Defeating Panic Attacks Guide

Panic attacks can last from anywhere between thirty seconds to thirty minutes and can be so distressing sufferers sometimes have the feeling they are losing control or about to die. The experience can be one of extreme agitation, terror, fury, or immobilisation, accompanied by extreme symptoms of the fight, flight, or freeze response; racing heart, rapid breathing, trembling, shaking, nausea, numbness, tight chest, difficulty swallowing, and hot flushes or chills. Episodes can return in waves, are frightening and often exhausting.

Panic attacks are normally initiated when the amygdala responds to a trigger in the environment that the person may or may not even be aware of. They can be triggered by situations, smells, sounds, or feelings; based on deeply held fears or associational memory. They can often occur at inappropriate times and are due to an overreaction by the amygdala, often in response to a cue or trigger that doesn’t pose any real threat or danger. If there was a real danger or emergency then the physiological responses would be appropriate and helpful.

Most people will experience some sort of panic attack once or twice in their lives, but those who have more regular panic attacks can start to fear them, and this anxiety can become a self-fulfilling prophecy, with an attack being triggered simply by the fear of having one. For example, a person may once have had a panic attack at the cinema, so during their next visit to the cinema they fear the same thing happening again, which can start to trigger panic attack symptoms. This can lead to the person avoiding the cinema altogether, and then avoiding other public places in the future. This is the type of Escape Avoidance Learning we discussed in Chapter 4, and it can lead to agoraphobia and other clinical anxiety disorders. 

Important: Don’t Try to Escape the Situation!

When suffering from a panic attack it’s vital you resist the strong impulse to escape the situation.  Although panic attacks are very frightening and uncomfortable they can’t physically hurt you. Fleeing from the situation may make you feel better in the short-term but in the long-term it will reinforce the power of the attacks, and make it more difficult to overcome them.

We discussed earlier in the book that the amygdala learns from experience. So staying in the situation will help the amygdala to learn that the situation is safe and it doesn’t need to react in the same way in the future. While this is much easier said than done, it would be beneficial to see these situations as opportunities to work on changing the anxiety response; reducing and eventually eliminating further episodes.

Although it is very difficult to calm a panic attack through cortex-based logical thinking, there are some things you can do during an attack that will help reduce the ability of the cortex to create the conditions in which the panic attack can get worse:

1. Understand it’s only a feeling: Interpreting the symptoms of a panic attack as life threatening can cause the symptoms to get a lot worse. So it’s important to try to recognise you are having a panic attack and nothing more. This will ensure you don’t add fuel to the flames.

2. Don’t worry about what other people think: In the middle of a panic attack people often feel embarrassed and worried other people are judging them. Don’t let your cortex try to predict what other people are thinking, it is probably wrong anyway, and it will only add to the stress and panic.

3. Don’t focus on the panic attack: Try not to obsess about when a panic attack may come. Not worrying about panic attacks is one of the best ways to avoid them. Constantly focusing on bodily sensations like sweating and butterflies in the stomach, can lead you to thinking yourself into a panic. While again, this is easier said than done, if you do find yourself thinking or worrying about a possible panic attack, use one of the defusion exercises in Chapter 7 and then focus your attention on the present moment. With practice these defusion techniques will get easier and work faster.  

So what should we do if we start to recognise symptoms of a panic attack starting, or if we suddenly become aware we’re caught up in one? How can we best cope? While we can’t immediately stop the attack, there are a number of strategies that can reduce the power of the symptoms and also shorten the duration of the attack. These strategies are, of course, designed to help us switch from the aggressive sympathetic nervous system to the calmer parasympathetic nervous system.

Always keep in mind that in order to eliminate or greatly reduce future panic attacks you need to try to avoid escaping the situation. This can be difficult at first and will require patience and courage, but with time and practice it will get easier. Experiencing short-term fear will provide you with long-term peace.

