Panic/Anxiety Attacks - What to Do

“Serenity is not freedom from the storm, it is peace amidst the storm.”      Unknown

When people experience a physical injury, they reach for a first aid kit.  We’re going to build an Anxiety First Aid Kit. It will include a lot of tools you can use to help you manage your anxiety and/or panic episodes.  Not every tool works for every person. It will be very important that you get to know yourself, select tools which work for you, and reject tools which do not work for you.  You probably won’t be able to complete this task in an hour, or even a day. It will take a lot of trial and error to find which tools work best for you specifically. Once you’ve identified the best tools, it will then require practice to master them.  

What will improve are your feelings of helplessness.  You will be busy trying things, finding answers, and creating solutions.  One of the problems with anxiety which makes it worse is the feeling of helplessness.  It comes out of nowhere and turns you inside out. Being busy finding solutions will help you feel less powerless.  So be patient. Help is coming.

I’m going to refer to panic attacks or anxiety attacks as “episodes”.  Some people experience a panic attack which is so severe it feels like a heart attack.  These usually last just a few minutes. Some people experience a lower level of anxiety, but it persists for hours, even days.  So I’m going to refer to whatever kind of anxiety or panic you are experiencing as an episode. Whatever your experience, creating a first aid kit will help you get them under better control.  

You will also see the word “grounding” used in this text.  Some people dissociate, feel like they are floating away, or feel like they are leaving their bodies when they are anxious or panicking.  To combat this feeling, use exercises described as “grounding” exercises. They will help keep you anchored to the ground and feeling less spacy.  

So let’s get started.  First, let’s find out what kind of person you are.  People respond differently to panic and anxiety and require different things to feel better.  If you don’t know the answers to these questions that is OK! That’s what we are working to learn.  Pay attention during your next episode and see what feels better and what feels worse.

1. Inside or outside?   When you are having an episode, do you need to indoors to feel safe?  Or do you do you feel better being outside?
2. Alone or with people?  Do you need to be around other people?  Or do you need to get away from people and be alone?
3. Contained or free?  Do you need to feel contained, in a small safe space?  Or do you feel better if you are free to move around?
4. Quiet or noisy?  Some people feel better if they are around a lot of bustle, noise and movement.  Others need quiet and very little external stimulation.
5. Move or be still?  Some people feel better if they get up and move around, i.e. going for a run or cleaning.  Other people feel better if they get quiet and still.

Now, knowing more about what you need during an episode, let’s look at the many things you can do for yourself when you’re anxious or panicking.  

1. Observe them.  Panic and anxiety are like quicksand. The more you struggle and fight to stop them from happening the worse they get.   Don't do anything else to avoid them. Panic or fear are paradoxical. The more effort you try to put to avoid them, the more vicious and merciless they become.  The thing to remember is not to fight the episode as that only makes it worse. Remind yourself you are safe and the episode will taper off and end soon. Remember, you have handled these episodes before. You were OK then and you will be OK now.
   
   Panic attacks won't kill you or harm you in any way really. It's very hard to trust that but hey, what have you got to lose? The next time you have one, try to look at the attack as an observer, a scientist, looking in from the outside. Let the attack run its course and gather evidence as it does so. What happens? Did you die? Pass out? Shake a bit or have a racing heart?   Once you gather evidence, you will begin to realize that episodes don’t lead anywhere. Most of the things you panic about never happen. For the things that do happen, panicking doesn’t stop them - or cause them to happen faster. So you spend a lot of time panicking for nothing.
   
   The symptoms are real.  But what your thoughts make up about them are not.  Getting over the fear of having an episode will enable you to relax and say, "bring it on panic, I'm not afraid of you!"   Panic and anxiety episodes are mostly bluff. They tell you terrible things are happening, but they don’t. Watch them. Gather your evidence and call them out.
   
   
2. Allow the fear to explore your body and mind. Let it sit there. Allow the intense bodily sensations to conquer your body.  Breathe. Relax. Be curious. When you face your fear directly, wolves become puppies.
   
   
3. Focus on your breathing. Try to take deep breaths through your nose and let your stomach expand. Continue this until your symptoms improve.
• Focus on breathing into your belly.
• You can sit or stand, but be sure to soften up a little before you begin. Make sure your hands are relaxed, and your knees are soft
• Drop your shoulders and let your jaw relax
• Now breath in slowly through your nose and count to four, keep your shoulders down and allow your stomach to expand as you breathe in.
• Hold the breath for a moment
• Now release your breath slowly and smoothly as you count to seven.
• Repeat for a couple of minutes.
  
  
4. Relax your muscles.  Start at the top of your head and slowly move through your entire body.  Stop at each area and consciously relax your muscles completely before moving to another area.  Practice this even when you are calm. You will learn where you hold panic in your body and you will master relaxing your muscles in a few seconds.  Ask your therapist to walk you through this if you’re not clear how to do it.
   
   
5. Keep cold packs in your fridge. When you experience an attack, take one out and place it on your wrist, inner arm up. The cold does two things. It cools you down causing your blood pressure to lower, and the cold distracts you from the panic attack physically. Away from home? Place your open wrist on something cool. Plastic, metal, anything cool.
   
   
6. If your panic or anxiety are caused by trauma triggers, get your therapist to explain what happens when your brain is triggered so you understand what is happening.  Have compassion on your poor brain - it’s just trying to protect you.
   
   
7. Confront the thoughts that might be causing or contributing to your episode.  If you know the thinking which is provoking it, counter it with facts.
   
