Panic Attacks (Or the tiger in the room!)

Panic Attacks (Or the tiger in the room!)

Panic attacks!

I can't tell you how many people have consulted me for help with panic attacks over the years! Although anyone can experience a panic attack, many people who struggle with panic attacks see themselves as weak or incapable. The opposite is often true and people who have panic attacks are often high achievers who feel themselves handicapped by constantly having to avoid situations which may give rise to a panic attack!

- Sylvia is a qualified lawyer who stays in a dead end job because she is afraid of having a panic attack during a business meeting

- Gaynor is a stay at home mother who cannot go out of the house, even to do her shopping, as she fears having a panic attack in the street or in the shops.

- Stuart is an intelligent young man who would love to study to be a game ranger but who is so afraid of bugs that he won't even go into the garden!

- Jacob has written a book but is too nervous to submit it to publishers in case he will have to appear in a meeting or have to do public speaking to promote his book (and trust me - it's good!)

Have YOU battled with panic attacks too? 

Many people who suffer from panic attacks would be surprised to hear that this is a relatively common condition. Some people experience panic, or anxiety attacks once or twice during times of stress, while others have a full blown Panic Disorder, experiencing panic attacks a few times a week, or even on a daily basis.  (A Panic Disorder will be diagnosed if there are at least three panic attacks within a three-week period in reaction to situations that are not life threatening and which are not associated with physical exertion) 

Panic attacks can occur at any time of the day or night and are so disturbing that many people have been rushed to emergency medical centers with suspected heart attacks or seizures, only to be told "It's only a panic attack".

ONLY a panic attack! Most people who have suffered a full-blown attack would have difficulty accepting this phrase. There is nothing 'only' about a panic attack! panic attacks can be so terrifying that the person is convinced that she is about to die on the spot! To be told that you are 'only' having a panic attack does not make it less real or less frightening - but often leaves the person feeling foolish and misunderstood, convinced that there is some un-diagnosed medical problem which the doctors have missed, like an impending heart attack! 

Unfortunately, it has been my experience that many medical doctors have not been sufficiently trained in how to help people with panic attacks. The usual medical treatment involves reassuring the patient that she is 'fine' and prescribing medication, which is often addictive and which may come with side effects that are sometimes more debilitating than the panic attacks themselves!

Is that a good solution? 

If more doctors recognized that panic attacks are relatively easy to treat without prescription medication, patients would be referred for treatment at the early stages of the problem. This would mean that there would be fewer people with chronic and severe forms of panic disorder and fewer dependent on prescription drug therapy! 

What are Panic Attacks?

A panic attack is a physiological response to fear or sudden anxiety. Sometimes the object of fear is physical (like a spider) or an event (fear of flying, fear of heart attack or dying). Other times the panic attack occurs without an apparent trigger and may just 'happen'. 

The symptoms of a panic attack include the following: shortness of breath or feelings of suffocation; vertigo or faintness; heart palpitations; chest pains; trembling; sweating; chills or flushes; nausea; tingling sensations in hands, feet and face; fear of dying, collapse or 'going crazy'; an uncontrollable desire to run away or escape. 

If you look closely at these symptoms, you will agree that they very closely resemble the body's reaction to a frightening or life-threatening event. The experience of a panic attack is no different in symptoms or intensity to the experience of being threatened with a knife in a dark and lonely alley, or coming face to face with a dangerous wild animal! There is the same feeling of intense fear, the same rush of adrenaline and the same overwhelming need to escape! The only difference is that there is no actual danger present, or the perceived danger is one that would not unduly worry the majority of people. 

In essence, then, a panic attack occurs when the brain 'misinterprets' a situation or event as life threatening and sets into motion a series of physiological and chemical events which result in what we call a 'flight or fight' response.

In other words, your body is made ready to either run away or to fight to the death! There is a surge of adrenaline, which provides the energy (and the desire!) to fight or to run away. Then there is an increase in the heart rate and the person begins to breathe faster and with shallower breaths, trying to get more oxygen to flow into the lungs. If there was really physical danger present, the individual would use up all the adrenaline in fighting off her foe and that would be that! During a panic attack, however, there is no actual need to fight or run away, so the rapid breathing often becomes hyperventilation. Hyperventilation upsets the levels of carbon dioxide and oxygen in the body, causing dizziness, tingling sensations, shortness of breath, chest pains, feelings of suffocation and fear of collapse or dying. All of these sensations, in turn, further frighten the person who is experiencing the attack - leading to more severe symptoms, thereby significantly prolonging the attack and increasing the severity of symptoms. 

How to control a Panic Attack

Now that you understand that a panic attack is a series of physiological and chemical responses caused when the brain 'misinterprets' a situation as life threatening, you can use this knowledge to achieve control over your panic attack so that you can either minimize it significantly, or even completely prevent it, without the use of strong drugs.

Is there really a tiger in the room?

The first thing to tell yourself is that a panic attack cannot kill you. Nobody has ever died of a panic attack and you are not going to be the first one in history! While panic attacks FEEL life threatening, they are not at all dangerous. believe it or not, other people may not even notice that you are having a panic attack, unless you tell them. Panic attacks feel MUCH worse than they look! Furthermore, although it feels like it, there is actually no tiger in the room! Look around you - can you see one?

Panic attacks don't last long

Secondly, your body cannot sustain a panic attack for long. Even if you do nothing at all, your body will adjust itself to balance oxygen and carbon dioxide levels and remove excess adrenaline from the blood stream within at most 10 - 15 minutes, but usually only a few minutes. So what you are facing is not a life threatening illness, but only a brief 'episode' of panic. Running away or avoiding the situation is not what has relieved you of the panic attack - panic attacks actually just 'fizzle out' if you ignore them.

