Managing a Panic Attack

" Knowing your unique blueprint for how you experience panic episodes in your mind (cognitive narratives), body (somatic presentations), and the length of time it lasts helps you shift these patterns to create room for alternative coping strategies. "

A panic episode is one of the most frightening events we experience. Panic attacks are so disruptive because they pull us out of the present moment and into a chaotic realm of overwhelm, fear, terror, and hypervigilance! An estimated 4.7% of adults have experienced a panic disorder at some point in their lives. 

According to the DSM-5, a panic disorder is a type of anxiety disorder. A panic disorder involves the repeated occurrence of panic attacks. It begins with a rapid onset of intense fear or discomfort which inhibits overall functioning. According to the DSM-5, a panic attack involves 4 or more of the following sensations:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying

​The highly dysregulating event causes us to incorrectly believe we are dying or in immediate threat. Sometimes, panic episodes become so frightening and confusing, individuals seek out emergency medical attention to find relief. A study measuring emergency room (ER) visits in the United States from 2009-2011 found 1,247,000 anxiety related ER visits. This represents .93% of total ER visits. The most common form of treatment for these visits was benzodiazepine treatment.

​To effectively treat panic disorder, psychiatric medications, cognitive behavioral therapy, desensitization therapy, exposure therapy, and mindfulness-based stress reduction therapies are clinically appropriate modalities of choice. Below are additional strategies to manage and overcome episodes of panic.

Ride the Wave
Face the panic rather than running from it.

During a panic episode, we may feel like we are going to die, but in most cases, there is no immediate danger to the body. Staying with the panic episode actually leads to more rapid resolution. Breathing through the uncomfortable sensations helps the body and the nervous system down regulate the panic response. “Riding the wave” of the panic attack teaches your body to stay with the reactions (sweating, heart palpitations, chest construction) rather than getting overwhelmed by them and entering into a dissociative (where you "leave" or disconnect from your body), fight, or flight response. When practiced over time, this method improves overall stress tolerance. The clinical term for this concept is desensitization.   

Mindfulness
Viewing the panic attack from an objective perspective diminishes its power. Instead of the panic episode throwing you into a whirlwind of unending panic and anxiety, you observe it as an event with a start and an end. Shifting the mental narrative from “I’m panicking” to “I’m noticing panic” externalizes the panic episode and creates distance between you and the panic. Mindfulness also helps explore triggers, precursors, and antecedents to panic episodes. There may be a theme to when, where, and why you experience these episodes. Recognizing this helps create a plan to apply appropriate interventions.

Cognitive Reframing
By recognizing what thoughts arise during a typical panic response, you can intentionally redirect them. Common thoughts during a panic episode include, “I’m dying” or “I’m out of control.” Knowing your unique blueprint for how you experience panic episodes in your mind (cognitive narratives), body (somatic presentations), and the typical length of time it lasts helps you shift these patterns to create room for alternative coping strategies.

Positive coping statements minimize emotional distress during a panic episode. Examples include:

• I am safe.
• This feeling isn’t comfortable, but I can accept it.
• This will be over soon.
• This isn’t an emergency.
• I am going with the flow until my anxiety decreases.
• I am alive in this moment.

Physical Activity
Moving the body provides relief during a panic episodes. Physical activity in the following ways can help improve emotional control during a panic episode:

• Stretching
• Yoga
• Shaking
• Running
• Walking
• Hiking
• Dancing

​Engage Your Frontal Lobe
During a panic episode, the limbic system of the brain creates a fight or flight response. Engaging the frontal lobe creates focused concentration and a distraction from the source of panic. Completing a task, writing a narrative, or talking to another person improve activity in the frontal lobe.

Diaphragmatic Breathing
Diaphragmatic breathing, or “deep belly breathing” uses the whole stomach and abdomen to breathe. To begin this process, breathe inward for 5 seconds and breathe deep into the stomach and abdomen. Before breathing out, pause for 2-3 seconds. Then slowly breathe out for 5 seconds. Repeat this cycle for 5 minutes. This technique provides relief to the nervous system. Closing your eyes during this practice also filters out excess visual stimulation and deepens the practice.

Bilateral Stimulation
Bilateral stimulation activates interhemispheric communication in the brain. Multiple regions of the brain communicate with one another and down regulate the limbic system (anxiety center in the brain) and nervous system in times of panic, hypervigilance, and anxiety.
Eye-movement desensitization reprocessing (EMDR) is an evidenced-based method used in the treatment of post traumatic stress disorder (PTSD). It uses bilateral stimulation through eye movements, tactile sensations, or auditory tones to reduce physiological activation and emotional distress around traumatic memories. Other examples of bilateral stimulation include:

• Walking
• Running
• Boxing
• Listening to bilateral music with headphones
• Bilateral tapping (tapping your legs, knees, or shoulders with your hands in an alternating rhythm)

Environmental Shifting
Shifting your physical environment can also help diffuse the panic episode. A new environment creates new stimuli for the body and brain to adjust to. If your panic episode occurred in a building, getting outside can be a great way to reset. Smelling a flower, taking a drink of water, or touching the grass can also help.

Reach Out For Help
If you are having trouble managing your panic attacks on your own, you may require the help of psychiatrist, psychologist, or psychotherapist. Talking about these episodes is the first step to overcoming them!

Hilary Morris, LPC and her team teach clients to manage and find relief from their panic episodes. They use evidenced based methods to help patients gain control over their panic, feel confident, and get back to living their lives! They use cognitive behavioral therapy, exposure therapy, desensitization therapy (EMDR and Brainspotting), biofeedback, and stress inoculation training to provide their patients with relief. Their clients become stronger than the sources of panic in their lives and improve overall confidence!

To learn how they can help, contact them to set up an initial consultation.

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