   
8. Do something.  Sitting and feeling at the mercy of your anxiety creates more anxiety.  You start to have anxiety about having anxiety. Actively do something to help yourself - turn and face it.  This will make you feel more in control of your body, mind, and emotions and will keep you from feeling so helpless.
   
   
9. Laugh.  Even if that’s hard. Just the act of laughing about something, anything can break that spinning out of control feeling.  Try to do something long term that you can lose yourself in, like a funny TV show or movie that you enjoy. Some people buy and keep on hand movies which they find calming and funny so they always have them ready when they need them.  If there is someone in your life who makes you laugh, meet them for lunch. Laughter can be the best medicine.
   
   
10. Exercise to the point of tiring yourself out.  If you can't sleep normally, it can help if you’re physically exhausted.  
    
    
11. Talk to friends and family.  One of my clients had a code in their family.  They could call anyone, even at 3 a.m. and say, “talk to me”.  The person on the other end would talk about the boring things they did that day; going to the grocery store, waiting in traffic, going to the post office.  The calm, boring drone and the sound of a loved one’s voice on the other end can be really calming.
    
    
12. Sleep.
    
    
13. Meditation may be a useful tool.  There are different schools of thought regarding meditation.  Use the one which makes the most sense to you.
    
    One school of thought is that you should not try to control your thoughts.  Merely be an observer and learn to let them go by. There is an app on iPhone and Android which has proven very helpful - Headspace.  There is a free version and a subscription. Most of my clients use the free version and find it very helpful. It actually teaches you this form of meditation.  Many people think meditation is about envisioning scenes or trying to control your thoughts, and it can be. But that type of meditation can be very daunting when you’re panicking or you are new to meditation.  This version of meditation is about relaxing and letting your thoughts go by. I highly recommend it.
    
    The other school of thought focuses on controlling your thoughts.  Start by closing your eyes, taking as deep a breath as possible, hold for a few seconds, then breathe out. Repeat this a couple of more times.  As you are breathing in imagine a happy, safe day when everything was perfect. Try to engage all five of your senses. What did you see? What did you hear?  Feel on your skin? Smell? Taste? Breathe in and visualize this scene, breathe out all the negativity. You may also choose to focus on just one idea; a loved one who is comforting and makes you feel safe, a spiritual guide, a point on the wall, whatever calms you.  When you master the task of keeping out intrusive thoughts and concentrating on only one thing, you may want to attempt keeping your mind totally blank. That is a choice for you to make. Make your meditation work for you. Either way, it will require practice and patience.  It won’t work immediately, so be prepared to invest some time and energy into mastering this skill. Do this regularly twice a day in morning and evening, you should be able to feel the difference within two weeks or less.
    
    
14. Simple Grounding Technique - place both feet flat on the floor.  Lean back into your chair, and make note of the feeling of the chair under you and against your back.  Cross your arms over your chest. Gently tap your shoulders, alternating one side at a time. Alternatively, you can place your hands on your thighs if you are in public, tapping one leg at a time. Although not as effective as shoulder tapping, this technique can still calm you down.
    
    
15. If it is a situation causing the episode, leave the situation you are in as soon as possible. If you need to, make an excuse such as needing to use the bathroom or go to another room.  
    
    
16. If possible, grab a large glass of water or bottle of water and slowly drink the whole thing.
    
    
17. Believe it or not simple things like a little exercise and going on walks to get some fresh air improve the quality of your life and give you a positive outlook on things.  They improve your blood circulation and and can be the answer to the occasional episode.
    
    
18. Breathe into a small paper bag. It increases the CO2 in your lungs and slows your heart rate and breathing all by itself.  You may keep a paper bag in desk, purse or back pocket. It's unobtrusive and no one really notices.
    
    
19. Manage your thoughts.  If you are thinking, “I’m going to die”, “I can’t take this”, “I’m going to lose my mind”, that’s only making the anxiety worse.  Get control of your thoughts, “This has happened before”, “It’s just a panic/anxiety attack”, “I’ve had them before and I will survive”.   
    
    
20. Play music.  Baroque music is a form of classical music which research has shown to be very beneficial to the brain and to calm the emotions.  But, again, this is your anxiety first aid kit. Choose the kind of music which calms you. Be are of contamination*, discussed below.
    
    
21. Consider using medication as a tool.  You may want to consider using medication, temporarily, to help bring your anxiety symptoms down while you learn and master these tools.  Just because you get on medication doesn’t mean you have to stay on medication.
    
    The best use of this was a client who worked it out with his doctor to have a prescription for an anti-anxiety medication filled once per year.  He would tell himself that he would use all his other anxiety reduction skills first, but, if he couldn’t tame the anxiety he could always take the pill and it would make it go away in 20 minutes.  Guess what? He never needed the pill. But just knowing it was there for him if he needed it made him calmer.
    
    
22. Identify triggers - when possible.  You can’t always know what triggers an attack.  However, if you can figure out what caused it, that really helps you understand what is happening and why your emotions are responding this way.  It helps you feel less crazy and allows you to trust your brain more when you understand why it’s reacting this way. Episodes don’t usually come out of nowhere, they just feel like they do.  
    
    
23. Apply pressure.  There are weighted blankets and weighted pillows you can buy.  Drape yourself in a heavy quilt. Have your dog sit on your feet.  Ideally it will be something heavy and comforting. This helps ground you.  
    
    
24. Write out what’s going on. Keep writing until you start to notice it makes a difference, lets some of the things you’re anxious about out.
    
    
25. Take a shower/bath. Notice the sensations of the water.
    
    
26. Write somebody you care about an email.