What is a panic attack?
A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes. To officially meet criteria for a panic attack, you need to have at least four of the following symptoms during the panic attack:
- Palpitations, pounding heart, or accelerated heart rate.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint.
- Chills or heat sensations.
- Numbness or tingling sensations.
- Feelings of unreality or being detached from yourself.
- Fear of losing control or “going crazy.”
- Fear of dying.
Sounds awful, right? In fact, it is not unusual for someone who is having a panic attack to present at the emergency room, thinking they are having a heart attack or that they are otherwise in mortal danger. Once any heart problems are ruled out, you can focus on coping with panic attacks, knowing that you are not having a life-threatening emergency.
A panic attack can last from a few minutes to half an hour. Many people report that their panic attacks last for hours, but the most intense physical symptoms (sweating, heart racing) usually pass after ten to thirty minutes. However, the nervous and drained feeling after a panic attack may last for several hours.
If you are experiencing panic attacks, you are not alone. They are common, in fact up to 35% of the population experience a panic attack at some time in their lives.
A panic attack is also referred to sometimes as an anxiety attack. Technically speaking, “panic attack” is the clinical term that is defined and diagnosed, whereas “anxiety attack” is a lay term without a formal medical definition. Clinicians tend to use them interchangeable to mean “panic attack”. Sometimes, people say they had an “anxiety attack” when they’re referring to feeling really anxious for several hours; this isn’t a panic attack, just high anxiety. Whatever you call them, panic attacks are not dangerous, but they are very aversive. The good news: they are very treatable!
Without treatment, frequent and prolonged panic attacks can become disabling. The person may avoid a wide range of situations (such as leaving their home or being alone) for fear of experiencing an attack. This can worsen symptoms, creating a downward spiral of anxiety. If this sounds like you, please get help!
What causes panic attacks?
When the body is faced with immediate danger, the brain orders the autonomic nervous system to activate the ‘flight-or-fight’ response. The body is flooded with a range of chemicals, including adrenaline and cortisol, that trigger physiological changes. For example, heart rate and breathing are accelerated, and blood is shifted to the muscles to prepare for physical combat or running away.
A panic attack occurs when the ‘flight-or-fight’ response is triggered, but there is no actual danger. A person may experience the symptoms of a panic attack in harmless and apparently stress-free situations, such as while watching television or while asleep. At other times, someone might have a panic attack because they are doing something they are afraid of, like flying in a plane or seeing a snake.
Some factors that can make you more vulnerable to having a panic attack (aka, inappropriately activating the ‘flight-or-fight’ response) include:
- Chronic (ongoing) stress, which causes the body to produce higher than usual levels of stress chemicals like adrenaline and cortisol. (Global pandemic, anyone?)
- Acute stress (such as experiencing a traumatic event), which can suddenly flood the body with large amounts of stress chemicals.
- Habitual hyperventilation, which disturbs the balance of blood gasses because there is not enough carbon dioxide in the blood.
- Intense physical exercise, that for some people can induce a panic attack. It is probably due to the physical aspects of exercising like sweating and rapid heartbeat that are also symptoms of a panic attack.
- Excessive caffeine intake, which is a stimulant and therefore can increase anxiety.
- Illness can cause physical changes, lowering your vulnerability to a panic attack.
- A sudden change of environment, like entering an overcrowded, hot or stuffy environment, can lead to feelings of panic.
- Other pre-existing anxiety, such as fears, phobias, and excessive worries, that prime your brain to mistakenly believe that there is an existential threat.
9 Tips for Coping with Panic Attacks
- Cut down on caffeine to lower your overall anxiety level. This is some serious low-hanging fruit that will reduce your baseline level of anxiety, making it harder for your body to panic. Wondering how to reduce your caffeine consumption? Here are some tips:
- If you don’t get a headache or other withdrawal symptoms from skipping all caffeine, then just go for it! Replace your current caffeinated beverages with their decaffeinated counterparts, or switch to water.
