PANIC ATTACKS: RESOURCES, TREATMENT, AND HOPE

PANIC ATTACKS: RESOURCES, TREATMENT, AND HOPE

Your chest tightens. At first you try to ignore it, but dread seeps through the cracks in your confidence. You try to distract yourself out of this discomfort; you try to reason with it, but it won’t let go. Your breath quickens but you can’t get enough air. Your heart thumps and you can feel the pulse in your neck. You’re head is hurting and woozy and lightheaded. Your arms are numb and tingly – not a good sign. You just want it to end, but that seems to make it all the worse.

You feel out of control and yet alone. The worst IS happening. Your hearts pounds. Is this a heart attack? Am I going to die? Maybe it’s not, you reassure yourself, but it feels horrible and terrifying and you never want to feel this way again. If this sounds familiar, then you’ve probably had a panic attack. Panic is a terrible feeling, but there is hope for dealing with this challenge (whether for you, a friend, loved one, or family member) and I’ll describe the first steps that you can take in this article.

My Story

My name is Jason Drwal. I’m a clinical psychologist and I’ve worked with hundreds of people with panic attacks for a variety of reasons: social anxiety, panic disorder, PTSD, and phobias. About eight years ago, I had to leave a job a college professor because I was having panic attacks every time I taught class. I felt embarrassed, angry, and helpless. The more I tried to cover it up and wish it away, the more I worried about losing control. Worse yet, I bore this burden by myself and didn’t reach out for help for many years. This experience (and my work with many patients with panic attacks) taught me a valuable lesson about how to cope with panic: self-acceptance and reaching out for help are the two most important steps in recovery.

Acceptance And Support For Panic

Acceptance means we don’t pressure or demand that we change instantly; we don’t try to over-control our feeling, emotions, and behaviors. This is critical in coping with panic because much of the problem is being so afraid of how we feel that we get overwhelmed and this creates the very panic we are trying to avoid. It also means we don’t blame, put down, or belittle ourselves for having this problem. We don’t think less of ourselves or have to be embarrassed or ashamed. We can have panic and still be competent and worthwhile, although there’s no question that panic can make life more challenges.

Since accepting my challenges with panic, I have learned to live a fuller, richer, more productive, and happier life. Panic doesn’t rule my life and I use my potential in my work and personal life like never before. I still have moments where I get nervous and self-conscious but I can cope with those.

My philosophy is this: you don’t have to eliminate your panic before you start living life. Yes, that can happen in some cases but the road to recovery often requires setting out before you are fully prepared. I started this blog as a way for me to reach out and offer hope and help to those who are struggling with panic attacks.

This blog will offer you practical advice and novel insights that will help you to take those first steps to making change. This is not an inspirational blog. Yes, I hope to inspire you to begin to get your life back, but I won’t do it by giving you quick fixes and simplistic solutions to a complicated and chronic problem. I won’t offer an you an instant cure. I’m not a guru who will solve your problems for you. You’ll find honest discussions and help about the struggles of panic. I’ll share techniques and perspectives that aren’t discussed anywhere else.

If you want to join a supportive, helpful, and encouraging community, join my list and you’ll receive advice and blogs to help cope with panic.

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What Are The Steps To Recovery?

I have found that most person with panic first need encouragement and hope and then guidance in taking small steps to work on changing. Small steps include things like learning how and why you have panic attacks, not beating yourself up and have self-compassion when you have a panic attack, and learning to relax and calm down. For people who are further along, you’ll find advice on confronting your panic by going to situations you avoid and dread, and reacting differently when you’re in the middle of an attack. In addition to improving your panic symptoms, I’ll talk about how to live a more peaceful and contented life. Regardless of your motivation, you’ll find the kind of ongoing support that is necessary to make change and start living the life you deserve.