Many of my clients have been significantly helped by this knowledge and find that it really makes a difference to tell themselves that "This will only last a few minutes and then it will be gone".

YOU can control the symptoms!

Thirdly (and here's where YOU can be in control!) there are two main things to work on when preventing or minimizing a panic attack.

  • The first is preventing hyperventilation syndrome (see above).
  • The second is preventing a build up of adrenaline. Of the two, preventing hyperventilation syndrome is by far the most important - and so easy to do that it almost seems too simple!

To prevent hyperventilation syndrome, all you have to do, at the first sign of anxiety, is to slow your breathing down to about 10 deep breaths per minute. Breathe slowly and deeply in through your nose (try to breathe from your diaphragm rather than from your chest), hold your breath in for a few seconds and then release your breath slowly from your mouth. While you are breathing out slowly, it helps a lot to silently say (think) something calming like 'relax' or 'it's ok' (there's no tiger!). Your diaphragm is a big sheet of muscle just under your lungs at the bottom of your rib cage. To achieve breathing with your diaphragm, you must push your diaphragm down towards your navel, so that your tummy 'balloons' out, while at the same time allowing air to enter your lungs naturally. When you relax your diaphragm, it will return to its usual position and thereby expel the air slowly from your lungs. It is worthwhile practicing this technique while you are alone and relaxed, but if you find you struggle too much - don't worry! Slow, even and deep breathing will do the trick just as well. It is more important that you relax, than worrying about technique! 

Once you have controlled your breathing and are more relaxed, you may find it useful to walk around a little, thereby using up some of the adrenaline in your body.

Sometimes a panic attack can creep up unexpectedly and before you know it you have all the full-blown symptoms, without even having a chance to practice your breathing! You may even wake up at night in the middle of an attack. Don't worry! Even right in the middle of a panic attack, you can begin to control your breathing - slow breath in through your nose, hold your breath for a few seconds - and then slowly release the air through your mouth, thinking 'relax' and even consciously allowing your muscles to release tension and loosen up.  The first few breaths may be a little difficult, but you will soon get the hang of the slow rhythmic breathing. Remind yourself that the panic attack will only last a few minutes and that it cannot harm you. Continue the slow breathing and before long you will be feeling much better!

Learning to control the symptoms of a panic attack improves with practice. Most people find that the breathing technique alone helps almost immediately, but some people need to keep trying until it works properly. It is advisable to find about 10 - 15 minutes once or twice a day to sit comfortably in a quiet spot and practice deep, slow breathing, not forgetting to think the word 'relax' every time you breathe out and making sure that you relax all your muscles as you breathe in and out. If you do this regularly, you will not only decrease the incidence of panic attacks, but you will also increase your ability to control the panic attacks if they do occur. Many of my clients find that once they have learned to control their panic attacks, the attacks disappear altogether! 

What else can I do to help panic attacks?

There are many other things one can do to decrease the incidence and severity of panic attacks.    

  • Health comes first! The first thing to remember is that the healthier your lifestyle, the less you will suffer from panic attacks. Regular exercise is a big help - as is a balanced healthy diet and regular meals. Make sure that you get sufficient sleep - studies have shown that sleep deprivation increases the incidence of panic attacks. Avoid stimulants like alcohol, drugs, caffeine and foods high in sugar. If you suffer from anxiety and stress, try and find out the causes and take steps to address them. If you are not sure why you are experiencing anxiety, consult a professional.
  • Focus on the bigger picture! Don't let panic attacks define you or hold you back. Try and involve yourself in something enjoyable and fulfilling. If you are a very active person socially and career-wise, take up something relaxing like yoga or pottery. If you are withdrawn and inactive, join a club, offer your services as a volunteer, or take up a hobby or sport which would bring you into contact with people. Taking your mind off your problems is often a big help! If you tend to take on too much, learn to ask for help!
  • Therapy can help. Many therapists use techniques like progressive relaxation or meditation to help the client learn how to access his own calming response (everybody has one!) and to lower anxiety levels to more comfortable states. This is often combined with psychotherapy to help improve self-esteem and understand the causes of the anxiety and cognitive therapy to 'reprogram' the negative thoughts underlying the anxiety or panic. (There REALLY is NO tiger in the room!)
  • Natural remedies can help. Be careful of relying on prescription drugs to treat panic attacks. They can become addictive and they do not solve the problem - usually only adding to it! There are many natural products which help and may be used alone or in combination with therapy.

Here are a few natural medicines for anxiety and panic attacks that I have formulated that can be very helpful and which have been used by my clients over the years:

Mindsoothe is an herbal remedy that helps to balance brain chemistry and improve mood and well-being. It also helps to reduce overall anxiety levels when used regularly. 

PureCalm is an herbal remedy that comes in convenient drop form. It can be added to a little water to sip when you need it. PureCalm helps to relax and calm you without risk of addiction or unwanted side effects. 

For these and any other natural medicines, please visit Native Remedies (USA) or Feelgood Health (South Africa)

Michele Carelse is a Registered Clinical Psychologist and Licensed Counselor with more than 20 years experience. She is also the President of Feelgood Health - a range of natural herbal and homeopathic remedies in South Africa aimed at promoting emotional, psychological, cognitive and physical health. Michele also formulates herbal and homeopathic remedies for the international natural health industry and has formulated most of the natural medicines on the Native Remedies website. If this blog or any other service she offers has helped you, or you need some help, please write to Michele. 

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