 seconds. Hold your breath for 2 seconds. Then exhale for 5 more seconds. Repeat 5 times.[5]
    • Breathing into a paper bag is not routinely recommended anymore. It may not be as beneficial as was believed in the past, and may even be detrimental.
  3. Take prescription medication. One of the most effective ways to stop a panic attack is by taking oral agents classed as anti-anxiety medications, usually benzodiazepines.[2]
    • Common drugs used to treat panic attacks that are classed as benzodiazepines include alprazolam, lorazepam, and diazepam. These agents have a fairly rapid onset and can help to relieve symptoms within 10 to 30 minutes.[6]
    • Other agents prescribed that fall in the group of benzodiazepines start to work a little slower but stay in your blood stream longer. Examples of these agents include clonazepam, chlordiazepoxide, and oxazepam.[6]
    • These agents are often prescribed in low doses to take regularly until the panic attacks become more manageable by using other types of medication, such as selective serotonin reuptake inhibitors, or participating in cognitive behavioral therapy.[6]
  4. Try to continue your activity. As much as possible, carry on normally and continue with your current activity and daily routine to prevent the panic from consuming you.[7]
    • Continue talking, moving, and keep your thoughts focused. By doing so, you are sending messages to your brain, and your panic, that there is no danger, no alarm, and no reason to be in a fight-or-flight state.[7]
  5. Avoid running away. If you have a panic attack at a specific place, maybe a grocery store, then you may want to run away and leave the store as quickly as possible.[7]
    • By staying where you are, and taking control of your symptoms, you are taking steps to train your brain in recognizing the absence of real danger in the grocery store.[7]
    • If you run away, your brain begins to associate that place, and maybe all grocery stores, with danger, and may create feelings of panic each time you enter a grocery store.[7]
  6. Focus on other things. With the help of a therapist, you can learn ways to naturally focus your thoughts, and take control of the panic.[8]
    • Examples include drinking something either warm or cold, taking a short walk, singing along to a favorite song, talking with a friend, and watching TV.
    • Additional things to try in order to focus on something other than the panic include stretching exercises, doing a puzzle, changing the air temperature, rolling down the window if you are in a car, going outside for some fresh air, or reading something that is interesting to you.
  7. Distinguish between a stressful experience and a panic attack. While both types of experiences are similar in that physical reactions occur, such as elevated blood pressure, sweating, and increased heart rate, they are distinctly different events.
    • Stressful experiences happen to everyone at one time or another. The body’s natural fight or flight instinct may be activated during a stressful or anxious situation, just as it is during a panic attack, but there is always a trigger, event, or experience that is directly tied to the reaction.
    • Panic attacks are not tied to an event, are unpredictable, and the severity of an attack can be extreme and terrifying.
  8. Implement relaxation techniques. Take steps to calm down by using established methods of relaxation to take control of the exaggerated stressful or anxious experience.
    • If you suffer from panic attacks or panic disorder, working with a cognitive behavioral therapist will help you learn relaxation strategies to take control of the panic when it starts.
  9. Use your senses to tackle the attack. Whether you experience a panic attack, an anxiety attack, or find yourself in a stressful situation, by focusing on your senses, even for just a few moments, you can slow down the unwanted physical symptoms that are happening.[9]
    • Use your eyesight to notice pleasant things in your immediate surroundings. If you are in a safe place, try closing your eyes and visualizing your favorite flower, favorite painting, favorite beach, or something that makes you feel more relaxed.[9]
    • Stop and listen to what is around you. Try to find music in the distance, hear the birds, the wind or the rain, or even the hum of traffic on a nearby highway. Try to find something new that you can hear, other than the sounds of your heart beating and sounds that are part of the stressful event.[9]
    • Continue to apply the senses by identifying the smells around you. Perhaps you are inside and someone is cooking, or you are outside and you can smell rain in the air.[9]
    • Focus on the sense of touch. You may not realize it but you are always touching something. If you are seated, focus on the way the chair feels, or notice if the table your arm is resting on is cold, or warm, or if you can feel a breeze on your face.[9]
    • By taking those few moments to review what your senses are experiencing, you have redirected the focus away from the panic, anxiety, or stress.
    • This is clearly not resolving the cause of the panic, anxiety, or stress, but concentrating on your senses is useful in addressing the unwanted physical reaction your body may be experiencing.