Common Problems With Panic And How to Deal With Them

First, let me explain medically what a panic attack is. During a panic attack you’re body goes into physical overload. You enter a fight-or-flight response. Your body responds with adrenaline and other stress hormones that ready your muscles for a fight to the death. But in panic, the danger isn’t out there. It’s inside. On top of the physical sensation, there’s a catastrophic feeling that you might die, go crazy, or just lose control of your body and mind. Different people have different symptoms but they could include

  • profuse sweating
  • a feeling of suffocating
  • racing heart
  • shaking and trembling
  • feelings of detachment as if you’re floating out of your body
  • hot or cold flashes
  • fear of dying, losing control, or going crazy

Read my blog about What Are Panic Attacks And Panic Disorder? for more information on panic attacks and mental health problems that cause panic attacks.

This is the list that is used by psychologists and other mental health professionals to diagnose panic attacks but, if you’re like me, reading this list fails to capture why panic is such a life altering experience. There are five challenges with panic that make it so debilitating: feeling helpless, isolating yourself, losing your potential, embarrassment, and numbing your emotions. I describe these challenges below and offer suggestions and resources to cope with each one.

Helplessness

Panic attacks are very short: they last anywhere from a minute up to twenty. But the aftereffects of panic are long lived and can last years or even a lifetime if untreated. At its core, panic is about feeling helpless, helpless in the most basic way possible – the ability to control one’s own mind and body. Panic strikes from the inside out and it feels like there is no way to stop what has rooted itself into the deepest parts of our gut. Panic tears at our lives in so many significant ways: paralyzed by fear we are unable to make even basic decisions. Simple things like, what should I wear to work? Or should I get out bed now? become monumental decisions.

But everyone who’s had panic knows this feeling. You’re not alone. Helplessness is a very human and understandable reaction to feeling overwhelmed, confused, and vulnerable. What you have to do first is arm yourself with information about panic and treatments options. Below is a list of suggestions for reading. Some are treatment books for panic; others are general guides for coping with anxiety. Either way, read about your problems and learn options for coping with panic and anxiety. You will feel more in control.

How Chest Breathing Worsens Panic Attacks

There is one thing you can start practicing immediately to decrease your sense of helplessness during a panic attack – learn how to breath. You’re telling me you don’t stop breathing during an attack. I know, but what I’m suggesting is learning how to breath in a way that doesn’t amplify the panic and actually calms you down. Here’s the theory behind it.

Gasping for air, whether you feel like you’re just choking up and can’t speak or you actually feel like you’re suffocating and will pass out, is one of the most terrifying and embarrassing symptoms of panic. But there is a physical explanation – you are trying to taking in a lot of air, a natural response when you’re heart is pounding like you’re running a marathon. The problem is that you are taking in too much air and, believe it or not, too little carbon dioxide. You’re not giving your body a chance to use the air inside your lungs and stuffing new air in. It is a highly inefficient and effortful way to breath. Too little carbon dioxide in your body can lead to dizziness. (S0me ER physicians will have panic sufferers breathe  into a paper bag, giving the body more carbon dioxide. This article challenges that conventional wisdom).

You can actually see the labored breathing in this video of Dan Harris (the ABC news anchor who talks about an on-air panic attack). As he talks about statins (around 1 minute in), you can see his chest and upper body moving as he tries to breath. I think we know this feel all too well.

Dan Harris describes his panic attack.

“I was overtaken by a massive, irresistible blast of fear. It felt like the world was ending. My heart was thumping. I was gasping for air. I had pretty much lost the ability to speak. And all of it was compounded by the knowledge that my freak-out was being broadcast live on national television. Halfway through the six stories I was supposed to read, I simply bailed, squeaking out a “Back to you.”

How Diaphragmatic Breathing Improves Panic

There is a simple remedy to that you can start practicing the next time you are having a panic attack. It’s called diaphragmatic breathing. Instead of breathing through your chest, you breath through your stomach, well, actually the muscle right below the ribs, which is called the diaphragm. This will draw in the air your body wants during panic and allow you to exhale more fully, another step panicked breathers miss.

