What to do in case of a panic attack
what is a panic attack?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; p. 214 [1] ), panic attacks refer to a sudden surge of intense anxiety and discomfort that peaks within minutes, and is defined by several symptoms including increased heart rate, trembling, shortness of breath, chest discomfort, tingling, nausea, feeling detached, and fear of losing control or of dying. Panic attacks are estimated to affect 40% of Australians at some point in their lives. [2]
Panic attacks can be unexpected (for example as in the case of Panic Disorder), or they can be quite specific to certain situations. For example, they may occur:
In social situations (e.g. public speaking, performing)
When faced with specific phobias (e.g. spiders, snakes, heights, flying)
Around injections/blood (e.g. visit to the dentist, immunisations)
Related to traumatic incidents (e.g. reminders of car accidents or traumatic surgery)
When thinking about your health (e.g. jumping to the ‘worst case scenario’ about a health symptom)
When you feel trapped (e.g. in enclosed spaces such as lifts, buses, trains)
After a panic attack, worrying may set in - What if it happens again? What if you can’t cope? What if there’s no one around when it happens? What if it happens and you can’t escape?
You may then start to avoid places you’re unfamiliar with, or where you’ve previously felt anxious. You may turn to carrying medication ‘just in case’ you need it, or only going places when a familiar person is with you. Over time you may find:
Your idea of what’s safe in this world shrinks, to the point where you’re very limited in where you will venture and what things you will take on
You develop a series of subtle avoidances (e.g. rather than escape altogether you may have ‘safety figures’ or ‘safety behaviours’).
Your mood suffers because of how much your fear holds you back, and its effect on your quality of life.
Given how distressing panic attacks can be, the impact on an individual’s quality of life can be devastating. They can also lead to repeated presentations to medical practitioners for the distressing physical symptoms.
WHAT causes PANIC ATTACKS?
Several factors come to mind when consider what causes panic attacks: [3] [4]
Family history. Twin and family studies of Panic Disorder revealed that genes make a significant contribution to the emergence of panic disorder.
Your health. Some medical conditions may yield symptoms that mimic panic symptoms, including thyroid diseases, cardiac diseases, and respiratory disorders. The use of stimulants such as caffeine and nicotine can also contribute to your experience of a panic attack.
The degree of stress experienced. Sometimes a panic attack may be brought on by a clear and ‘significant’ trigger, for example, having to give a speech in front of 100+ people. At other times, it may be harder to find a clear trigger, but upon reflection you may be able to see that you’ve experienced heightened levels of anxiety in preceding weeks.
Your thoughts. Panic attacks arise when you perceive there to be a threat. How you think has the capacity to ‘ramp up’ your anxiety.
WHAT CAN BE DONE TO HELP WITH PANIC ATTACKS?
When it comes to helping with your panic attacks let's approach it from two angles.
While we can look at what to do to calm down the immediate panic symptoms so that you're better able to cope with the distress, we strongly encourage that you also seek assistance to address the anxiety in the longer term.
We've outlined these two approaches and you can also grab the printable tip sheet below (and also get access to our Resource Library of tip sheets).
WHAT TO DO WHEN YOU'RE IN THE MIDDLE OF A PANIC ATTACK
Slow down your breathing as this will help to decrease your anxiety. Start by holding your breath while counting to ten, then breathe in over four seconds and out over another four seconds. Breathe from your diaphragm rather than your chest, and continue for 5 to 10 minutes, repeating if necessary.
Check your thoughts in case they’re escalating your panic symptoms. Catastrophising about the worst case scenario can increase your panic symptoms. Instead, look to test if the thoughts are true (e.g. Is it the case that no one will help if I have a panic attack in public? Have I ever heard of someone passing out from a panic attack?). Alternatively, you can try to take a mindfulness approach by letting the thoughts come and go without getting caught up in them.
Keep in mind that the panic attack will eventually subside. It may not feel pleasant in the meantime, but it will pass. Think of it as ‘surfing’ the wave of anxiety.
WHAT TO DO A LITTLE LATER FOLLOWING A PANIC ATTACK
After the panic attack it’s helpful to take action to help manage your panic attacks in the longer term. Steps that you can take include:
Ruling out any underlying medical conditions in consultation with your health professional. Some medical conditions (e.g. respiratory conditions, cardiac diseases, thyroid diseases) may contribute to the experience of panic symptoms.
Making lifestyle changes to keep your overall stress levels down, including:
Decreasing strain on your body by limiting the use of stimulants that may produce panic-like symptoms (e.g. excessive caffeine consumption may lead to heart palpitations).
Engaging in aerobic exercise on a regular basis.
Look to improve manageable sources of stress by developing skills including stress management, time management, and developing efficient processes to streamline your life and decrease your daily hassles.
Seeking assistance from a mental health professional such as a psychologist to learn skills to help you manage the anxiety. Psychological treatment options shown to be effective include:
Cognitive Behaviour Therapy which includes exposure therapy in the forms of graded exposure and also interoceptive exposure (which is exposure to those uncomfortable panic symptoms). This is the treatment that has the strongest evidence-base for Panic Disorder. [5]
Acceptance and Commitment Therapy.
Mindfulness (either on its own, or as part of Mindfulness-based Cognitive Therapy or ACT).
Our psychologists who help with panic
REFERENCES
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Association.
[2] https://au.reachout.com/articles/what-are-panic-attacks
[3] Lam-Po-Tang, J. (2011). Panic disorder and agoraphobia. Australian Doctor, 28 October 2011, 29-36.
[4] Hettema, J.M., Neale, M.C., & Kendler, K.S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry, 158, 1568-1578.
[5] Australian Psychological Society (2018). Evidence-based psychological interventions in the treatment of mental disorders: A review of the literature (4th ed.). https://www.psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/Evidence-based-psych-interventions.pdf
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