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Panic Attack Exercise 1: Deep Abdominal Breathing

An audio version of this exercise can be found here: Dr Matt Lewis: Calming Panic Attacks

https://soundcloud.com/dr-matt-lewis/calming-panic-attacks-audio-exercise

Deep breathing can be effective when having a panic attack as many of the symptoms we experience are related to hyperventilation, which is fast and shallow breathing. When we go into hyperventilation, we breathe out carbon dioxide too quickly, resulting in low levels of it in the body. This is identified immediately by the amygdala and triggers a highly reactive response. This is why people who are having a panic attack are advised to breathe into a paper bag; the bag will capture the expelled carbon dioxide, allowing it to be inhaled back into the bloodstream. However, by using conscious deep breathing we can relax the amygdala and prevent hyperventilation, or bring it under control after it has been triggered.

Step 1

Sit as comfortable as you possibly can, placing one hand on the chest and one hand on the stomach.  If you’re unable to sit down you can still do this exercise standing up.

Take a deep breath in and see which part of your body rises. People often find that their chest rises as they breathe in. However, effective abdominal breathing will cause your stomach to expand as you inhale and retract as you exhale. Your chest shouldn’t move much at all.

Step 2

Try to focus on breathing deeply in a way that expands your stomach as you fill your lungs with air. You should feel your stomach rising underneath your hand when you breathe in. Many people tend to pull their stomachs in as they inhale, which keeps the diaphragm from expanding downward effectively. So focus your attention on your stomach rising as you inhale.

Important Note

Some people find focusing on breathing increases their anxiety, especially if they have asthma or other conditions that cause breathing difficulties. If you find the breathing exercises uncomfortable use the other recommended exercises instead.

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Panic Attack Exercise 2: Progressive Muscle Relaxation

A panic attack often results in muscle tension throughout the body, and tight muscles also tend to increase amygdala activation. So learning and practicing muscle relaxation techniques will help to shorten panic attacks and make them less likely. If you are prone to panic attacks, you should practise the following exercise regularly so you are able to use it quickly and effectively when experiencing severe anxiety. 

The exercise uses a two-step process. Firstly, you systematically tense particular muscle groups in your body, and then you release the tension and notice how your muscles feel when you relax them. Anxious people are often so tense throughout the day that they may not recognise what being physically relaxed feels like. Through practice you can learn to distinguish between the feelings of a tensed muscle and a completely relaxed muscle.

Then you can begin to quickly initiate this relaxed state at the first sign of the muscle tension that accompanies your feelings of anxiety. By tensing and releasing, you learn not only what relaxation feels like, but also to recognise when you are starting to get tense
 

When first trying the exercise it should take around  10-15 minutes to complete. Or you can just practise with different muscle groups for 2-3 minutes at a time. You don’t have to be feeling anxious when you practise it, practising it when you are calm can make it easier to do when feeling anxious or starting to panic.
 

Step 1: Getting ready
If possible, find a quiet, comfortable place to sit, then close your eyes and let your body go loose. You can lie down, but this will increase your chances of falling asleep. Although relaxing before bed can improve your sleep, the goal of this exercise is to learn to relax while awake. Take between three and five slow, deep breaths before you begin.

Step 2: Apply muscle tension to a specific part of the body
Focus on a specific muscle group, such as your left hand. Take a slow, deep breath and squeeze the muscles as hard as you can for about 5 seconds. It is important to really feel the tension in the muscles, which may even cause a bit of discomfort or shaking. In this instance, you would be making a tight fist with your left hand. It is easy to accidentally tense other surrounding muscles (for example, the shoulder or arm), so try to only tense the muscles you are targeting. Isolating muscle groups gets easier with practice.

Step 3: Relaxing the tense muscles
After about 5 seconds, let all the tightness leave the tensed muscles. Breathe out as you do this step. You should feel the muscles become loose and limp as the tension flows out. Deliberately focus on, and notice the difference between, the tension and relaxation. This is the most important part of the whole exercise. Remain in this relaxed state for about 10 seconds, and then move on to the next muscle group.

