How Not To Panic

How Not To Panic

By

Dr. David Koehn

Taken from a series of articles on the internet, here is rendition on how not to panic.

When you were a kid, were you terribly afraid of the dark?  Do you remember the feeling of walking down the basement stairs of home or your grandparents’ house, or getting up in the middle of the night to go to the bathroom? Was your worst fear that some indefinable something lay under the bed or be behind the closet door? Would you get so scared that you would actually see something freaky? Could you in fact go crazy from terror, or even scare yourself to death? Currently, does the coronavirus put your head into a spin?

Many therapist hear echoes of this “fear of what’s beyond fear” in many of the anxiety conditions they treat, and most clearly in panic disorder. First, a quick description: Most of us at some point will have at least one panic attack, which is a sudden surge of fear along with physical symptoms, such as a racing heart, shortness of breath, or feeling faint. But having panic attacks does not indicate a disorder; one must also really fear having more panic attacks. Generally, one will worry that the panic signifies something terrible like “having a heart attack” or “going crazy.” Panic attacks become problematic when we’re so afraid of them that we alter our lives to avoid them. For example, one may stop using elevators, taking public transportation, or driving over bridges if these situations are tied to panic.

If you have ever experienced a panic attack, you know they are miserable: There’s a gripping fear, a sense of impending doom, and an overwhelming drive to escape the situation. 

In addition to the experience itself, panic in panic disorder usually triggers a fear that something else—something beyond panic—is going to happen. We imagine that whatever it is will be qualitatively different from the panic alone, such as: 

• I will pass out while driving and crash into someone.
• My tunnel vision will turn into blindness.
• I’ll get so panicked on a bridge that I’ll jump off it.
• I’ll lose my mind and do something horribly embarrassing.

Panic does not cause these terrifying events. What is actually beyond panic? In the short term, just more panic. Inevitably, the body and mind stop generating the panic symptoms and the attack ends.

The best tested treatment for panic disorder—cognitive behavioral therapy—focuses on training the mind to understand that panic is just panic, no less and no more. With practice and hard work, we can move through our fear and our expectation of something worse than panic.

What makes panic overwhelming is what we imagine will happen. When we conquer our belief that panic is going to include something worse, we’re free to face the panic itself. People tend to find that they can deal with a panic attack when it is stripped of its most terrifying forecasts. 

Perhaps many other things in life are similar to panic. Things we could deal with as they are, but struggle with because we fear they will turn into more than we can handle. For example, we can deal with an awkward and dreaded conversation; it will just be awkward, no better and no worse. Also, we can face a busy workday on very little sleep; we will be tired at times, no more than that. Similarly, we can finish a tough workout; it will hurt, then it will be over.

Our minds repeatedly create ghosts that we treat as real, and that we believe will be more than we can manage. When we face our lives as they actually are, we find we are enough.

Panic attacks are characterized by a combination of mental, emotional, and physical symptoms. These attacks typically begin with a sense of dread, nervousness, and fear. Feelings of anxiety often increase in intensity as the person begins to experience sensations such as, shortness of breath, heart palpitations, chest pain, excessive sweating, tingling, shaking, and even nausea.

These uncomfortable physical symptoms are frequently met with fearful thoughts and emotions, such as being afraid that the attack will cause one to lose control, go insane, have a medical emergency, or even possibly die. During a panic attack, it is not uncommon for a person to go through feelings of depersonalization and derealization in which the person feels detached from the self and reality.

Panic attack sufferers often have no control over when their symptoms will strike. For people with panic disorder, these attacks come on suddenly, without any warning or cause. Those with specific phobias may only have panic attacks when exposed to their specific fear; however, these feared stimuli may not always be easy to avoid.

Given that attacks can occur at any place or time, some people may try to jump in and help the person through the panic attacks. It is truly kind for someone to try and help a person through these challenging symptoms. However, well-meaning friends, family, and even strangers may try their best to help, only to say the wrong thing to the person having the attack.

Some ideas on what not to say to someone during a panic attack are:

• Just Calm Down. If told to calm down, the panic attack sufferer may feel as though you are suggesting that he has complete control over their symptoms. The fact is that if a person going through a panic attack could just calm down, he would! You may think you are helping to redirect the person by telling him to calm down, but in reality, it can just cause him to be more aware and self-conscious of his symptoms.
  • Instead of being verbally directive, try to get the person to calm down using one of the many strategies to get through panic attacks. For example, you may try to help him through a relaxation technique such as deep breathing, guided imagery, or progressive muscle relaxation (PMR). By utilizing such techniques, you will be able to redirect the person while making them feel secure and understood.
    • Reinforcing that the person’s fear is unfounded can increase one’s sense of anxiety. Instead of bringing the lack of threat to her attention, try being a voice of encouragement. Use a soothing voice and simply remind the panic sufferer that you are there for her.

