Understand the cause of your panic attacks in order to select the treatment that will work for you.
This article is to help you
understand your panic attacks better, and
help to show you how to stop them by choosing the right treatment or self help
Table of contents
- What is a Panic Attack?
- Self help & Treatment
- What causes Panic Attacks?
- What does a panic attack feel like?
- Symptoms of panic attacks
- Panic Disorder
- How to stop Panic Attacks
- Panic needs fear to survive
- Early warning signs
- Why breathing helps
- Grounding technique
- Coping statements
- What not to do
Video taken from my online self help course for Panic Attacks
What is a Panic Attack?
A panic attack is the name given to a set of physical and emotional symptoms that you experience when your brain mistakenly identifies something as a ‘threat’ to you. Your panic attack occurs when you are given a stress response in a situation that you do not need it.
Panic Attack Self Help and Treatment
The recommended treatment for panic attacks is Cognitive Behavioural Therapy; CBT. CBT is an excellent model for addressing the thought processes that occur with panic attacks, and also is extremely useful in helping you change behaviours that may keep your panic attacks going.
However, many people and this could be you, have panic attacks that just come out of the blue, and I would personally recommend having an understanding of your brain, in addition to CBT. I say this because there are different routes in your brain that can result in panic attacks and I shall explain this to you once I talk about the cause of your panic attacks.
In order to choose the right treatment option for you, you need to understand what causes your panic attacks.
What causes panic attacks?
Panic attacks can be caused by;
- your amygdala
- anticipatory anxiety
- underlying medical conditions
How to stop panic attacks
If you want to get over panic attacks, you first need to understand the cause of your own panic attacks. This will allow you to select the best treatment that will work for you and you can read about this below.
Panic Attacks caused by your amygdala
Many people experience panic attacks that just occur out of the blue, or in similar situations, that do not necessarily involve anticipatory anxiety. If this is you, it is probably your amygdala. I shall explain what sort of treatment you need in a minute, but I better give you an example first.
Example of amygdala based panic
Lets say you keep having panic attacks in the car (or in a lift, or plane; the same places.) If a therapist tries to work with this using your thought processes alone, it may not work, as your amygdala is not logical.
Your amygdala acts first and thinks second. This simply means that if you are in danger (ie. your brain detects a ‘threat’) it will not wait to protect you while you rationalise whether or not you are in danger. It activates your fight or flight response first, just in case, to prepare you for danger, as it is better to be prepared than risk being harmed.
If this is you, and you want to stop having panic attacks, you need to retrain your amygdala to let it know the car (lift or plane, or whatever your trigger is) will not harm you.
Your amygdala learns from experience. If you keep having panic attacks, and do nothing about it, your amygdala will keep activating your stress response in situations you do not need it; you will keep having panic attacks.
Panic Attacks caused by anticipatory anxiety
Anticipatory anxiety simply means you are worried about something that may happen in the future, such as “what if I have panic attack;” you anticipate something bad happening, or see the worse case scenario. Being afraid makes up a large part of anticipatory anxiety.
The difference between anxiety and panic attacks
If you have anxiety, you can feel it rising, almost like a build up. Although the feelings associated with anxiety range from unpleasant to very uncomfortable, you are able to cope with them much better than the feelings you get with panic attacks.
With panic attacks, you have no warning before you experience a series of extremely intense and distressing, physical and emotional symptoms. I had panic attacks myself, and that last sentence does not describe it well enough for me, so I am going to explain what a panic attack feels like!
What does a panic attack feel like?
One minute you are going about your business and the next, you might break into a sweat, your heart is pounding out of your chest, it’s getting hard to breathe.
This is a panic attack, but it can be different for different people.
You might feel like someone has placed a cushion over your mouth and nose, where it feels like you are getting smothered or suffocated, even though there is nothing over your face. This is something I personally experienced each time I had a panic, so I feel for you if you get this. It does go away; I have not experienced this for years.
You are terrified and convinced that you are not breathing, there’s not enough air getting into your lungs. ( I used to put my finger beneath my nostrils to get reassurance that there was still air going in and out!)
You check your pulse, and it may be rapid, or you might not be able to feel it at all.
You are shaking, sweating and feeling complete and utter terror as you might be having the thought (maybe for the first time in your life) that you are actually dying. You could also feel pins and needles, numbness and/or tingling anywhere in your body (this used to bother me a lot in my arms and legs.)
