How to Deal with Panic Attacks

What Science Says Actually Works

Let me tell you something important. A panic attack cannot kill you. I know that sounds blunt. But when you are in the middle of one; heart pounding, chest tightening, convinced something is terribly wrong; that single fact can be the most powerful thing you hear. Panic attacks are not dangerous. They are not a sign that you are broken. They are your nervous system doing exactly what it was designed to do, at exactly the wrong moment.

And the good news? There is solid, science-backed evidence on exactly how to stop them, manage them, and prevent them from taking over your life. Let us get into it.

What Actually Happens During a Panic Attack?

First, you need to understand what is going on in your body. A panic attack is a feeling of intense fear, followed by intense physical reactions, when in actual fact there is no real danger. Your brain; namely, your internal alarm system, registers a situation as life-threatening and activates the fight or flight response. A response you have activated on many occasions in your past. (American Psychiatric Association, 2022).

Your system is overrun with adrenaline. Your heart races. Your breathing quickens. Your chest tightens. Your hands tingle. You experience dizziness, separation or fainting. Some people feel as if they are about to die. Some people feel like they are going crazy. That’s all not really happening. The situation is a false alarm. On your brain the button has been pushed when there isn’t any emergency. Once you understand that, you’ve made the first step toward regaining control.

Techniques To Follow

Here are some techniques/tools that can help you gaining control of yourself.

1.      Controlled Breathing, A Most Powerful Immediate Tool

If panic strikes, you’ll breathe rapidly and shallowly. This is called hyperventilation and it exacerbates each and every symptom. It lowers carbon dioxide levels in the blood, which makes you more dizzy, tingly, and feels unreal. The cure is simple yet deceptive. Take slow, deliberate breaths. Diaphragmatic breathing or “box breathing” is the technique that the research has always shown to be effective.

Take a slow, deep breath in, counting to four through your nose. Count to 4 and hold. Slowly breathe out through your mouth, counting to 4. Count to the 4th. Repeat. It immediately stimulates the body’s natural “rest and digest” system (parasympathetic nervous system) starting to counter the fight-or-flight response in as little time as minutes (Jerath et al., 2015). Do not be waiting when panic is at its highest. As soon as you become aware of your first signs of anxiety, begin breathing. Remember that you’re not escaping the fear. You are blocking it at the root.

2.      Cognitive Behavioural Therapy

If you experience panic attacks regularly, this is the intervention you need to know about. Cognitive Behavioural Therapy, or CBT, is the most extensively researched and consistently effective treatment for panic disorder available (Clark et al., 1994). It works by targeting the two things that maintain panic attacks over time; catastrophic thinking and avoidance behaviour. Catastrophic thinking occurs when your brain jumps to the worst possible conclusion when you have a physical sensation. Heart racing? Must be a heart attack. Feeling dizzy? Should be on the verge of falling.

CBT helps you recognize these thought patterns and to replace them with more logical and realistic ones. The other one is avoidance. Avoidance of places, situations and activities reinforces the panic because when you avoid it you get a reward for avoiding it (the relief). Your brain will learn that those situations are too dangerous and will make it more likely that you will panic again in the future.

This is addressed in a systematic manner in CBT by a technique called exposure; slowly and safely approaching the situations you’ve been avoiding until the brain realizes they are not a threat. CBT has been shown to be effective in reducing panic attacks and many aspects of them (Clark et al., 1994), and to have a lasting effect with many participants remaining panic-free at follow-up assessments.

3.      The 5-4-3-2-1 Grounding Technique

Panic attacks thrive on disconnection from the present moment. Your mind spirals into catastrophic future scenarios while your body is flooded with alarm signals. Grounding techniques pull you back into the here and now, fast. One of the most popular and effective grounding methods is the 5-4-3-2-1 technique. It’s very easy to work out. Notice 5 things you can see around you right now. The four things you can touch. There are three things that you can hear. There are two things that you can smell. There is one thing that you can eat. That is it. Simple, practical, and with a lot of effectiveness.

Using all five senses is a conscious way to check out any panic and focus your attention on the here and now. Grounding techniques for acute anxiety and panic symptoms have been consistently shown to be effective in breaking the negative thought cycle that underlies acute anxiety and panic (Hofmann et al., 2010). When the next time panic arises, don’t struggle with it. Ground yourself instead.

4.      Accept the Panic,  Do Not Fight It

When a panic attack reaches its peak, most people tend to try to resist it, force it out of their minds or work hard to end it. Consider the following problem. This resistance; this struggle  just heightens the panic. The fear of fear is added onto the fear and the cycle goes round and round. Acceptance-based approaches, however, are quite different, and are based on a radically different approach to therapy known as Acceptance and Commitment Therapy (ACT).

You don’t try to resist the fear, you accept it. You see it outside of judgment. You remember: It’s not harmful, it’s not dangerous, it’s uncomfortable, but it will pass. Craske et al. (2014) concluded that acceptance-based strategies were effective in reducing the intensity and duration of the panic symptoms, removing the unpleasant secondary layer of suffering that comes from trying not to think about them. If you surrender to it rather than swim against it. It’s power diminishes much more rapidly than if you fought it. Remind yourself during the next attack: This is panic, not danger. I am safe. This will pass.

5.      Lifestyle Foundations That Reduce Panic Long-Term

Panic attacks are not solely a matter of what one does while experiencing the attack. It’s all about what you do daily. The facts are indisputable. Regular physical activity, regular sleep, decreased levels of caffeine and good social support all significantly lessen panic attack frequency and intensity over time (Asmundson et al., 2013).

One of the mechanisms underlying panic disorder is anxiety sensitivity; the fear of physical sensations, with exercise demonstrating particularly significant reductions in this tendency. These factors are similar to reducing your base rate of anxiety. The lower your baseline, the less likely any particular trigger is to tip you over the edge to a full-blown panic attack. It’s not sexy to stick to a regular routine every day. However, these are the unsexy facts that lead to long-term recovery.

The Bottom Line

Panic attacks are scary. They are also very curable. Breathe deliberately. Challenge catastrophic thoughts. Focus on the here and now. Embrace it, don’t resist it. But establish the daily behaviours that will increase your protection over time. It’s not a sign of weakness to have panic attacks. You are human. So, with the correct tools, you can take charge of your life. Count from the first one.

References

American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders. 5th edn, text revision. Washington DC: APA Publishing.

Asmundson, G.J.G., Fetzner, M.G., Deboer, L.B., Powers, M.B., Otto, M.W. and Smits, J.A.J. (2013) ‘Let’s get physical: A contemporary review of the anxiolytic effects of exercise for anxiety and its disorders’, Depression and Anxiety, 30(4), pp.362–373.

Clark, D.M., Salkovskis, P.M., Hackmann, A., Middleton, H., Anastasiades, P. and Gelder, M. (1994) ‘A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder’, British Journal of Psychiatry, 164(6), pp.759–769.

Craske, M.G., Treanor, M., Conway, C., Zbozinek, T. and Vervliet, B. (2014) ‘Maximizing exposure therapy: An inhibitory learning approach’, Behaviour Research and Therapy, 58, pp.10–23.

Hofmann, S.G., Sawyer, A.T., Witt, A.A. and Oh, D. (2010) ‘The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review’, Journal of Consulting and Clinical Psychology, 78(2), pp.169–183.

Jerath, R., Crawford, M.W., Barnes, V.A. and Harden, K. (2015) ‘Self-regulation of breathing as a primary treatment for anxiety’, Applied Psychophysiology and Biofeedback, 40(2), pp.107–115.