A Practical Guide For Getting Through Panic Attacks
By Marie Miguel
Updated April 15, 2020
Reviewer Wendy Boring-Bray, DBH, LPC
Every one of us has felt a full-body stress reaction. Like the one you feel when you're waiting to give a dreaded presentation at work, or looking at those three dots wiggle on your iPhone in the middle of an emotional conversation, or flying high in the air preparing to skydive.
It's that racing heart, sweaty palm, stomach-rattling anticipatory feeling that makes you want to scream and cry, or run away, or freeze up like a deer in headlights.
You know that feeling-pure, unadulterated fear.
A panic attack is like that.
But turn up the intensity from nervous to horrified, from motivating anxiety to disabling fear, remove the environmental context and do away with the euphoric rush of endorphins that follows the successful defeat of the thing that was so scary, to begin with.
Most panic attacks come on without warning or discernible trigger. That can feel especially terrifying, which intensifies the panic and creates a vicious cycle of fear that, in some cases, can lead to agoraphobia.
But what exactly does anxiety attack look and feel like? How does it differ from your run-of-the-mill anticipatory anxiety?
What are the clinical symptoms of a panic attack?
The symptoms of a panic attack are varied and multiple. Not everybody experiences all symptoms at once. One person can have different symptoms between attacks.
Agitation or irritability
Chills or hot flashes
Feeling dizzy, lightheaded, or tightness in head (as if in a vise-grip)
Shaking or trembling
Heart palpitations (skipping a beat); increased heart rate; feeling like one's heart is "pounding"
Tightness, pain, or discomfort in the chest
Feeling short of breath; unable to catch one's breath
Lump in the throat or a choking sensation
Nausea (or vomiting)
Numbness or tingling
Feeling frozen or unable to talk
Racing thoughts; difficulty concentrating or "thinking straight"
Depersonalization or Derealization; feelings of unreality and detachment
Fear of losing control, of doing something embarrassing or dangerous, or of losing your mind
Fear of dying
Many people report that their panic attacks come out of the blue. Without any apparent reason for these intense feelings, sufferers often fear they are on the verge of "losing their mind" or a medical emergency like a heart attack.
When someone experiences a panic attack in a particular place-for example, in a train station-they may avoid going there again in an attempt to prevent more panic attacks. The repeated decision to avoid places where one has had a panic attack may develop into agoraphobia.
The issue with this behavioral pattern, though, is that the train station is not what is provoking panic.
The source of the alarm is an overwhelmed nervous system with a hyper-vigilant stress response, whose genesis could be in any number of things: trauma; genetics; intense, acute stress; prolonged periods of stress; neurological, psychological, or physical disease; or any combination of these factors.
The thing provoking the panic attacks is a psychological disorder.
How to calm down from a panic attack: controlling it at the moment
Mental health professionals and panic attack sufferers have learned how to treat panic attacks in many ways.
If you are suffering from panic: you are not losing your mind, nor are you dying.
Panic attacks are highly treatable and not life-threatening.
It is important to try and internalize this belief in the long-term, to break the cycle of fear.
But in the short term, let's explore how to calm a panic attack while you're in the midst of it. Then we can explore long-term solutions, too.
If you are wondering how to avoid a panic attack, or how to prevent a panic attack-it may be helpful to reframe this question. The question that will produce a more productive, long-term solution is: How can I learn how to get through and overcome panic attacks?
After identifying which coping strategies and treatments work for you, you will learn how to handle panic attacks without letting them run your life.
Recognize what's happening
The first step in how to control a panic attack is to acknowledge that you are having one.
It means noticing the sensations you are feeling, and then naming them as symptoms of a panic attack.
Notice that you're having trouble breathing, or feeling unreal, and tell yourself (internally or aloud) that this is just a panic attack. It is not life-threatening. You are not going to die. You are not going to lose control of yourself. It will pass, and you will return to baseline.
Repeat this affirmation to de-escalate the intensity of your panic.
Once you recognize you're in the throes of a panic attack, get a glass of water and have a few sips. Drinking water relieves dry mouth and can help support your body's return to homeostasis by stimulating your parasympathetic nervous system.
Additionally, putting something cool or chilly in your mouth can help ground you-something pivotal when learning how to deal with panic attacks.
Relief from medicine, either pharmaceutical or herbal
If you are wondering how to stop a panic attack when you can feel it coming on, psychiatric medication is the quickest route. Note that, while it can halt the attack, medication does not cure the disorder or reduce the number of panic attacks you may experience in the future.
If a prescribed drug is present, take it when you first recognize that you are suffering from a panic attack.
If you are not using psychiatric medication, or do not currently have access to your prescription, you may find relief with herbal treatment.
