“I was on my way back from work on the subway, when I suddenly found it really hard to breathe. I was sweating, clutching at my tie desperately. I could feel my heart racing, and my knees felt very weak. I was terrified -I honestly thought I was going to die!” Have you ever experienced anything similar?
What is a panic attack?
A panic attack is much more than experiencing anxiety. Although it involves anxiety symptoms, such as palpitations, shortness of breath, dizziness, feeling weak, chest pains, trembling; it also includes the feeling that something terrifying is happening to you, such as losing control, going crazy, or even having a heart attack. This is why when someone suffers from a panic attack they desperately try to escape from the situation, and might even go to ER to check that they’re not dying.
What can happen after a panic attack
After having experienced a panic attack, some people can then develop frequent panic attacks and/or worry constantly about having another one. This is what is known as Panic Disorder, where you’d constantly be worrying about having another panic attack and its consequences (losing control, fainting, etc). In other cases, people fear being in a place where it would be hard to get out of if they did have a panic attack, and therefore begin to avoid certain places (supermarkets, public transport, the cinema, etc), leading them to isolate and even struggle to leave their house.
Problematic ways of coping
Since experiencing a panic attack is so terrifying, some people adapt their life in order to reduce the chances of having another one. This may mean that they stop doing things where they might experience symptoms similar to the ones in a panic attack (such as exercise), or they may be scared of going out alone in case they have a panic attack and there’s no one there to help them. In the same way, some people use substances to gain a sense of ease, or constantly check their bodily symptoms to ensure that they aren’t close to experiencing a panic attack (which can in fact trigger even more anxiety and actually lead to a panic attack). This of course has a huge cost on their social as well as personal life, narrowing down their world more and more each time since they would be cutting out on meaningful things in their life.
What to do instead
If you have identified any of the above behaviours in your own life, then it seems like therapy might be a good option for you. Your therapist would analyse your case, and help you understand what it is that triggers and maintains your own anxiety.
To simplify, what you’d be working on together is for you to regain control of your life. What would you be doing if it weren’t for this constant fear? What do you feel that you are you missing out on? What plans and choices would you be making, both in your day-to-day life as well as generally speaking, if it weren’t for this dreadful fear? In this way, you would be helped to reduce the avoidant behaviours (such as having quitted exercise, or declining social invitations, for instance). Escaping from these situations has probably helped you feel relieved in the moment; however, they have just maintained and increased your fear in the long-run, making you feel even more trapped. Your therapist would help you create your own personal ladder of fears so that you can together begin to confront those situations gradually, starting off with those that seem more manageable, and lastly overcoming the harder ones. You wouldn’t be plunging into these situations -at the same time, you’d be learning coping skills to help deal with the triggering feelings that may arise. Some of these tools might be deep breathing exercises, encouraging self-instructions and grounding exercises, for example. In fact, you would practise them together in session. For instance, if your mind is constantly on the look out for signs that you might be having another panic attack, you will learn that they are actually false alarms, so you would practise to make room for these uncomfortable feelings (with exposure techniques, allowing you to overcome ‘the worry hill’) and you would identify those panicky thoughts as anxiety speaking and learn to not buy into them (this is what we call ‘defusing’ from our own thoughts). Most importantly, your therapist would help you question what the worst thing about feeling that you’re losing control might be, and find if you experience that in other areas of your life too.
What to do if you actually did have a panic attack
Each case can be different, but generally speaking, it is advised to find some physical space (don’t have people leaning on you or talking too close to you, and try to find some place with fresh air). Then put into practice grounding strategies to bring your mind back to the present moment. One of my favourite ones involves going through the five senses -trying to mentally name five different things you can see, four different things you can hear, three different things you can touch, two different things that you can smell, and to take one big, deep breath. This will help bring your attention to what’s really going on around you, and not to what your anxiety is telling you that you’re experiencing.