How These 8 Techniques Help Me Manage My Panic Attacks
I developed this coping routine based on my experience and the psychology textbooks I use as a trainee psychologist
The first time I got a panic attack, I was in my college classroom.
That was the first panic attack I ever had. At that time, I was completely caught off guard. All I could do was look on the floor, breathe through my mouth softly, and try to calm my racing mind. In five minutes or so, as my tension decreased in its intensity, I went out and washed my face.
I was really confused because I could not figure out the reason why my anxiety skyrocketed through the roof. I have always been a person with high levels of anxiety but it never cumulated in a long period of constant anxiety that even made standing up a task for me and made me sweat bullets.
I assumed that it was a one-time thing and went on with my life.
I was so wrong. The same thing happened to me again after a week when I was walking down the road with my partner. And then again in another class. After four of such panic attacks in a period of two months, I came to the realization that it was something that was being triggered at random hours of days and situations.
As a trainee psychologist, I decided to use my psychology textbooks and research articles on the internet to devise a coping plan. I read about other people’s experiences with panic attacks.
Over a period of the last 12 months, I have come to know what works in dealing with these attacks. Along with the techniques to be used during the attack, I have also developed a routine for the time when I am not in a panic attack. This routine focuses on anxiety-reducing habits.
I got the first panic attack in October 2019 and then started implementing this routine in December 2019. As a result of these interventions, I cured my panic attacks in four months. My last panic attack was in March this year and I have not had one since then. During that last attack, I felt in greater control of my thoughts and mind and could go through the wave of anxiety with lesser fear and physical symptoms.
What Is A Panic Attack
“Anxiety can be defined as the response of an organism to a threat, real or imagined. It is a process that, in some form, is present in all living things.”
In simpler words, anxiety is the body’s natural response to stressful situations. When you’re facing a possible threatening situation, your body reacts by releasing large quantities of cortisol and adrenaline to prepare you for the fight or flight situation.
In the short term, your breathing increases, your heart rate increases, and your muscles tense, etc. to increase the blood flow to your brain. Alongside this, your mind becomes more alert to take quick decisions in life-threatening situations. This readies you to either fight or flight away from the harmful circumstance.
While these bodily changes have helped the survival of the human species, if the body remains in this state for a long period, it can do more harm than good. The human body is not supposed to stay in such a state for long durations. For instance, high levels of cortisol in the body wreak havoc on almost all the systems of the body.
Thus, anxiety is necessary, however, too much of it can harm you both physically and psychologically.
Panic attacks and panic disorder
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5, panic attacks have been described as the following: an abrupt and sudden surge in anxiety and fear that reaches its peak within minutes and usually lasts for 5 to 30 minutes (however, it could be longer). During the attack, the individual shows at least four symptoms on the list mentioned in the manual.
- Abnormal sweating.
- Trembling or shaking.
- Shortness of breath or feeling smothered.
- Feelings of choking.
- Chest pain or discomfort.
- Dizziness or faintness.
- Chills or hot flashes.
- Numbness or tingling.
- Derealization (feelings of unreality) or depersonalization (feeling detached).
- Fear of losing control or going crazy.
- Fear of death.
An essential point to make is that not everyone who goes through panic attacks will develop a panic disorder. When the individual who is getting panic attacks feels excessive worry about a future panic attack along with a significant change in behavior such as avoiding an unfamiliar situation etc. for longer than one month, it can be diagnosed as panic disorder.
According to Mayo Clinic, the signs tend to become visible in late adolescence or the early years of adulthood. There is also a gender gap in panic disorder as women are more vulnerable to developing this disorder than men.
Panic attacks are also very common in the general population. According to stats, about 11% of Americans get at least one attack in a year. Some of the factors that increase the risk factor of panic attacks and panic disorder are:
- Trauma in life such as sexual abuse.
- Family history of panic disorder.
- Life stressors such as a change in jobs.
- Excessive smoking and caffeine intake.
This is my favorite technique out of all. I have been doing this since the first panic attack hit me out of the blue and it has really helped me put my anxiety to rest.
The 4–7–8 breathing technique was developed by Dr. Andrew Weil and is based on the ancient Indian breathing exercise called pranayama. Here, the focus is on controlling the breathing pattern and as a result, regulating the restlessness of the mind. As this style of breathing forces the body as well as the mind to focus on the breathing, it helps to soothe my racing heart and uneasy mind.