Step 4: Repeat the tension-relaxation steps with the other muscle groups

To make it easier to remember, you can start with your feet and systematically move up (or if you prefer, you can do it in the reverse order, from your forehead down to your feet).
 

For example:
Foot (curl your toes downward)
Lower leg and foot (tighten your calf muscle by pulling toes towards you)
Entire leg (squeeze thigh muscles while doing above)
(Repeat on other side of body)
 

Hand (clench your fist)
Entire right arm (tighten your biceps by drawing your forearm up towards your shoulder and ‘make a muscle’, while clenching fist)
(Repeat on other side of body)

Buttocks (tighten by pulling your buttocks together)
Abdomen (suck your stomach in)
Chest (tighten by taking a deep breath)
Neck and shoulders (raise your shoulders up to touch your ears)
Mouth (open your mouth wide enough to stretch the hinges of your jaw)
Eyes (clench your eyelids tightly shut)
Forehead (raise your eyebrows as far as you can)
 

Step 5: Relax

After completing all of the muscle groups, take one minute  to enjoy the  state of relaxation.
 

It can take time to learn to relax the body and notice the difference between tension and relaxation. At first it can feel uncomfortable to be focusing on your body, but this can become quite enjoyable over time.

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Panic Attack Exercise 3: Quick Tense and Relax

Once you have become familiar with Exercise 2,  you can begin to practise a very short version of progressive muscle relaxation. In this approach, you learn how to tense larger groups of muscles, which takes even less time. These muscle groups are:
 

1. Lower limbs (feet and legs)
2. Stomach and chest
3. Arms, shoulders, and neck
4. Face

So instead of working with just one specific muscle group at a time (e.g., your stomach), you can focus on the complete group (your stomach and chest). You can start by focusing on your breathing during the tension and relaxation.

When doing this shortened version, it can be helpful to say a certain word or phrase to yourself as you slowly exhale (such as “relax”, “let go”, “stay calm”, “peace”  etc.). This word or phrase will become associated with a relaxed state; eventually, saying this word alone can bring on a calm feeling. This can be beneficial during times when it would be hard to take the time to go through all the steps of progressive muscle relaxation.

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Panic Attack Exercise 4: Release Only

You can further shorten the time you take to relax your muscles by becoming familiar with the ‘release only’ technique. One of the benefits of tensing and releasing muscles is that you learn to recognise what tense and relaxed muscles feel like.

Once comfortable with this you can start doing ‘release only’, which involves removing the ‘tension’ step of the exercise. For example, instead of tensing your stomach and chest before relaxing them, try just relaxing the muscles. At first, the feeling of relaxation might feel less intense than when you tensed the muscles beforehand, but with practice, the release-only technique can be just as relaxing.

Remember it’s vital to practise progressive muscle relaxation often, feeling anxious or not. This will make the exercise more effective when you really need to use it.  It may seem a little tedious at first, but it can become a very effective tool for treating anxiety and reducing the power and duration of panic attacks.

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Panic Attack Exercise 5: Physical Exercise

If you’re in a place where you’re able to move about when having a panic attack it would be very beneficial to pace or exercise. Remember, this is the emergency arousal system kicking in, preparing your body to fight or flee, so physical exertion is exactly what your body is ready to do. If your sympathetic nervous system is activated, you can put it to use as nature intended. If you run or walk briskly when you feel anxious, you’ll make use of the muscles that have been prepared for action. Exercising will also burn off excess adrenaline and make use of the glucose released into the bloodstream by the stress response.

Many of the physical sensations you experience when exercising are similar to the way the body reacts when the emergency arousal system has been activated; increased heart rate and blood pressure, faster breathing. So exercising can also be a form of exposure therapy, allowing you to experience and get used to these types of physical changes, making us less afraid and more accepting of the sensations over time.

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