You may have had different symptoms, but if you have had a panic attack, you will be able to relate to what I have just said.
You could very well end up in hospital and get a series of tests, to be told
“It’s okay, there’s nothing wrong with you. You just had a panic attack.”
If you are very accepting of this information, or if it gives you some sort of relief or explanation regarding what has just happened to you, you may never experience an attack again, or as severe.
More than likely though, it is very hard for your brain to understand, that what you have just experienced, is “just a panic attack.”
When I had panic attacks, I felt like my life was spiralling out of control. I was physically and emotionally exhausted as my panic attacks would wake me from my sleep. In work, I couldn’t concentrate as all my attention was focused on helping me to breathe. I took time of work and flew home, I can still remember standing in the queue at the airport, trying to look normal and sneakily taking my pulse, which made it worse.
After one month out of work, feeling a good bit better, I flew back and once I arrived back into my apartment, bang, it all started again. That was 10 years ago and during those 10 years I have studied panic attacks; for myself, I am a psychologist, but the knowledge I acquired through training wasn’t helping me in the long term, so I took time out (years) to study it myself in depth. Now I can hopefully help you.
I’m the psychologist behind MoodSmith and as I said, had panic attacks myself so I have a good idea what you shall be looking for in this article.
You might be looking for reassurance, or wanting to match your symptoms against a list, to find out if you really are having panic attacks. This in itself can give you some relief. You probably want information on how to stop them but even if you do not read the entire page it is important that you know this.
Panic attacks are treatable. There is no magic bullet, where you do one thing and they stop forever. Reassurance helps in the short term, but if you want to make real changes, you have to understand where your panic attacks are coming from; you have to understand your brain.
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Overcome panic attacks
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Panic Attacks take a serious toll on your body. You may well feel physically and emotionally exhausted afterwards, and, at the same time, feel, “hyper” due to the rush of adrenalin in your body.
With this in mind, it is extremely difficult to “just relax” and accept that there is nothing seriously wrong. More than likely, it is playing on your mind,
“what has just happened to me?”.
If this was your first attack, there would have been a slow build up of anxiety in your body to cause the anxiety attack in the first place.
This will not miraculously disappear just because you have been informed that there is nothing physically wrong with you. The high levels of anxiety will still be there.
Symptoms of Panic Attacks
I have a more detailed list of symptoms relating to anxiety here., but the following list is more specific to panic attacks
- gulping for air; each in breath can feel like a gulp and your chest expands too much
- feeling like your breathing is not right; you are very aware of your breath and it is not regular
- feeling like you are dying or having a heart attack
- feeling like you are suffocating
All of these symptoms are due to your fight or flight response getting activated in a situation where it is not needed. You can read more about your nervous system and general anxiety symptoms here.
People sometimes ask me what the difference is between panic attacks and panic disorder. You can experience a panic attack without having panic disorder, but you cannot have panic disorder without panic attacks.
The crucial differences are, with panic disorder
- you are having many panic attacks where you cannot find a clear trigger
- you have started to change your behaviour due to the panic attacks, eg carrying water with you, needing someone to come with you if you have to go out, avoiding things that you think might cause a panic attack
- you worry about the next panic attack happening
Living with Panic Disorder
Panic Disorder can easily consume your life. Your physical health may become affected, as not only are you physically and emotionally exhausted, but you cannot rely on being able to sleep, as your sleep may well be affected. It can be difficult to perform to the best of your ability in work or school, as you have to contend with all the physical symptoms you are now regularly facing on a day to day basis.
You may also feel like you are losing control and going crazy, and that other people can see it happening to you.
Over time, you may not go out as much as normal, or find it difficult to be alone. This can start to affect your mood. If you have been coping, by avoiding situations that are uncomfortable for you, you may be at risk of developing Panic Disorder with Agoraphobia. Read more on this by clicking here.
If you would like my help, I have an online course that is available to start immediately. View the course
For example. If you have to go shopping and you previously had a panic attack in the shop, you understandably might avoid the shop.
If I asked you to come shopping with me, you might think “I can’t, I will have a panic attack.” Even though you may think that you are protecting yourself from having a panic attack, by avoiding a “trigger,” you are in fact, teaching your brain something that will not help you in the long run.
If you keep thinking “I can’t, I will panic.” You are helping your brain learn,
Shop = panic
The thought of the shop, may remind you of your previous attack, and you can start to feel nervous in your body. You will want to avoid it at all costs.