Weil demonstrates the breathing exercise in his YouTube video. There are four steps in one cycle of breath.
- You start by exhaling all the air out of your lungs through your mouth.
- Then, breathe in for four seconds. I like to do the counting in my head as I go about it instead of looking at a watch, since that can be distracting.
- Hold it in for seven seconds.
- In the last step, slowly exhale from your mouth for eight seconds.
You should start with four breaths as beginners and increase the number as you increase your mastery. For me, I immediately start feeling the easing of my tension in the first round of breathing. By the time, I reach the four rounds, my mind has reached a sense of calmness.
Whenever you feel your anxiety levels increasing and suspect that it could turn into a panic attack, immediately start doing this. While it might feel awkward in the first go, as you practice it, it will start coming more naturally to you.
I have done this exercise hundreds of times and it has reduced my anxiety effectively almost every single time.
Visualization involves imagining yourself in a safe and serene space to calm your nerves. As your thoughts start to wander off or get preoccupied with dread, this helps to bring it back to focus and relaxes the mind.
You can start this by imagining yourself in your safe space that makes you happy and relaxed (your room, a meadow, mountains, beach) whenever your anxiety starts building up towards the peak. Along with the visual images of the place, imagine the sounds, smells, and other sensations that you are likely to experience in that setting. Engage as many senses as you can, in this visualization of the safe space.
While it might be difficult to calm down from this visualization in the first few sessions, it will start coming more naturally and work more effectively. When I did it for the first time, I was not very impressed with the effects; however, in my third and fourth attempts, I sensed some relief.
There is a scientific basis as to why this technique works. In a 2015 study, an fMRI machine was used on a set of people and it found out that their brain activity was similar in both the cases: when they actually experienced the painting and when they imagined the painting. This provides evidence for visualization having effects that are similar to being in the relaxing setting one imagines.
5–4–3–2–1 Grounding Technique
Other than visualization, grounding ourselves in our reality is another effective way to distract yourself from anxiety. While there are several ways to go about this, I prefer to use the 5–4–3–2–1 technique due to its simple and defined nature. Additionally, as Ellen Hendriksen, a clinical psychologist, describes, it helps in “bringing our attention to our senses, grounds us in the present and counting the items interrupts the spinning of our thoughts.”
As your thoughts start spiraling and your body gets tensed, identify:
- 5 things that you can see in your vicinity. It could be the wall, the fan, or the plants.
- 4 things you can touch. If you're sitting on a couch, feel the fabric against your hand.
- 3 things that you can hear. This could be the sound of the fan or the traffic.
- 2 things you can smell. It could be your coffee or your perfume.
- Finally, 1 thing you can taste. If you can’t taste anything, try to imagine the taste of the food item you had last. Other than this, you can also carry candy or a chocolate bar with you.
If I find it hard to visualize, I go with this grounding technique. If one round of identifying these objects does not work, go with another round. Keep on doing this till your anxiety start subsiding. This works as an excellent tool to distract yourself from unwanted thoughts.
Progressive Muscle Relaxation
Progressive Muscle Relaxation has been given by Edmund Jacobson and involves tensing and then relaxing a group of muscles, one by one. PMR has been found to be effective in dealing with stress, anxiety, and depression.
During a panic attack, follow the following steps for the exercise:
- You can either lay down or sit on a chair. For me, both work equally well. Loosen any tight clothes that you’re wearing. Also, remove your shoes, if possible. Make yourself comfortable, as much as the situation allows you to be. If you’re in a public place, you can go and sit in a chair. If you’re at home, lay down on the bed or a couch.
- Start with the top portion of your body and move towards the south. You can start the exercise with your forehead. Wrinkle your head like you’re trying to concentrate on something. Hold this position for five seconds. Then let go of the tension slowly. Bring your forehead to the earlier position. Focus on your muscles relaxing. Let it stay loose before you move to another set of muscles.
- Follow the same procedure for all the muscle groups as you move down from your crown of the head. Continue this till you reach your toes.
If I am unable to go through a full routine due to any external factor, I just focus on my shoulders and tense-relax them. You can choose a part of the body where you carry the most stress and use this technique there.
The logic behind this technique is that if you will relax your body, it would be difficult for your body to get tight during a panic attack.
As a beginner, the best way to go about it is to follow the audio guidance of a YouTube video and practice it 3–4 times before a panic attack instead of doing it directly during the attack. The audio tends to make it easier for you to just follow the steps, instead of putting in the efforts to think about the next step.