David Carbonell explains how to breath during a panic attack in this video.

 

This next video is by singing coach Eric Arceneaux. What does this guy know about panic? Probably nothing. To my knowledge Eric hasn’t ever suffered from panic attacks. But he knows how to teach people to breath effectively and fully and that’s what you need do during a panic attack (really, you should do this all the time). If you really want to learn about how to overcome the gasping-for-air-feeling during panic, then learn to sing. Eric’s video is a wonderful demonstration and his technique takes you beyond the basic belly breathing technique that most psychologists know to fully using your torso to breath (if you’re short on time, watch the first 3 minutes). You’ll have to practice this when you’re not panicking to learn how to do it properly. As an added bonus, breathing this way will actually make your voice stronger and more confident and it will reduce vocal strain.

A video by voice coach Eric Arceneaux.

 

Isolation

Panic can build walls between us and those to whom we are closest. Maybe you’ve had this thought: “If I call up (or answer calls from) certain family or friends, they’ll ask where I’ve been and pressure me to do something. I know they’re frustrated with me so I feel like I’m letting them down but they also don’t understand why it’s difficult to do certain things in public. They don’t understand that I’m always thinking about when will the next attack strike? How easy or difficult will it be to get out of the situation? Will they pressure me to stay? Will they be angry if I have to leave?”

Isolation is one of the main barriers to coping with and overcoming panic. Cutting yourself off from people keeps you alone and unable to get support. When I say isolated from people, I don’t just mean trusted confidants to share your most personal secrets; I also mean the people in everyday life: coworkers, neighbors, members of your church, etc. If you want to start working on panic, a first step can be just spending time with others. Instead of always ditching any social commitment, try to accept some smalls ones. Make some small talk at work. If you don’t work, try to say “hello” to your neighbor when you’re grabbing the mail. When you buy groceries ask the cashier about her day instead of just scooping up your bags and running out the door.

If you’re in the fortunate position to have someone you really trust (but haven’t opened up to), consider talking to that person. Maybe it’s a friend, a sibling, a distant cousin; it doesn’t matter. If you can share some of what is going on, it will make you feel better and reduce some of the isolation (and maybe the shame) that goes with having panic.

I’ll warn you that you can’t guarantee a perfectly accepting response when you reach out to others but you have to try at some point. Risk is unavoidable. If you’re too afraid to reach out to someone in person, join an online community. There are several supportive communities. Below I have listed a few reputable ones that you can explore.

Online Forums For Panic And Anxiety

  • Psychcentral.com anxiety-panic-phobia forum has the most active forums I have seen on a number of conditions. This is the anxiety-panic-phobias forum but there are many more. The members are helpful and supportive.
  • Social Anxiety Support forum is an active community for people with social anxiety. If you only have panic attacks without any social anxiety, it may not be the right forum for you but it is well used.
  • Panic survivor is an older website that has created a community for panic attack survivors. It is administered by caring, thoughtful people. The number of members is down but the comments that are posted seem really helpful.
  • Support Groups – Anxiety is the anxiety section of a massive collection of support groups. It is actively used and there are many helpful members. It is often a place to vent about life’s frustrations and the challenges of mental health issues.

Contact me!

I want to hear how you are doing, feedback about this site, and suggestions for future topics. I respond to every email.

Losing Your Potential

At a broader level, panic can keep us from doing everyday activities: holding down a job, volunteering, participating in social groups, leaving the house, or just taking the poor dog for a walk. If you are involved in activities, it can limit your participation: you have great ideas you want to share at a work meeting but you’re afraid to raise your hand; you have a great question to ask in class but you don’t want the attention; you get invited to social gatherings but turn them down; you have trouble making friends because you are anxious and stressed and you come across as serious, irritable, or cold.

