Panic attacks are very common and about 21 million Americans are experiencing them. The prevalence of panic attacks is almost twice among women than men.
A lot of people are anxious about being anxious. Anxiety about anxiety occurs when you first experience a fearful reaction, for example while shopping in a grocery store, driving a car, going on heights, flying in a plane or riding a bus. Once you experience this anxiety two things happen, 1) you begin to have anticipatory anxiety about getting the same physiological reaction like rapid heartbeat, sweaty palms, constricted breathing, dizziness, 2) this anticipation leads to negative self talk, like, “oh no, here it comes again”, “I am losing control”, “I can’t stand this” What will others think if I panic?” This leads to emotional reaction and eventually a panic attack. Consequently, you get trapped in a vicious cycle of anxiety and a spiral of mounting panic attack. This panic can rise to more intense levels if nothing is done at the outset. Anxiety can rise from level one to level ten, one being mild and ten being a full blown panic attack.
It is important to use effective anxiety management techniques when you just feel butterflies in your stomach. You are more likely to abort your anxiety at this level if you begin to change your negative self talk and replace it with positive coping statements, use abdominal breathing and progressive muscle relaxation technique. It is also important to note that anxiety can range from mild to severe on the Anxiety scale which ranges from level one to level ten.Upto level four, it is anxiety at several levels like mild to moderat and severe. The moment, it reaches level 5, it becomes a panic attack and this panic can also range from level five to level ten. At each level, you will feel different intensity of physiological symptoms. For example, at level 5 the person will experience heart pounding, constricted breathing, spaciness, dizziness, definite fear of losing control, and a compulsion to escape. At level 6, the intensity of panic is moderate and the person experiences heart palpitations, difficulty breathing, feeling disoriented, and panic in response to perceived loss of control. At levels 7-10, all of the symptoms become exaggerated and the person will feel terror, fear of going crazy or dying, and a compulsion to escape. It is important to recognize the early warning signs of panic up through the Level 4 on the scale in order to gain control over your panic reactions. You will be able to abort your panic attacks effectively if you recognize the symptoms and begin to use the following coping techniques to counter your anxiety.
Anxiety Management Techniques:
1. Avoid Emotional Flooding by Retreating:
It is important to take a little retreat if you begin to get anxious in a situation. For example if you are driving on the freeway, get over into the far right lane, slow down, and pull off onto the shoulder. Retreat does not mean that you avoid the situation altogether,. It only means that you leave the situation temporarily with the intention to return to the phobic situation. Avoidance will perpetuate your anxiety and reinforce avoidant behaviors. Retreat gives you a chance to take some deep breath, use effective coping statements to deal with the situation and compose yourself to re enter the situation. By staying in the situation where you are having anxiety, you might get emotionally flooded and will feel terrified to come back to the situation. Therefore it is important to gain your composure with retreat and then re enter the situation.
2. Engage in conversation with another person:
Remember that distraction is very important to take your mind off uncomfortable feelings you are experiencing therefore, it is very useful to engage in conversation with another person to help you take your mind off the anxiety symptoms you are experiencing while waiting in the line, flying in a plane, riding a bus or taking an elevator.
3. Engagement in Physical Activity:
When you are experiencing anxiety, a surge of adrenaline flows in your body as a result of arousal of fight or flight reaction. Therefore, when you move around, or do a workout, go for a walk, jog or swim, this extra energy is dissipated and it helps you reduce the level of anxiety before it escalates to higher degree on the Anxiety scale. It is also helpful to engage in repetitive acts like counting numbers, snapping a rubber band against your wrist, adding and subtracting numbers. These activities help you distract your mind from the physiological symptoms of anxiety that you are encountering.
4. Engagement in Activities that Require Focused Attention:
Calculation, knitting, sewing, puzzle and playing a musical instrument also help in distracting your mind from the panic symptoms. The idea here is not to dwell on the physical symptoms but distract your mind in these activities to prevent the vicious cycle of panic.
5. Use Thought Stopping Technique:
Thought stopping technique helps disrupt your negative thought patterns. In order to use this technique, visualize a big Red STOP sign, take few deep breaths and shout the word, ”STOP”. This will empty your mind at the moment but negative thoughts will reappear if you do not replace them with positive coping statements like, “I feel calm”, “I am strong”, and so on. It will be helpful then to practice deep abdominal breathing. Thus, using this technique at the onset of a panic attack you will be able to abort your panic symptoms.
6. Abdominal / Diaphragmatic Breathing:
Research studies have demonstrated that diaphragmatic breathing helps you gain control over your panic attacks. It helps retain the oxygen level in your system and thus reduces your anxiety. To do abdominal breathing, lie down flat on your back, put your right hand on your stomach and inhale to the count of one, pause, and then exhale slowly through your nose counting slowly to three. When you inhale through the nose, you will feel your stomach rising because you are holding the oxygen in your stomach. It should be deep breathing so that the muscle in your diaphragm is pushed and makes a cavity in your stomach where you hold your breath. Since people tend to have shallow breathing when they experience panic attacks, breathing from your abdomen or diaphragm helps retain the oxygen level in your body. As you practice and get better in doing this simple exercise, you can increase the difficulty level by increasing the number of breaths, for example inhale to the count of three, pause and exhale to the count of six. Remember that exhaling should be double the numbers of inhalation for optimal benefits. Once you have mastered this you can advance to doing the combination of inhaling to the count of four and exhaling to the count of eight, and so on. Abdominal breathing helps in aborting panic attacks as it addresses the core cause of panic attack–, lack of oxygen in your system due to the arousal of fight or flight reaction. Therefore, it is particularly important to use this technique when you are experiencing anxiety which is beyond level four on the Anxiety scale. Once you have mastered the technique, remember to use it anytime you feel the initial symptoms of panic. Remember to do it slowly for three to five minutes, until your panic begins to subside. If you get light headed, pause for 30 seconds, and then resume your breathing.
