Panic Attacks  

What are Panic Attacks? 

Humans have an inbuilt fear mechanism that is set in motion when we are in danger. Imagine that you walked out of your office or home right now and were confronted by a vicious dog. What would you do? Run back inside? Scream? Wave your arms or grab a stick and ward off the animal? Whatever you decide to do, you are in the process of a flight/fight reaction. It is a defense mechanism that helps you to either escape (flee) a threatening situation or attack (fight) a dangerous person/animal. Some dramatic changes take place in your body: your heart starts pounding, your breathing may become labored or you might hyperventilate, you might start shaking or trembling, your hands might become sweaty, your legs will probably feel rubbery. All of these things happen because adrenaline has been sent soaring throughout your body, preparing your muscles and heart to fight or flee.  

A panic attack occurs when we have all of the symptoms created by a fear response, but there is no real threat. It is the fight/flight reaction when no real danger is apparent. It is a false alarm.  

What causes Panic Attacks? 

There are several theories about what causes an initial panic attack. Some believe it is due to chemical or hormonal imbalances in the brain or a hypersensitive nervous system. There does appear to be a genetic link. Others theorise that there is some malfunction in the autonomic nervous system. The most likely cause is a stressful life event like death of a loved one, divorce, or school or job stress. Another common cause seems to be the cumulative effect of stress in one’s life. So, if you have experienced a lot of stressful events over a long period of time, it can come out in the form of panic attacks.  

We understand better what causes subsequent panic attacks. Once you have experienced the terror of one panic attack, it is understandable that you have some fear about experiencing another one. The panic attack itself is associated with several internal cues (palpitations, light headedness, shortness of breath) and external cues (the place or situation where you had the initial panic attack). What happens is that you associate these cues with experiencing another panic attack and create the false alarm again. For example, you have a panic attack on the train on your way to work. Now, every time you go to take the train, you associate it with panic and you set off your fear response. Or, you are racing to get to an appointment on time and your heart is thumping and you are out of breath. Suddenly, in your mind, these “normal” symptoms become catastrophic. You are associating them with the same symptoms you had during the panic attack. You may say something to yourself like: “Oh no, here comes another panic attack!” or “Oh no, I can’t breathe! I’m losing it!” Once again, you set off the fear response and have a panic attack.   

Let’s look at some of those symptoms and see why people are so afraid of them.  

Symptoms of Panic Attacks: 

Any of the following bodily symptoms may occur during a panic attack: 

Palpitations or racing heart 

Chest pains or tightness across the chest 

Dry mouth 

Sweaty palms 

Cold, clammy hands 

Dizziness, lightheadedness, faintness 

Butterflies in the stomach 

Nausea and/or diarrhea 

Chills or hot flushes 

Weak or rubbery knees or legs 

Tingling or numbness in the hands, arms or feet 

Shortness of breath, feeling of being smothered 

Choking sensation or feeling a lump in the throat 

A feeling of partial paralysation 

Trembling or shaking 

Dreamlike sensations or disorientation 

Feeling detached from oneself (depersonalisation) 

Intense fear: of losing control, going mad, or dying 

Important Truths about Panic Attacks: 

1.    They are not dangerous! The symptoms feel dangerous, but they are the body’s normal reaction to a threatening situation. Doctors have told me that we are built to handle a lot more adrenaline rushing through our bodies than we might realise. So we could continue feeling all of the symptoms caused by adrenaline for hours and still be okay. We won’t die! We won’t have a heart attack! We won’t faint! We won’t go crazy! We won’t suffocate! 

2.    Our emotional reaction to the symptoms keeps the symptoms going! When you are scaring yourself with thoughts like: “Oh my God, I can’t stand this!” or “I feel like I’m going to die!” you feed your own fear and keep the adrenal pumping through your body, which keeps the symptoms going. 

3.    If you can calm down (stop the scary thoughts and slow your breathing down), the “attack” will subside within about 3 minutes. That’s how long it takes for the adrenaline to be absorbed by your liver and kidneys. 

How to Cope With Panic Attacks: 

 During an intense panic attack, people have said it is the most frightening experience of their entire life, leaving them feeling helpless and lost. Once you have had a panic attack, the fear of having another one plays on your mind. You don’t want to put yourself in any situation that might trigger another one. This is understandable. However, by not facing any fearful situations, you are feeding the fear. So, although it can be helpful to retreat from the situation until you calm down, it is most important to go back into the situation and face it head on. If you don’t, you will find your activities and movements becoming more and more restricted. I have known people who are almost housebound because they fear panicking in their job environment or on the bus or train or when they are out shopping.  

Do you want to be free of the fear and reclaim your life?  

Let’s look at a few coping strategies, starting with some that you can use when you are in the midst of all those horrible symptoms:  

During a full fledged panic attack: 

1.    Retreat from the situation causing the panic. This does not mean you escape, but rather you leave for a short time while you recover from the symptoms. You then re-enter the situation.  

2.    After retreating to a “safe place,” slow your breathing down. You can immediately hold your breath for 5-10 seconds, and then take a slow breath in and out through your nose. Each breath should take 3 seconds to inhale and 3 to exhale. 

3.    Talk to someone if possible. Express your feelings. Speak to yourself in a soothing voice. Tell yourself “It’s okay, I can handle this.” 