If you want to start working on this, think of some small goals to start working on. These goals don’t have to be about improving your panic but it could be – going places that you’ve been avoiding, sharing about your symptoms with someone. But the goals can be very small and very simple. Maybe it is to walk that over-active dog you have. Maybe it’s go buy that easel, even if you have to order it from Amazon, and learn to paint. (by the way, is Bob Ross not the most relaxing painter you’ve ever seen? just youtube him if you don’t know what I’m talking about). If you want more help, I have a free goal setting guide to help you get started.

Embarrassment

Embarrassment is a key factor in panic. Not only do you have to worry about the overwhelming terror of the attacks themselves but then you have to dread people staring at you. The fear is that panic can strike when you least want it to, when it is least acceptable, and least convenient. Maybe you experience shyness or social anxiety. For these people, embarrassment is at the core of their panic symptoms. The panic is an affect-effect of feeling tremendous pressure to not make a fool of themselves doing the most basic things in public – talking, writing, or even just looking different.

For others, going into public is not the problem but there’s a constant fear that a panic attack will strike around other people and they’ll be helpless and look strange. And the embarrassing part is that panic can strike in the most mundane situations. Why should you feel terrified standing in line at the grocery store, sitting in a movie theater, talking in front of people? Embarrassment comes from thinking that your reactions are silly, absurd, all in your head, and other harsh judgments. Often, the pressure to just get over it, created by ourselves and well-meaning friends and family members, creates the very panic we are trying so desperately to avoid.

Coping With Embarrassment

What do you do about self-consciousness and humiliation? Start by being more compassionate to yourself. Understand that this problem doesn’t make you less of a person, worthless, or stupid. It’s a struggle that many people have gone through. Panic is such a common occurrence. One national representative survey found that over 25% of people have experienced a panic attack and I’m willing to bet it’s higher if we asked the questions differently. Besides panic, who hasn’t felt choked up, afraid, or embarrassed in some situations. One thought experiment that I ask many of my patients to do is to look at how you would judge a friend or family member who has panic. Would you look down on them? Ridicule them? Or would you empathize and understand the pain they are going through?

Numbing Yourself

Panic sometimes becomes so overwhelming that you want it to end now. You may drink, use drugs, or take more than the recommended dose of your prescribed medications in ward off any potential panic attacks, especially if you have to do something challenging. The plus side is that you can sometimes go to these situations but the downside is now you’re either addicted to these substances or you’re running the risk of becoming that way. On top of it, you can never really be yourself when you’re intoxicated or over-medicated. In a backwards way, the more you try to suppress these feelings the more they spring back, more intensely and violent than before. Anxiety can rebound, meaning that once the substances start to wear off the anxiety is even more intense. They often make your body even more susceptible to panic, although in the short run they suppress them when under the influence. Beside that the substances become less and less effective over time.

Just ask yourself if you routinely have to use some kind of substance to cope with your feelings. If so, then you may need to get some help. Talk to your primary care doctor or a mental health professional.

You’re Not Alone

Many famous public figures have struggled with panic attacks. This article in The Atlantic by Scott Stossel discusses famous figures stricken by panic attacks during stage performance, renowned Greek orator Demosthenes, Actor Hugh Grant, Singer Barbara Streisand, and Comedian Jay Mohr to name a few. In fact, if you think your panic is bad, consider Scott Stossel. He’s a mess (I think he would agree) and candidly shares it in this article about this tortured existence. Despite these afflictions, he is a highly successful author and the editor at The Atlantic.

Where To Go From Here?

I know I’ve given you a lot of information so you may want to come back to this post to digest more of it later. Pick just one thing to start working on (whether that’s learning to diaphragmatically breath, read a self-help book about panic, get support, set a goal, reduce your embarrassment, change negative coping, or finding inspiration. You can get better with practice, persistence, and patience. Good luck in your journeys and I wish you well.

Photo by Sander van der Wel

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Jason Drwal

Jason Drwal

I am a writer, blogger, clinical psychologist, parent, devoted spouse, coffee snob, runner, and connoisseur of exotic foods.

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