Panic Attacks

What is a Panic Attack

A panic attack is widely regarded as one of the scariest things a person can experience in their lifetime. Here are a few signs to look for if you think you maybe having a panic attack:

• A gradual but dramatic increase in the respiratory rate, often resulting in intense hyperventilation.
• Numbness or tingling in the face, especially around the lips. May also occur in the extremities, chest, or even the entire body.
• Racing or uncontrollable thoughts
• Feelings of intense dread, or impending doom
• Irrational fear or intense anxiety
• Feeling faint
• Racing heart and/or arrhythmia
• Feelings of unreality or dissociation
• Sound distortion/visual disturbances and/or auditory hallucinations

While not dangerous, it can sometimes feel as if something more physically dangerous is occurring, check our guide on differentiating panic attacks between more serious conditions here.

Certain medicines or recreational drug use can increase the chances of a panic attack, particularly with abuse. Stimulants in particular are known to cause anxiety and panic in some users. Heroic doses and binging both drastically increase the chances of this occurring as a side effect.

Dealing with Panic Attacks

First and foremost, don't worry, you aren't dying. Panic attacks may manifest with strong physical symptoms (such as feeling faint or numbness) which may make you feel as if something else is happening, but they aren't dangerous and they are only temporary. It is important to note that while the feelings and sensations are very realistic and strong, they are superficial in a physical sense, and represent no actual physical distress. Acknowledging this issue in an objective manner can pave the way for rational thinking during spells of even the most intense anxiety and/or panic.

If the panic is being caused or exacerbated by the effects of a drug, remind yourself that it is only temporary and the experience will end. See How To Deal With A Bad Trip for more techniques, or join #tripsit to speak with people who can help.

With stimulant use, panic attacks can sometimes manifest as a symptom of malnutrition or dehydration, and dealing with these issues can help calm you down. Check our [Quick Guide to Stimulant Comedowns] for more information.

The A.W.A.R.E Method

This is a summary of a method found here. A more in depth description of the method can be found in the links at the bottom of the page.

• A - Acknowledge & Accept
• W - Wait & Watch
• A - Actions (To make oneself more comfortable)
• R - Repeat
• E - End

Acknowledge & Accept

Acknowledge your reality. Your heart is racing, and your body feels strange but it isn't your body doing this to you. It is all in your head. Think of the anxiety as quick sand. The harder you fight it the further you sink. You may be afraid, but you are not in any real danger. Accept it for what it is, a temporary sensation.

Wait & Watch

Wait on relief to come, you don't have to chase it. You don't have to immediately fix anything, remember this is only temporary. Take a moment to decide on a course of action, don't just jump in blindly struggling and fighting for relief. You don't have to act until you're ready. You don't have to act at all unless you want to. The outcome will be the same either way. This will end.

This waiting period can also be used to 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. A link to download a panic diary can be found in the links section below. The author has given permission for this panic diary template to be shared, downloaded and reproduced, so don't be afraid to share this link with friends, family and acquaintances if you think they may benefit from it.

Actions

It's not your job to bring the panic attack to an end; that will happen no matter what you do.

Your job now is to see if you can make yourself a little more comfortable, while you wait for the attack to end. See subsections "Slowing The Heart" and "Guided Breath Control" below. These are effective methods for calming oneself. More on this step can be found in the previously mentioned links.

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.

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.

Guided Breath Control

One method of calming a panic attack works through controlling the breath, ceasing hyperventilation. It can be performed as follows:

1. Count to 5 on the inhale.
2. Hold for 5 counts
3. Release slowly over 5 counts.
4. Pause for a short moment and then repeat.

This can be repeated until you reach a consistent and steady breathing rate. Pace your counts so that they match a comfortable breath. You can always count faster or slower with more or less numbers respectively. Check the links below for more breathing exercises.

Slowing The Heart

A racing heart can be an uncomfortable symptom associated with panic attacks as well as more generalized forms of anxiety. Two methods for getting your heart rate under control are performed as follows:

1. The carotid artery runs down your throat next to the vagal nerve. Give the artery a gentle massage with your fingertips to help stimulate the neighbouring nerve into slowing your heart rate down. This will trigger the vagal nerve which is responsible for controlling your heart rate.
2. To do the valsalva maneuver, after taking a deep breath, strain the muscles in your abdomen the same way you would to give a bowel movement. Hold the pressure for five seconds, and then let go. You may have to do this multiple times to get the desired effect.

Helping someone else suffering a Panic Attack

Talk soothingly to the person that is suffering from a panic attack. Move slowly but with purpose so that your intentions are obvious. Do not be offended if they shrink away from you or attempt to get away as if they believe you're trying to hurt them. Don't expect someone in this state to be entirely rational, but it can help to listen to their fears and calmly repeat the reality of the situation.

If they seem to want space, let them have it. People in the midst of this experience are often having extremely strong and seeming uncontrollable feelings of terror. They may not want to be seen in that state.

If your friend is comfortable with your presence, it may benefit them to have you guide them through counting and controlling breaths with the technique explained above.

Links

• A downloadable pamphlet the covers general information regarding panic disorders

• Guided meditation can help calm a panic attack

• More breathing exercises

• Free panic diary template

• In depth explanation of the A.W.A.R.E system for managing panic attacks