You will find, in the long run, that it is more helpful to you to think,
“okay I am a bit anxious but I will give it a go, and go to the shop.”
You may well feel anxiety, but if you talk yourself through it, and remind yourself “if I steady my breathing, I will calm down my body…”
You are starting to break down the learning that you do not want.
Shop = panic
and are teaching yourself to have a more helpful pattern in your brain.
Shop = is okay
Living with panic attacks can result in getting caught up in a life of fear;
fear of what happens during an attack,
fear of the next one,
constantly researching your symptoms,
looking for a cure.
This endless cycle, can take over, and it can be extremely difficult to actually start to do the things you need to do, to finally get rid of panic.
Living with panic attacks means feeling terror, that most people cannot imagine.
You never feel okay.
During an attack, every part of your body is doing something, making you feel things that were beyond your own imagination before.
It is practically impossible to explain to someone what life is like for you now, and have them really understand, and “get” what it feels like.
I fully understand what life is like for you. I understand that it might be difficult to read this page, that you might constantly Google your symptoms to check that you are okay. I understand what it feels like for your body to completely change in the blink of an eye.
To constantly “check” to make sure that you are okay, that you are not dying, that your heart is still beating. I get, that you might check your pulse on your neck or your wrist, to check it is beating, and not feel reassured, as it is beating so fast you cannot count it.
I understand what it feels like to be okay one minute, and feel like you are smothering the next, actually gasping for air. I get, that your breathing no longer feels right, that you are aware of it all the time.
I also understand, that you do not have to live like this. There are things that you can do, to take control.
In order for you to take control, you need to understand the role of fear and panic attacks.
Fear comes from you not fully understanding what is happening. You cannot fix anything, unless you first understand what the problem is.
Understanding what is happening to you and why, takes away the fear.
Without fear; your panic attacks will stop
Panic needs fear to survive
Afraid of your thoughts
Your thoughts can reach scary places when you start to have panic attacks.
Any sensation in your body can spark thought processes that you would rather not have. You might feel your heart beating and start to think that you are about to have a heart attack.
You might be feeling okay and become aware of the fact that you are okay.
Your thoughts can then be taken up with
“Was I feeling okay yesterday?” and then,
“What happened to make me anxious?”
Your thoughts are scanning for possible things that could go wrong. Fear then quickly turns into panic.
In this example, it is your thoughts that stimulated your anxiety.
Your thoughts are not neutral, which means they can make you “feel” something in your body.
When you remember a really great funny time, you might feel a little happier just recalling the memory.
When you remember a particularly bad argument with someone, you can start to feel angry when you go over it again in your head.
It follows then, that when you were feeling okay, your thoughts “was I okay yesterday?” stimulated your anxiety and you go from feeling okay to feeling panicky.
Afraid of the sensations in your body
This is one of the most uncomfortable fears. You become terrified of what is happening in your body. Scared when it is actually happening and, living in fear of it happening again.
Afraid of having another attack
Even when you feel okay, you live in fear of the next one. Checking your body to see how you are doing. All this does, is make you more alert to the normal sensations we all have in our body.
Afraid of meditation and breathing techniques
Most of the time you want to distract yourself from what you are feeling in your body.
Any technique that involves you paying attention to your body can be alarming in the beginning, as it brings all your attention to what you are feeling.
On one hand, meditation does focus your attention on what is going on in your body right now, which you may not like. On the other hand, it helps you to accept what you are feeling and over time, takes away the fear.
Panic Attacks find it hard to exist without fear.
Afraid to go to bed
If you have panic attacks in your sleep, you probably wait until you are exhausted before going to bed. When you lie down you may feel your heart pounding and hear it beating in your ear, against the pillow.
All your thought processes are then focused on your heart. Being exhausted, your body is probably relying on adrenaline to keep you going, causing more anxiety.
You get out of bed and the cycle begins again.
Afraid to go out
You might feel safer at home and be terrified to go outside, worried that you might have a panic attack. Even thinking about going out can cause you to feel fear.
Once you feel fear, you will start to feel anxiety in your body.
This anxiety will then trick you into believing that you should stay at home.
The anxiety that you now feel, it not because of being outside, it has been created by your brain responding to what you are thinking about.
Afraid to stay at home alone
Being at home alone can be too much for some people. You are left alone with your thought processes and may not have anything to distract you from what is going on in your body and mind.