• I Wouldn’t Do That, You’re Embarrassing Yourself. This just comes across as a truly insensitive comment. Many people already feel embarrassed about having to manage a panic attack in public, so there is no need to bring this to the person’s awareness.
  • Instead of further shaming the person, try affirming her strength. Let her know that you are there to be supportive and that she has no reason to feel shame. She may already feel humiliated, so it can be most helpful to remain positive. Phrases such as, “You’re doing a great job,” “You will get through this,” or “I am here for you,” can all go a long way in helping a panic sufferer feel more confident at such a vulnerable time.

• You’re Just Overreacting. These few words can be tremendously discouraging for a person facing a panic attack. It can be hard enough to have to deal with uncomfortable symptoms, but even more challenging when others are minimizing a panic sufferer’s experience.
  • Panic attacks are a real set of symptoms and should not be confused with emotional reactions that are within one’s control. The panic sufferer often perceives these attacks as frightening, and by telling the person he is overreacting you may make it harder for him to calm down.
  • You will get better results if you try to put the person at ease. He may like to be in a quiet area, away from other people, outside where he can get some fresh air, or inside where he may feel less distracted and more secure. If you feel uncertain of what to say or if you are feeling a little frightened yourself, try silently staying by his side as the panic attack subsides.

The surest path to overcoming panic attacks is to train yourself to respond to panic in accepting and calming ways. As you read the steps described below, think about how they compare to what you usually do during a panic attack. The Panic Trick tells us that your gut instinct of how to respond to a panic attack will likely be to do something that makes the problem worse rather than better. The path to overcoming panic attacks requires responses that are quite different from what you usually do. If you keep doing the same thing, you'll probably keep getting the same result. If you seek anxiety relief, you need to look for different methods.

You can use these five steps to guide your responses during a panic attack. The regular use of this approach will go a long way towards your goal of overcoming panic attacks. They are adapted from Anxiety Disorders and Phobias: A Cognitive Perspective, an excellent professional text by Beck, Greenberg, and Emery as well as Anxiety and Phobia Workbook by Bourne.

The Five Steps of “AWARE” in overcoming panic attacks are:

1. Acknowledge & Accept
2. Wait & Watch (and maybe, Work)
3. Actions (to make myself more comfortable)
4. Repeat
5. End

Let's take a look at what each step entails.

• Acknowledge & Accept - All progress starts here. This is the most important single step to overcoming panic attacks.
  • Here I acknowledge the present reality that I'm afraid and starting to panic. I won't try to ignore it, or pretend it's not there. I won't struggle to distract myself, tell myself to "stop thinking about it!", or snap any rubber bands on my wrist. I'm acknowledging simply that I am afraid, not that I am in danger. The thought that I am in danger is just another symptom of panic, not an important or useful thought.
  • Here I accept the fact that I'm afraid at this moment. I don't fight the feeling; ask God to take it away; blame myself, or anybody else. I accept, as best I can, that I'm afraid in the same way I would accept a headache. I don't like headaches, but I don't bang my head against the wall in an effort to get rid of them, because that makes them worse. Overcoming panic attacks begins with working with, not against, my panic and anxiety symptoms.
    • What makes a panic attack acceptable (not desirable, but acceptable) is that, while it feels awful and fills me with dread, it isn't dangerous. It won't kill me or make me crazy. Someone pointing a gun at me, that's not acceptable. I might get hurt or killed. If someone points a gun at me, I have to do whatever I can to change that: run, hide, fight, yell, bribe, or beg, because the consequence of being shot is so terrible that I must try to avoid it.
    • On the other hand - a policeman giving me a ticket, even if I don't deserve it, I can live with that, and can hopefully keep my temper in check so I don't make things worse for myself.  Accepting the symptoms, not resisting, is a powerful step to overcoming panic attacks.
    • What Can a Panic Attack Do to Me?  It makes me feel afraid, that's what a panic attack does. And, if I'm having a panic attack, I'm already there! I'm already experiencing the worst that will happen. I just need to ride it out. That's the surest path to overcoming panic attacks.
    • Why should I accept a panic attack? Because the more I resist panic, the worse it gets. The more I develop the habit of acceptance, the more progress I make toward my goal of overcoming panic attacks.

That's Acknowledge & Accept. How does that compare to what you usually do during a panic attack?