Valerian root is one alternative that is fast-acting and comes in capsules. Passionflower and Chamomile are other options, though not as strong. Valerian and chamomile can be commonly found in drug stores or grocery stores, though passionflower may require a trip to a specialty herb store.
Deep-breathing: hit or miss
Many guides that explain how to treat a panic attack include a section on deep-breathing.
While deep-breathing can help some people immediately, for others it can increase anxiety.
If you are well-practiced in deep breathing, using that skill is an excellent remedy for panic attacks.
However, if you do not have much experience with breathing exercises before experiencing your panic attack, it may not be the immediate solution for you. Without guidance, you may end up hyperventilating (breathing in your chest instead of breathing through your diaphragm).
If you'd like to give it a shot, here are deep-breathing tips:
1) First, look at your nose.
2) Once you've set your focus on your nose, see what your breath feels like moving in and out from there for three breaths.
3) Now, pay attention to your belly. Are your abdominals clenched or relaxed as you breathe? Do you feel your stomach moving as you breathe, or is your chest moving only? If your belly clenched, let the muscles relax. Now, let's move to breathing.
4) First, exhale deeply.
5) Inhale a deep breath into your belly for a count of 5, letting your stomach expand.
6) Hold your breath for 3 seconds.
7) Release your breath for a count of 8 or more.
8) Repeat the inhale and exhale pattern.
9) If you find yourself getting distracted, that's OK. You're still doing a good job. When you lose focus with your breathing, just return to step 1 and repeat.
Many tools can help you with deep-breathing. If you're a visual person, you could watch visual deep breathing guides. If you prefer to be guided by someone speaking, there are a multitude of guided breathing exercises available for free.
Get moving! It is a fight or flight response, after all
An alternative to the deep breathing, relaxation approach is to move your body. It could mean throwing your sneakers on and going on a run, taking a few laps around your kitchen, doing jumping jacks or dancing to your favorite music.
Exercise is especially beneficial to building resilience in the long-term, but it has short-term benefits too. Exercise can release pent up physical energy, as it works alongside the adrenaline rush your body experiences during a panic attack.
According to John Ratey, M.D., author of Spark: The Revolutionary New Science of Exercise and the Brain, Twenty minutes of sustained exercise can improve your mood. So, once the panic attack ends, you may feel even calmer when you exercise.
Ground yourself; return to your body
When we're experiencing a panic attack, we can often feel dissociated or unreal. Even if you are not experiencing depersonalization or derealization, grounding is helpful for feeling present and in control of your thoughts again.
Here are some suggested grounding techniques, but you can find more through a quick search online:
Drinking cold water
Deep breathing exercises
Walking outside barefoot
Smelling a strong smell like vanilla extract, or an essential oil
Receiving physical touch like a hug or back rub
Observing and stating out loud the names of 5 different items in your environment
Picking a color and naming every item of that color in the room
Return to business as usual
The end goal is to get through the panic attack and resume your regular activity.
To the best of your ability, return to whatever task you were doing before the panic attack hit.
If you can't focus on that just yet, turn your attention to another task.
Refocusing your thoughts onto an external activity can prevent you from ruminating on the discomfort of what you have just experienced.
You may find it useful to talk to a trusted friend or loved one to let them know what just happened if they were not present for the attack. Connecting with other people helps you feel present after a panic.
And also: don't forget to have a snack. Replenish your energy with a tasty treat. Experiencing the sensation of taste can also be useful in grounding.
If can't muster the energy to cook, go for a walk, shop, clean, or whatever you had been doing before-it is ok if you just need to take a nap. Panic attacks can wipe you out. When you wake up, try to practice some more grounding exercises, and see if you can get moving a bit afterward.
How to overcome panic attacks: a long-term job
Learning how to deal with a panic attack is hard work-but it is do-able, and it is worth it to heal. Some techniques mentioned here will work every time. Some will work for you once, and then rarely again. Some won't work at all. Learning how to handle a panic attack involves coming to understand your responses, feelings, and needs.
It is critical to seek professional help not just to survive a panic attack but overcome them. Trained professionals know how to help a panic attack sufferer overcome the often-disabling psychological experience more than anyone else. It is through therapy that you will build coping skills and resilience to emotional distress.
Your therapist will teach you how to use cognitive behavioral therapy (CBT) techniques, to decrease catastrophizing (the "I'm losing my mind!" belief). They will help you determine when you are holding onto thoughts based on irrational fears, how to restructure them and coach you on accepting the discomfort of anxiety.
Additionally, up to 90% of individuals who struggle with panic attacks have other psychological conditions. Mental health professionals will be able to determine if you have any additional conditions like depression or PTSD. Once you know the nature of what you are struggling with, you and your therapist can develop an effective treatment plan, so that you may heal and become the calmest, present version of yourself yet.