You might not be able to kick back and watch TV or do what you need to do around the house, as your mind is racing.
There will be nothing in your home that is actually causing the anxiety.
The anxiety, will be caused by a habitual response you have developed –
fear of thought processes,
fear of what may happen,
fear that there is no one there to help you if you need it.
It is your thoughts that will be keeping this going – maintaining the fear.
Understanding the root cause of panic attacks
This involves a detailed understanding of what causes anxiety. What you think, feel and do, shapes your brain.
This simply means,
what you habitually think,
what you habitually feel, and
how habitually you react,
lays down a learning process in your brain.
The following video is a recording of a webinar I did recently and shall help to explain panic attacks
Panic Attacks caused by an underlying medical cause
It is important to get medical conditions ruled out, before you commence any treatment or self help, as your panic attacks may be due an underlying organic cause such as
- mitral valve prolapse
If you are interested, you can read more on medical conditions that cause panic attacks here.
Self help checklist
What you think
Do you worry about getting another panic attack?
Do you worry in general?
Are your thoughts taken up with
“how will I cope? ”,
“what if I get anxious? ”
“I am going crazy?”
“I’m having a heart attack.”
What you feel
Anxious. On edge. Irritable. Worried
What you do
Are there things you do, that act as “safety blankets” or “crutches”? These might be, bringing water with you everywhere in case your mouth is dry,
Do you do a quick check in places, to get a route out quickly, in case you have an attack?
Do you sit nearest the door to get out quickly?
Are you avoiding things?
If the checklist seems familiar to you,
what you are thinking, feeling and doing, is ensuring that your brain stays anxious.
The longer you do these things, you stronger the learning pathway becomes in your brain. Eventually you will reach the end of your learning curve, and become skilled at being anxious.
When this happens, you now can do all of these unhelpful things automatically. You have an anxious brain.
Early warning signs
Even though it may seem like panic attacks come out of the blue, there are usually early warning signs that, with practice, you can learn how to stop a panic attack.
Start to monitor your attacks and note what your own early warning signs are.
Possible early warning signs include,
feeling a tightness in your chest
noticing a change in your breathing
feeling your heart beat faster
When you have developed a list of early warning signs, you are in a better position to stop your anxiety from developing.
What to do if you spot your own early warning signs of anxiety.
Remind yourself you are simply experiencing the effects of anxiety and that it will not harm you.
Start a mindfulness exercise such as the following one
Start by simply noticing your breath.
This may be difficult at first, but this is why it is called a mindfulness practice.
It does not have to be perfect each time you try it: you simply practice.
You can read more on Mindfulness by clicking here.
If your breathing feels labored or fast or uncomfortable, just notice it, and try not to engage your thought process, as anxiety related thoughts may increase your anxiety.
Start to count each out breath
breathe in, breathe out 1
breathe in, breathe out 2
breathe in, breathe out 3
breathe in, breathe out 4
breathe in, breathe out 5
Repeat this until the number 10 and start again with the number 1 through to 10.
Focusing on your breathing, with no judgement, and letting your thoughts come and go as they please will eventually calm your body and mind.
If you feel other symptoms of anxiety while doing this, just notice them and bring your attention back to your breathing.
If your heart is racing, just notice it racing, and bring your attention back to counting your out breaths.
At first this may feel difficult, but with practice you will lower your anxiety.
This is a good exercise to do on a daily basis, not just when you feel your own early warning signs of anxiety.
Developing a daily practice will help you to lower your overall anxiety levels and make it less likely that you will experience a panic attack.
Why breathing helps
When you notice your own early warning signs, regardless of what they are, they are due to the activation of the stress response (your sympathetic nervous system). You can read more on this by clicking here.
To calm down, whatever it is that you feel in your body, you need to activate your relaxation response (your parasympathetic nervous system.)
Different rates of breathing, result in different emotions and feelings in your body.
You breathe too much during a panic attack, resulting in hyperventilation.
What happens when you breathe too much?
Your heart rate speeds up.
You take in too much oxygen and your carbon dioxide levels lower.
This is known as hypocapnic alkalosis – or more simply put, your blood is too alkaline and makes you
suffocating or smothering feelings
And a host of other symptoms.
You can read more about the symptoms of anxiety by clicking here.
When feeling unreal, light headed and dizzy, you panic, which of course, makes you feel worse and your symptoms increase.
Breathing is something that your brain takes care of, it is normally outside of your control.