4.    Don’t fight the symptoms. Notice them as if they are floating past you. Remind yourself that the panic symptoms are not dangerous and they will subside in about 3 minutes. 

5.    Keep breathing slowly until you feel calm again. Then go straight back into the situation that triggered your panic attack. 

When you notice oncoming symptoms of panic: 

1.    Learn to recognize what happens for you before a full-fledged panic attack. It is different for each person. Perhaps your first sign is nausea, followed by sweaty palms. Or you notice you feel wobbly or your face becomes hot.  

2.    At the first sign of a panic attack, slow your breathing down as in #1 above. Use a few drops of lavender oil on a hanky, tissue or on the palm of your hand and hold it near your face as you breathe. If you are at home, burn some lavender oil in a burner or take a bath with several drops in it. 

3.    Distract yourself: Talk to someone. If you are in a public place, ask a salesperson to show you something. Talk to the person at the checkout. Ask someone for directions. Do some repetitive task like counting backwards from 100 in 3’s. Snap a rubber band against your wrist. If you are at home, try taking a hot shower, scrubbing a wall, or cleaning out a drawer.  

4.    Get physical: If you are at home, go outside and walk around the yard or around the block. Do some vigorous housework or gardening. Go for a bike ride. If you are at work or school, go for a walk to the toilet or outside for a few minutes.  

5.    Use positive self-talk: I recommend writing a few sentences on a small piece of paper or cardboard and keep it in your handbag or pocket. Choose statements that are soothing to you. Things like: “This will pass.” “You’re doing well.” “You can do it.” “Go girl!” “It’s only some anxiety symptoms. It won’t kill you!” 

Lifestyle changes that help if you suffer with panic attacks: 

1. Exercise daily: Physical exercise decreases stress in the body and is one of the best strategies for overcoming panic attacks. Find something you enjoy and make it part of your life. Walk, run, bike ride, swim, use an exercise bike or treadmill, roller blade. Join a gym. Find a friend to “buddy” up with and go walking together.  
2. Learn to take slow, deep diaphragmatic breaths: Throughout your day, stop and ask yourself, “How am I breathing? Is it shallow and coming mainly from my chest? Or am I breathing slower and from my stomach?” Take 3 deep, slow breaths. Ah, that feels better. Become used to this type of breathing. (Deep Breathing Exercises) Next to daily exercise, learning a deep breathing exercise is the second most important strategy for overcoming panic attacks. 
3. Take your focus off internal bodily sensations: It has been discussed above that panic attacks are caused by a fear of the symptoms themselves. People who experience panic attacks, often make mistaken interpretations of their internal symptoms. For example, heart palpitations become the precursor to a heart attack; butterflies and nausea are sure signs of a tumour; dizziness means fainting; a lump in the throat indicates imminent choking. It is the interpretations of these symptoms that cause the fear response and keeps the panic attack going. So, try taking your focus away from your internal world. Whenever you find yourself thinking about your butterflies, heart palpitations or dizziness, distract yourself. Tell yourself, “It doesn’t help me to focus on that stuff. Let’s go and do something.” Then go and do something! Get your mind off your symptoms. 
4. Learn a relaxation technique: This could be listening to a relaxation tape (see Barb's Visualisations), learning a progressive relaxation method or a meditation technique. See Meditation Techniques and Progressive Muscle Relaxation.  You could try yoga or Tai chi. Find something that suits you and stick with it. During the day, check in with yourself: is there any tenseness within your body? Can you relax that part? Let go of tension. 
5. Reduce or eliminate anything containing caffeine: coffee, tea, cola and chocolate are the main culprits. I have known clients whose panic attacks completely subside once they give up coffee. 
6. Eat a well-balanced, healthy diet with plenty of whole grains, fruits and vegetables. There is plenty of reading material on this subject, so start a plan today to eat for your health. Eliminate all junk and food containing white flour and sugar. In fact, try to eat foods with little or no processing. The closer to fresh the better. Drink herb teas and plenty of water. 
7. Give up recreational drugs and nicotine: Amphetamines are closely associated with anxiety and panic. So too is nicotine. There are a lot of drugs out there that can trigger panic attacks. I don’t want to lecture, but, if you are serious about being free of panic attacks, there is really no place for cigarettes or drugs. 
8. Increase your self-esteem: Stop being so hard on yourself! Learn to love the precious person you are! Try some of the exercises from Loving Yourself. Learn to be more assertive and to ask for what you want. Take a course, read some books or see a good therapist who can help you with self-esteem issues. 
9. Take on a “live and let live” attitude: Anxious people are usually serious people who expect and demand a lot from themselves. They often have unrealistic beliefs like “I must succeed or I am nothing,” or “I must always please others to be accepted and loved.” Challenging these beliefs and taking on a more realistic approach to life can control panic and anxiety. Everyday, do something fun. At first, this will seem hard for many of you, but it helps in cultivating a more carefree attitude, something you need.  
10. Learn how to express your feelings: Sometimes underneath panic attacks are withheld feelings, feelings that are “escaping” through panic. If you are the type of person who never shows their emotions, you may have a lot of suppressed feelings that want to come out. Choose a time when you will be alone, put on some loud expressive music and have a cry or beat the couch with a rolled up newspaper. Let your feelings out.