Preventing Future Attacks

  1. Talk to your doctor about your attacks. Your doctor may treat you with recommended medications or may refer you to a mental health professional to evaluate and prescribe medications. Both a regular doctor and a mental health physician will likely recommend a cognitive behavioral therapist.
    • Panic attacks are commonly Many panic attacks are commonly related to other underlying disorders, including some mental health conditions and some medical problems. Talk to your doctor to rule out an underlying medical condition.
  2. Seek medical help sooner rather than later. Studies show that people that are treated for panic attacks and panic disorder early, have better overall outcomes with fewer complications.[10]
  3. Take medications as prescribed. Commonly used agents include benzodiazepines, both rapid acting and intermediate acting.[11]
    • Benzodiazepines are considered addictive, so be sure to take them exactly as your doctor advised. Taking more than is recommended is dangerous and can cause serious and potentially fatal withdrawal effects if taken chronically.
  4. Take rapid acting agents only when needed. Rapid acting agents help to manage the symptoms when you feel a panic attack beginning. These are often prescribed to have available if needed, or when you begin to have a panic attack.[6]
    • Take these agents only when needed to avoid becoming tolerant to the prescribed dose.
    • Examples of medications prescribed to take when an attack begins, on an as needed basis, are lorazepam, alprazolam, and diazepam.
  5. Take longer acting agents routinely, or as prescribed. The intermediate agents take a little longer to start working, but have longer lasting effects.
    • These medications are often prescribed for routine dosing, to help you avoid attacks, until further steps, such as cognitive behavioral therapy, can be taken.[6]
    • Examples of intermediate acting agents include clonazepam, oxazepam, and chlordiazepoxide.
  6. Take an SSRI. Selective serotonin reuptake inhibitors, commonly known as SSRIs, are effective in treating panic attacks and panic disorder.[12]
    • SSRIs that are FDA approved for use in treating panic symptoms include fluoxetine, fluvoxamine, citalopram, escitalopram, paroxetine, and sertraline. Duloxetine is a closely related agent and is also approved for use in the treatment of panic symptoms.[12]
  7. Work with a cognitive behavioral therapist. This form of therapy is key in training your brain and your body to overcome panic attacks, and help you reach a point where they no longer occur at all.[10]
    • Know what to expect from cognitive behavioral therapy. Therapists trained in this form of psychotherapy use 5 fundamentals as they work with people that suffer from panic attacks. The 5 areas of focus include the following:[10]
    • Learning about the illness helps you to better understand what is happening that causes the frightening symptoms experienced when a panic attack occurs.[10]
    • Monitoring and recording dates and times of events, like keeping a diary or a journal, helps both you and the therapist to identify triggers that cause the attacks to begin.[10]
    • Breathing and relaxation techniques are a part of the tools used to reduce the severity of symptoms.[10]
    • Rethinking is used to help alter the perception of an attack from what feels catastrophic to what is realistic.[10]
    • Providing exposure, safely and in a controlled manner, to places or events that are triggers for your attacks, helps to train your brain and body to react differently.[10]
  8. Consider an evaluation for panic disorder. Panic disorder is diagnosed when 4 or more of the above symptoms are present.[1]
    • Early treatment for panic disorder improves overall outcomes and reduces possible complications associated with continued attacks.

Tips

  • Some serious heart problems and thyroid problems can look like a panic attack.
  • Make an appointment with your regular healthcare provider to rule out any medical conditions.
  • Seek treatment for panic attacks sooner rather than later.
  • Confide in a family member or close friend, especially for those times when you need immediate support during an attack.
  • Take good care of your body and mind. Eat a healthy diet, get enough rest, avoid beverages with high caffeine content, be physically active, and routinely participate in activities you enjoy.
  • Consider learning a new method of relaxation, such as yoga, meditation, or mindfulness.
  • It's important to concentrate on your breathing rather than your unpleasant body sensations of panic. It may seem hard to do it because you feel likely to pass out, breathing deep and slowly will relax you.
  • Have a talk with yourself, use something you have heard that sounded good when you heard it or come up with a go to conversation you put together. I speak out loud and am able to recognize stupid messages I may be listening to and keeping me from being able to pull out of it and calm down to stop it.

Related Articles

Sources and Citations

  1. ↑ 1.0 1.1 http://www.nlm.nih.gov/medlineplus/ency/article/000924.htm
  2. ↑ 2.0 2.1 http://www.psychiatry.org/panic-disorder
  3. ↑ 3.0 3.1 http://umm.edu/health/medical/altmed/treatment/relaxation-techniques
  4. ↑ 4.0 4.1 http://my.clevelandclinic.org/health/diseases_conditions/hic_Understanding_COPD/hic_Pulmonary_Rehabilitation_Is_it_for_You/hic_Diaphragmatic_Breathing
  5. ↑ http://www.healthcare-online.org/Panic-Attacks.html
  6. ↑ 6.0 6.1 6.2 6.3 6.4 http://www.vhpharmsci.com/vhformulary/tools/benzodiazepines-comparison.htm
  7. ↑ 7.0 7.1 7.2 7.3 7.4 https://www.adaa.org/sites/default/files/CBT-for-Panic-Disorder.ppt
  8. ↑ http://psychcentral.com/lib/tips-to-cope-with-a-panic-attack
  9. ↑ 9.0 9.1 9.2 9.3 9.4 http://www.helpguide.org/articles/stress/stress-relief-in-the-moment.htm
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 http://www.psychiatry.org/panic-disorder
  11. ↑ http://www.vhpharmsci.com/vhformulary/tools/benzodiazepines-comparison.htm
  12. ↑ 12.0 12.1 http://www.anxieties.com/152/introduction-common-medications-for-anxiety-disorders#.VaPrCZspDcs
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