What is a panic attack?
A sudden rush of physical and emotional symptoms that can occur apparently without warning or in response to a stressful situation.
Physical symptoms include:
- Heart palpitations
- Shortness of breath
- Tightness in the chest
- Increased sweating
- Clammy hands
- Light-headedness, dizziness, feeling faint
- Shaking or trembling
Psychological symptoms include:
- An impulse to run away
- Fear of dying or being out of control
- Feeling of unreality
What causes it?
Physiologically the body is reacting to a perceived threat – a similar reaction to the need to escape from a physical danger e.g. a fire or an accident. The body produces large quantities of adrenaline which causes increased heart rate, breathing and muscle tension. With panic attacks normally there is no apparent or immediate danger and they frequently happen in the most ordinary settings, on a train, in a shop, lecture etc. The lack of obvious explanation can make them more frightening. Sometimes they occur in settings that are more obviously stressful e.g. in an exam, in a crowd but soon the attack may become more frightening than the situation itself.
What can I do?
Stage 1: ‘first aid’
- Retreat - if appropriate quietly leave the situation until you feel calmer e.g. walk out of the shop, library, stop the car, leave the underground at the next stop.
- Slow your breathing down – focusing on your out breath rather than your in breath, as if you are sighing and continue for 2-3 minutes.
- Ground yourself – feel your feet firmly on the ground and if sitting, lean back against the seat back. Bring your attention into your feet and legs, letting them feel heavy.
- Stay in the present by looking around and noticing small details of external objects – become more focused in your surroundings than in what’s happening internally.
- Do a repetitive activity like counting backwards from 100, gently clench and unclench your fists 100 times.
- Accept and be prepare to ride out the sensations – they will only last a few minutes and are not dangerous.
Stage 2: immediately afterwards
- Talk to someone about everyday things to normalise the situation as much as possible
- Do something enjoyable – treat yourself to a snack or a meal (but avoid high sugar/caffeine/alcohol based foods at this moment), go for a walk in a park, watch TV
- Consciously relax any tensed muscles
- Remind yourself of things you are good at
- Decide how and when you can repeat the activity that caused the panic attack – don’t make it daunting
Stage 3: prevention strategies
- Identify any early warning signals (familiar physical symptoms or thoughts) and take remedial action
- In potentially triggering situations identify a withdrawal route which will allow you to exit temporarily e.g. sit/stand near an exit
- In potential trigger situations have someone you trust with you
- Have a distracting activity with you e.g. a good book, a game on your phone, headphones to listen to music
- Learn and practice body relaxation and breathing techniques so they come easily when you need them. More information and techniques are available here.
- Practice positive self statements e.g. I can calm myself, I have ways of coping with this, this will pass soon
- Limit your intake of food/drink containing refined sugar, caffeine, alcohol
- Consider consulting a counsellor to explore any context in which the panic attacks have occurred. Sometimes they are associated with more general stress, loss or unexpressed feelings
- A panic attack will not cause you to stop breathing or to suffocate
- A panic attack cannot cause you to faint
- You will not ‘go crazy’ during a panic attack
- A panic attack cannot cause you to lose control of yourself
- A panic attack is not dangerous and will normally stop after 3-4 minutes