I tend to freak out when I am having an attack. Thoughts like ‘I am so scared’, ‘I can’t deal with this’, ‘I am going to die’ are some of the many negative thoughts that cloud my thinking. These thoughts amplify the panic I am feeling at the moment.
To deal with this, I chant affirmations to myself as I go about the other exercises. Some of the self-talk you can use for yourself are:
- I am strong. I will overcome this challenge.
- I will be alright.
- I am okay.
- I have done this in the past, I will do it again.
- I am not crazy.
You can choose any affirmations you want. Repeat it to yourself as you do the breathing exercise or muscle relaxation. You can use your words to soothe yourself. The best way to do it is by imagining that you’re talking to your best friend as you say the positive words to yourself.
Research has proven the efficiency of using self-affirmations in dealing with anxiety and depression.
Using these five techniques during my panic attacks has helped tremendously. The 4–7–8 breathing helps you to calm your nerves, the grounding and visualization techniques act as a distractor for the mind from the negative thoughts, and the PMR technique relaxes the body. Self-affirmations, done alongside, aid to better control the spiraling thoughts and negative thoughts.
One point to remember is to practice these techniques before you get a panic attack. This would allow you to have greater control over your senses as a panic attack might make it difficult for you to think about it.
To cope with panic attacks and anxiety, you need to make lifestyle changes as well. I find it essential that I deal with my anxiety, not only during the panic attacks but in day to day life as well.
Adding this small thing to my routine has helped me feel much better about myself and the world around me. An article from Positive Psychology talks about the benefits of expressing gratitude for psychological well-being.
Keep a small notebook where you write three things you are grateful for, every morning before getting out of bed.
Keep it on your bedside table so that it is easily accessible in the mornings. This way, you start with a fresh and positive start.
For me, keeping a gratitude journal is similar to having the social support of someone who tells you that everything will be alright. It helps me remember my blessings and motivates me to overcome the anxiety.
Mindfulness meditation is a way of focusing on the current happening in your body and the mind, without reacting to that. This allows you to develop an acceptance of the changes and not attach any judgment to that. The way I go about it is:
- Find a quiet place for meditation. Sit on a chair or on a yoga mat. Make yourself as comfortable as possible.
- Take a deep breath. As you inhale and exhale, focus all your attention on your chest and stomach as they rise and fall with your breathing patterns. If your thoughts start wandering off, do not judge that and gently bring it back to the breathing. You should not be harsh on yourself for any distractions.
- You should this for ten minutes every day. The best way to go about it is to develop a routine that suits your schedule.
Such a practice is extremely helpful in developing mindfulness. This will help you not panic when the panic attack starts and when the symptoms start developing. You can just be mindful of the changes in your body and not attach any judgments to that.
Exercise and Diet
My body has been always been weak due to a lack of exercise. However, during the pandemic, I started doing a short workout. It helped me lose my excess weight and has made my body strong enough to deal with the physical symptoms of panic attacks.
Research has shown that exercise can be a useful treatment for anxiety in decreasing its intensity and frequency. It helps in reducing anxiety as well as depressive symptoms.
If you’re a beginner, start with shorter exercises and increase your intensity as you become more comfortable. You can also start with brisk walks and gradually increase the duration.
Coming to the dietary changes for panic attacks, I have cut caffeine entirely from my diet, as it is associated with anxiety. It was not very difficult for me since I drink coffee rarely. If you are a habitual drinker, I would recommend that you follow this guide. It could take up to a week for you to cut down on the caffeine intake. Patience and self-love is the key.
Making these changes in my routine has helped reduce the frequency of panic attacks from 3–4 times in a month at the end of 2019 and the beginning of 2020 to none in the past seven months.
Even the last attack I had was manageable and lesser in intensity. I used my five-step routine and sailed through the attack smoothly.
Fighting this battle has been the most empowering experience of my life. I feel that I can overcome greater challenges in my life. You can adopt these self-help strategies in your fight against anxiety and panic attacks. Making these changes in your routine and following the five strategies while going through an attack is likely to help you deal with your panic attacks.
If I can do this, you can do this too. Never underestimate the role of self-help and determination in dealing with mental health issues. However, if you have severe panic attacks and self-help does not work, I would recommend seeking a therapist trained in cognitive behavioral therapy.