7. Use Progressive Muscle Relaxation Technique:
There are sixteen major muscle groups in your body. When you are experiencing a panic attack, these muscle groups begin to tense up. Therefore, it is important to relax these muscle groups. Following is the abbreviated version of doing progressive muscle relaxation derived from the Anxiety and Phobia Workbook written by Edmund J Bourne.
Clench your fists for seven to ten seconds then relax them for 15-20 seconds, then tighten your biceps by drawing your forearms up toward your shoulders and make a muscle with both arms. Hold for about ten seconds then relax for 15-20 seconds. Tighten your forehead muscles by raising your eyebrows as high as you can. Hold for ten seconds then relax for 15- 20 seconds. Clench your eyes shut tightly and hold for about ten seconds then relax for 15-20 seconds. Then go to your neck and pull your head way back, as if you are trying to touch your head to your back. Hold for about ten seconds then relax for 15-20 seconds. Raise your shoulders as you were going to touch your ears. Hold for about ten seconds then relax for 15-20 seconds. Notice the tensing sensations and differentiate them from the feelings of relaxation which is experienced when you relax these muscle groups. Tighten your shoulder blades by pushing them as if you were going to touch them together. Hold for ten seconds then relax for 15-20 seconds.
This is just an upper body relaxation. You can go to the other muscle groups similarly and repeat the tense and relax cycle for muscle groups in your chest, abdomen, lower back, pelvic area, thighs, legs, ankles, heel and toes.
Use of progressive muscle relaxation facilitates a relaxation response and it also helps generate the alpha wave activity in your brain. It helps lower your blood pressure and produces a calming effect in the whole body. This leads to a significant drop in the anxiety and panic symptoms.
8. Change your Self Talk:
Since panic attacks are caused by the negative self talk that you engage in, while facing phobic situations, it is very important to change the self talk. It will be helpful if you write some coping statements on 3×5 index cards in bold letters and carry them with you. You may want to repeat these coping statements when you are taking a retreat from the phobic situation. Examples: “This feeling is uncomfortable but I can accept it”, “I can handle these sensations”, “this is not going to hurt me” “I can handle my anxiety”,” this is not dangerous”.
When you repeat your coping statements, it helps in the positive programming of your subconscious mind and your symptoms begin to fade away. Additionally, with the use of coping statements, you can also address your emotional reaction to the bodily symptoms. Instead of panicking and saying that you are having a heart attack just because your heart is racing, say to yourself that your heart is racing due to the arousal of fight or flight reaction and it will resume its normal beats as soon as you begin to gain control over your panic symptoms with the use of coping statements, deep breathing, and other techniques discussed earlier.
9. Use of Imagery Desensitization:
Panic attack occurs because you get sensitized to the physiological symptoms that accompany you when you are facing your phobic situations. You tend to anticipate these physiological symptoms as soon as you enter the phobic situation or even think about entering them. It is because you have become conditioned to getting those symptoms in those phobic situations. To be able to counter and address these conditioned responses, it is important to use desensitization technique to help you face these situations. Imagery desensitization is a technique in which you imagine a relaxing scene and then switch to the scenes of your phobic situation, which is constructed from least anxiety provoking steps to most anxiety provoking step. By associating positive feelings of relaxation while imaging the steps of your phobia hierarchies, it is hypothesized that you will be able to unlearn the connection you have formed in your mind between your symptoms and phobic situations. You can create these hierarchies for fears like riding an elevator, standing in the lines of a super market, flying in an airplane, being in a dentist office, driving on the expressway, and making a presentation. Seeking professional help is sometimes a good idea when you develop panic disorder with agoraphobia, Social phobia, Post Traumatic Stress Disorder, Generalized Anxiety Disorder or Obsessive Compulsive Disorder. Cognitive Behavioral therapist will be able to assist you in making these hierarchies and teaching you how to use the steps in the privacy of your home. Once you have overcome a fear with the use of Imagery Desensitization, you will be able to expose yourself to your phobic situations in real life without fear. Sometimes it is also helpful to do Real Life Densitization to conquer your fears. Real life desensitization is also called In vivo therapy in which the person encounters his or her fear safely with the help of a professional or a support person who can assist the person encounter these phobic situations.
It takes some practice to learn how to use breathing, relaxation, desensitization, and self talk. With consistency and persistence, you will be able to emotionally detach yourself from the first physical symptoms of panic and simply observe them. It is very important not to anticipate dangers and exaggerate your symptoms. This will only give rise to more panic. Instead, use the techniques discussed here to help you gain control of the situation and abort your panic attacks.
The Anxiety and Phobia Workbook by Edmund J Bourne, New Harbinger Publications, 2005