How to cope with panic attacks: five practical steps.
By MIKE GROPPERTeen depression(photo credit: INGIMAGE)
Yossi, a 30-year-old man suffering from recurrent panic attacks since his teens, sought my help. He described one of his attacks during an early therapy session. “I feel like I cannot breathe, all my muscles tighten up and my heart starts to pound very quickly, giving me a feeling that I am having a heart attack. I feel like I am choking, gasping for air, and that I am going to go crazy.”Because of his recurrent attacks, Yossi became a social recluse. Each day, after returning from work, he refused to take his girlfriend out. She felt frustrated, and threatened to leave him if he did not get some professional help.A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. When a panic attack occurs, the person may feel that he/she is losing control, having a heart attack or even dying.Panic-attack sufferers may experience heart palpitations, chest pain, breathlessness, vertigo or abdominal distress. Some people experience a feeling of impending doom or danger.As a rule, panic attacks are not life-threatening, but they are a terrifying experience to go through. People like Yossi who have recurrent panic attacks and spend long periods in constant fear of another attack may have a condition called panic disorder. At least 23% of the general population have reported an isolated panic attack some time in their lives (National Institute of Mental Health).While there are many theories about what causes panic disorder – genetics, turbulent family history, poor emotional coping skills, a very stressful event such as divorce, job loss or trauma – the focus in this article is to give the reader some practical emotional advice on how to cope with a panic attack if it occurs.It is important to state that people with panic disorder should always consult with their primary care doctor to rule out any possible medical causes for the symptoms. According to the American Psychological Association, the most effective treatment for panic disorder is a combination of cognitive-behavioral therapy together with relaxation techniques. Medication might also be appropriate in some cases.Cognitive-behavioral techniques for panic attacksStep 1. Useful psycho-education. Since these clients feel a total loss of control when confronting such scary symptoms, a brief explanation about how a panic attack gets started can be very helpful.I told Yossi that, on average, a panic attack does not last longer than 10 minutes, and the attacks are either triggered by the situation, that is, some place or situation that is associated with heightened anxiety, or they are completely unexpected and have no rational explanation.Furthermore, I explained to Yossi that heightened anxiety speeds up breathing (hyperventilation), and the brain and body interpret this as an emergency.In response to the feeling of an emergency, the body as well as the chest muscles tighten up, resulting in a fight/flight response that triggers the production of adrenalin, further increasing the breathing rate.The person begins to take in more oxygen than his/ her body needs, and the carbon dioxide level drops, resulting in the symptoms of a panic attack.Step 2. Do not panic about the panic! My first advice to clients like Yossi is to tell them not to panic about the symptoms of the panic attack, because this only intensifies the panic attack. Tell yourself that it will pass, but you need to let that happen and it takes several minutes.Step 3. Change your thinking. If, for example, you think you are suffocating, tell yourself instead that you are not going to suffocate, but instead your chest is tightening up as a result of the panic attack. This change in thinking can quickly lower your anxiety.Step 4. Deep-belly breathing technique. Deliberate deep breathing exercises help to rebalance the oxygen and carbon dioxide levels in the blood. One such breathing exercise is a five-two-five count. Using the stomach (or diaphragm) and not the chest, inhale (feel the stomach come out, as opposed to the chest expanding) for five seconds. When the maximal point of inhalation is reached, hold the breath for two seconds. Then slowly exhale through your mouth by pulling your belly in over five seconds.Repeat this cycle twice and then breathe normally for five cycles (one cycle = one inhale + one exhale).The point is to focus on the breathing and relax the heart rate.Step 5. Exposure and relaxation training. One of the techniques I use with clients is exposure therapy, which includes repeated and prolonged confrontation with feared situations and body sensations.This process helps weaken anxiety responses to these external and internal stimuli and reinforces realistic ways of viewing panic symptoms. In addition, I include relaxation-training exercises as part of my treatment, to give the client additional emotional tools to deal effectively with panic attacks.Longer-term psychotherapy can be very useful in helping people like Yossi to get to the root of the anxiety problem, but the need for immediate handson techniques is essential to alleviate the suffering that these clients undergo.The writer is a marital, child and adult cognitive- behavioral psychotherapist, with offices in Jerusalem and Ra’anana. www.drmikegropper.weebly.com, drmikegropper@gmail.com
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