If you are having a panic attack, you are breathing more than you should be, and you need to take control.
Taking control of your own breathing will allow the anxiety to melt away.
Controlling your breathing will
Calm your heart rate
Restore the levels of carbon dioxide, and your uncomfortable symptoms will go away
How to take control
If it feels like you are gulping in air, or notice that your belly really expands when you breath in, you are taking in too much air.
The uncomfortable feeling of panic breathing will naturally make you want to breathe more deeply, but don’t.
Your over breathing is the problem.
Breathe in, through your nose, slowly, do not gulp.
Breathe out slowly, through your mouth, as if you were blowing up a balloon. Make sure your exhale is longer than your inhale.
Each time you breathe out, relax your shoulders, let them drop.
Wait for the next breath to come. If you are gulping in air, you probably started to breathe in, before you needed to.
Wait for the next breath to come.
What to do if you are controlling your breathing and your mind is racing?
It is normal to have scary thoughts during a panic attack. In addition to taking your control of your breathing, you need to ground yourself.
This will take your attention away from your thoughts.
Focus on something else. I would recommend focusing on something else in your body, as your body is always with you!
Focus on the soles of your feet.
Shift them about a bit.
How do they feel on the ground.
Walk around and pay attention to your heel coming into contact with the ground, followed by the rest of your foot.
By doing this, you are taking your attention away from scary thoughts that add to your anxiety, and focusing on something neutral – something real. Your feet on the floor.
All of this sound too simple for you?
It may sound simple but bear in mind.
You experience a panic attack, due to activation of your sympathetic nervous system; your stress response
This is controlled by your brain, you did not choose to activate it.
Controlling your breathing IS your choice. You are activating your parasympathetic nervous; your relaxation response, which will restore balance in your body.
Focus on your feet too simple for you?
If you continue to focus on thoughts that are fuelled by panic, you will most certainly spiral more into panic.
Focusing on your feet, is you choosing to focus on thoughts that are not adding to your panic.
Remind yourself that you are only feeling this because you are hyperventilating and that you will be okay, or by using coping statements.
This will pass
I have felt this before and it goes away
The sensations are because I am over breathing, nothing else.
If my thoughts are scary, I know that they are not real. My thinking is irrational when I have a panic attack.
Pay no attention to my thoughts – I choose to focus on something else.
So what? if I am having a panic attack. It will pass
You can add some coping statements of your own.
Accept your feelings
Don’t run away from panic, but do not fight it either – just accept it.
Accept it for what it is – your nervous system being over stimulated.
Accept your feelings of panic without your own spin on what is happening. By this I mean thoughts such as “I am going to die, I can’t handle this” etc.
Accepting your feelings, is just describing them, for example
My heart is beating fast – as opposed to – I am going to have a heart attack
My breathing is fast as opposed to – I am suffocating
My heart is beating fast
I feel pins and needles
I am sweating
This way, you are simply accepting what is happening, without adding fuel to the fire.
Take control of your panic attacks by
What not to do
Do not smoke
If you are a smoker, you might reach for a cigarette to help you relax. Smoking will stimulate your nervous system, causing your heart to beat faster, and may in fact, make you more anxious than you were.
Do not misinterpret your symptoms
If you have had panic attacks before, you will know that any of your anxious thoughts relating to what may “really be happening” do not come true.
If your mind is focusing on some other scary reason for your symptoms, this will create more anxiety.
Talk yourself through it, know that whatever symptoms you feel, that it as a direct result of your sympathetic nervous system.
Do not run away from whatever you are doing.
It is a natural reaction to leave wherever you are, when you have a panic attack. If you are in a shop, you will want to leave, to get outside for fresh air.
It is not the shop, or the air in the shop that is resulting in the difficulties you have breathing.
It is your sympathetic nervous system.
If you leave whatever you are doing, you are sending a signal to yourself, that you are not safe where you are.
If you can manage to talk yourself through it, and stay where you are, your body and brain will thank you for it.
With panic attacks, it is all too easy to avoid places that you believe may cause you to have an attack.
It is not the place that is causing your panic.
It is your body giving you a stress response in situations where you do not need it.
Do not fight it.
With practice you can learn to accept that what you are feeling is as a result of anxiety. This acceptance, lessens the fear. Having less fear means that the attack will pass quicker.
Learning not to do these things will take away some of the fear.
Without fear, there is no panic.