- If you get a headache or feel really tired when you don’t have your morning coffee, start off more slowly. Try reducing your caffeine amount by about 25% per week. You could cut down from four cups of coffee to three for a week, and so forth. Or, you could replace about a quarter of your coffee with decaffeinated if you want to keep drinking four cups.
- Try some ibuprofen and short naps for any withdrawal symptoms, which typically include fatigue and headaches.
- Green or black tea is like methadone for coffee! Switch to caffeinated tea once you are down to minimal coffee, but not quite ready for a total caffeine detox.
- Give yourself about two weeks to the finish line, depending on how much coffee or other caffeine you have been consuming. If you miss the ritualistic aspects of having a hot morning beverage, experiment with herbal tea, hot lemon water, and decaffeinated coffee to find what you like the best.
- If you notice exercise-induced panic symptoms, shift to gentler exercise like walking or yoga while you work on reducing or eliminating panic attacks. But don’t stop exercising! Regular movement is an important part of managing anxiety. If intense exercise is not related to your panic symptoms, then there is no need to decrease your level of exertion. Yin yoga uses passive, longer-held poses to target connective tissues. It is usually relaxing, although some poses can be intense. At least you know your heart rate won’t get high, and if the stretching feels like too much, just back off.
- Learn to breathe. Sounds ridiculous, right? After all, if you’re alive, you’ve been breathing constantly for years. But, there are ways of breathing that increase your physical tension and anxiety, and ways of breathing that will relax you. Here is an entire article about breathing better. In the midst of a panic attack, take several slow, deep breaths, and continue to focus on slow, deep breaths for the duration of the panic attack.
Practicing yoga regularly will help you regulate your breathing better, as well as provide movement that is so crucial to regulating your nervous system downwards, away from that fight-or-flight mode.
4. Practice meditation and/or relaxation regularly. If you practice relaxation and correct breathing when you’re not having a panic attack, it will work better when you need it. Meditation and relaxation exercises strengthen your relaxation “muscle”, making it easier to relax your body when you’re feeling anxious. Meditation is transformative far beyond just managing panic attacks, as I discuss in the article “5 ‘Woo-woo’ things Backed by Science”.
Guess what, yoga will also provide an avenue for meditation and relaxation. What yoga class doesn’t involve attention to the breath, mindfulness, and at least a few glorious minutes in corpse pose?
5. Learn how to be unafraid of panic. This can be a tough one. During a panic attack, your primitive brain is very compelling in convincing you that you are in danger. Your alarm bells are going off, and it is beyond unpleasant. But ironically, the less scared you are of panicking, the less likely it is that you will experience panic. And remember, unpleasant is not the same as dangerous. Read on for tips about becoming less afraid of panic attacks. And remember, you are not in danger, it just feels like you are, and feelings are not facts.
6. Know that it will pass. The peak of a panic attack usually lasts about ten minutes, though you may feel an “anxiety hangover” for longer than that. During the most stressful part of the anxiety attack, tell yourself that it will pass, and that you are safe. Let it wash over you like a wave, even visualizing it as a wave passing over you.
Fleeing from the situation will only reinforce the perception that your panic attacks are unbearable and dangerous. If you sit and allow the symptoms to pass, you will gain confidence in your ability to cope.
7. Find mantras that work for you. When you are panicking, repeat them to yourself while you breathe. Examples to try: “I am safe.” “These feelings will pass.” “This is uncomfortable but not dangerous.” “I am breathing through this.” Experiment to find the ones that work best for you.
8. Focus your attention on something external. Distract yourself by focusing outside your own body and symptoms. For example, try counting backwards in threes from 100. Recall the words from a favorite song. Concentrate on the sights and sounds around you, by naming five things you can see, four things you can hear, three things you can touch, and two things you can smell. Again, experiment to find what works best for you.
9. Therapy really helps! In therapy, you can find help and support to recalibrate your body’s response to situations and thoughts that cause you to panic. You can get your nervous system back in balance, and learn ways to manage your anxiety that open up avenues for you to live with more calm, confidence and freedom.