• Wait & Watch (and maybe, Work). Wait - What is meant by "Wait" is this: don't just do something, stand there. It's similar to the suggestion "count to ten before you get mad".
  • One of the hallmarks of a panic attack is that it temporarily robs you of your ability to think, remember, and concentrate. This step will buy you a little time to regain those abilities before you take any action.
  • When you react before you have a chance to think straight, what do you do? If you're like most people, you probably flee, or struggle. You do things that actually make it worse. This is what people mean when they say things like "I know I'm doing it to myself" and the harder I try, the worse it gets. Jumping into action too quickly is a big obstacle to overcoming panic attacks.
  • So, even though you have a powerful urge to leave, postpone that decision for a little bit. Don't tell yourself you CAN'T leave - keep that option open so you don't feel trapped - but put off the decision about whether or not to leave. Stay in the situation. You don't need to run away to get relief. Let relief come to you.
  • Watch. Use the occasion to observe how the panic works, and how you respond to it. The best way to do this is to fill out a panic diary. The diary is a questionnaire which helps you notice important aspects of a panic attack, so you can respond more effectively over time. Feel free to download and reproduce it for your own personal use. You can also download a set of instructions.
  • Patients often report that just filling out a diary helps them to calm down. How does this work? It's not that they're distracted from the subject of panic, because the diary questions are all about panic. It helps you get a little distance from your emotions. It works because, while you complete a diary, you're in the role of an observer, rather than feeling like a victim.
  • The best way to use the diary is to fill it out during the attack, rather than after. If you're in a situation where writing is impractical, perhaps while driving a car, you can: use a digital recorder; have your support person read the questions to you and record your answers; or pull over for a few minutes to write.
  • What About "Work"? If you're in a relatively passive situation during the panic attack - a passenger in a vehicle, getting your hair cut, or waiting in a waiting room - "Wait & Watch" is all you need. If you're in a more active role - driving a car or giving a presentation - then you also need to attend to the "Work" of conducting that activity. Do "Wait & Watch", but also remain engaged in your task.

That's "Wait & Watch (and maybe, Work)". How does that compare to what you usually do during a panic attack?

At this point, you've already gone through the two most important steps to overcoming panic attacks. These steps, and all the steps necessary to overcome panic disorder and phobia, are covered in much more detail in Beck’s Panic Attacks Workbook.

• Actions (to make myself more comfortable) What's Your Job During an Attack?  It's not your job to bring the panic attack to an end; that will happen no matter what you do. Don't take my word for it. Review your personal history with panic attacks. Have you ever had one that didn't end?
  • The fact is, every panic attack ends no matter what you do. If you respond in the most cogent way possible, and do a good job at bringing it in for a soft landing, that panic attack will end. And if you do everything the most unhelpful way possible - struggling and resisting and fleeing in ways that make the panic worse - that one will end also. Even the first panic attack a person has, when they have the least idea of what's happening, those end as well.
  • The end of a panic attack is a part of a panic attack, just as much as the start of one is a part of it. It's not something you need to supply or make happen. The panic attack will end no matter what you do. Even when you don't believe it will end, when you have the fearful thoughts that it will last forever, it still ends.
  • So what is your job during a panic attack? It's a more modest task than you probably supposed. Your job is to see if you can make yourself a little more comfortable while you wait for the attack to end. And if you can't even make yourself a little more comfortable, then your job is just to wait for it to end.
  • Here are a few techniques that patients have found particularly useful while waiting for an attack to end.
    • Belly Breathing.  Regardless of what else you do, do belly breathing. It's also known as diaphragmatic breathing, but I think "belly breathing" is more descriptive. Many people think they know how to do deep breathing, but don't do it correctly, so they don't get good results. A good belly breathing technique is a very powerful tool in the work of overcoming panic attacks!
    • How to Talk to Yourself.  Talk to yourself (silently!) about what is happening, and what you need to do. One question my patients find very helpful is this: is it Danger or Discomfort? Some of the other responses my patients like include the following:

1. Fine, let's have an attack! It's a good chance to practice my coping techniques.

2. Answer your "what if...?" fears by saying "So what? I'll get afraid, then calm down again."

3. It's okay to be afraid.

• Get Involved in the Present. People don't panic in the present. People panic when they imagine something bad happening to them in the future or in the past. This is why your panic attacks are almost always accompanied by some "what if...?" thought. The reason you say "what if...?" is because what you fear is not actually happening!
• Get back into the activity you were engaged in prior to the attack, and become involved with the people and objects around you. If you're in a store, resume shopping, reading labels, comparing prices, asking questions, etc. It will move you closer to your goal of overcoming panic attacks when you bring your focus and energy back to the present environment. By this I mean, work with what is around you.
• Work with Your Body. Identify, and relax, the parts of your body that get most tense during a panic attack. This typically involves first tensing, and then relaxing, the muscles of your jaw, neck, shoulders, back and legs. Do not allow yourself to stand rigid, muscles tensed, and holding your breath. That just makes you feel worse! If you feel like you "can't move a muscle", start with just one finger!

That's "Actions (to make myself more comfortable)". How does that compare with what you usually do during a panic attack?

• Repeat. This step is here because you might start feeling better, then feel another wave of panic. Your first reaction might then be to think "Oh No, it didn't work!” The Repeat step is here to remind you that it's OK if that happens. Just take it from the top again. It's not unusual or dangerous. You may go through several cycles, and you just need to repeat the AWARE steps again, as often as you need.

How does that compare with what you usually do?

• End. This is here to remind you that your panic attack will end; that all panic attacks end; that they end regardless of how you respond; that it's not your job to make the attack end; and that your only job is to make yourself as comfortable as possible while waiting for the attack to end.

Have these statements been true for you? Don't take my word for it. Review your own history of panic attacks and see. And maybe the next time you panic, when you notice yourself thinking, once again, "Will this ever end?", you'll find yourself answering, "YES!"