A Step-by-Step Guide to Overcoming Panic Attacks

Overcome Panic Attacks for Good

Your heart is pounding. Heat creeps up your neck and you start to sweat. Your arms and legs begin to tremble. It feels like a cement block is crushing your chest as you try to breathe. It’s tough to see. You feel nauseous. Things start to feel like they aren’t real. It’s as if you’re paralyzed.

And then the thoughts come:

“This is what death feels like. I’m dying”

“I’m going crazy”

“Something is wrong”

“I’m having a heart attack”

“I’m going to faint”

Panic attacks are episodes of intense and sudden rushes of extreme fear and discomfort, and they often come without warning (although sometimes they can be triggered by a cue, as well).

Maybe you suffer from anxiety or panic disorder and have had multiple panic attacks. Or maybe you’ve only had one or two. Whatever your experience, I’m giving you a step-by-step guide on how to tame a panic attack, because you never know when one might happen.

What’s the deal with panic?

Panic attacks are REALLY GOOD at making you think that something is seriously wrong with you.

They are so intense and threatening that they convince you that you are in imminent danger – hence the, “I must be dying” thoughts.

And that makes sense. I mean, why else would your body being going haywire with fear if something wasn’t actually wrong? Right?

Wrong.

This is how panic works and what makes it so powerful – it convinces you that you are in danger, when you really aren’t. You get tricked into treating panic like it’s dangerous and ultimately end up doing the exact opposite of what will be helpful.

For example, we struggle and fight the panic instead of accepting it, we tense up instead of relaxing, we hold our breath instead of slowing it, we try and run away to find our safe person instead of facing it on our own or we try and distract ourselves from it. Now, these are all completely understandable responses, considering the fact that no one enjoys feeling panicked.

We intuitively try to turn away from what we’re experiencing and we try and do these things in an effort to make the panic stop. But, the reality is that these efforts backfire and only make our panic worse (more on this in a minute).

If we look at what’s really going on when we’re having a panic attack, we see that our catastrophic (but understandable) interpretations of what we’re experiencing are not actually true – nothing is wrong, you aren’t going crazy, you aren’t going to die.

“Fight-Flight-Freeze”

Panic attacks are the body’s “fight-flight-freeze” response kicking in. The “fight-flight-freeze” response is the body’s physiological response to danger – it prepares your body to defend yourself by giving you the energy to either run away, to fight off danger or to freeze & go ‘undetected’ by the threat. You can think of it like an alarm system.

Now, this alarm system is great when there’s actual danger – it’s necessary for survival. But sometimes our body’s react as if danger is staring us in the face, when it really isn’t. This what we call false alarms - aka panic attacks. So panic attacks are a very natural response that are being triggered at inappropriate times.

The Panic Cycle

With panic, we get tricked into thinking there’s danger when an “event”, such as a:

- thought (i.e. “What if I have a panic attack in the middle of class?”)

- physical sensation (i.e. difficulty breathing)

- emotion (i.e. anger or fear) or

- behaviour (like holding your breath because you’ve been speaking quickly)

triggers a fear response.

The “event” can either be cued by an external trigger in the environment, or not (meaning it happens 'out of the blue'). We respond with fear because we interpret the “event” in a catastrophic and inaccurate way.

Here’s an example. Let’s say you’re afraid of dogs. You’re walking down the street and a dog starts barking from behind the fence you’re walking past. The barking dog (external trigger) causes your heart to start racing (event – physical sensation). This symptom continues and others start, as well.

Then, you interpret your racing heart and your other symptoms to mean that you’re in danger (catastrophic misappraisal aka FEAR).

Then bam! Panic ensues. This is when you get FLOODED by symptoms (increased heart rate, shakes, hot or cold flashes, nausea, etc.), which causes your fear to increase – “Something is wrong. I’m going crazy”. This second wave of symptoms tends to feel worse.

And around we go – as your symptoms increase, so does your fear. And as your fear increases, so do your symptoms. Hence, the ‘panic cycle’.

Inevitably, the panic attack eventually ends (they always do – and we’ll get to how best to navigate this in a moment) and you feel a wave of relief. Don’t just take my word for it – check in on your own experience. Have you ever had a panic attack that didn’t end?

But what can sometimes happen, is that people come to worry about having another panic attack. It is this anticipatory fear that sets you up for another panic attack, because it becomes easier to produce another “event” that triggers the onset of the panic cycle.

Panic Isn’t Dangerous

The good news is that although panic attacks feel incredibly uncomfortable and scary, they aren’t actually dangerous or harmful (even though they’re really good at convincing you that they are).

(As an aside - fainting during a panic attack is extremely rare. This is because fainting requires a drop in blood pressure. When experiencing a panic attack, your blood pressure naturally increases, which makes it really difficult to pass out. In order to faint during a panic attack, you usually need to have some other condition that lowers your blood pressure to such an extent that it overcomes the increase).

Taming Panic

So, the key to getting off the panic attack merry-go-round is to lean into panic with acceptance, rather than resistance.

Some of you might be rolling your eyes at the idea of ‘accepting’ your panic attack or you might even be tempted to stop reading this, but hear me out!

Like we’ve covered, our gut reaction to fight back against a panic attack only makes it worse. The key to interrupting the panic cycle starts with how you respond to the “event”.

Psychologist Dr. David Carbonell, Ph.D refers to the “event” as an “invitation to panic” – you can either take it, or not. In other words, you can treat the event as dangerous and get sent into a flurry of panic, or you can treat it as the discomfort that it actually is, follow the AWARE approach and ultimately not panic.

In his blog www.anxietycoach.com, Dr. Carbonell outlines the following steps in the AWARE approach that are the key to effectively managing a panic attack:

1. Acknowledge & Accept

Acknowledge the present reality – that you are having a panic attack and you feel afraid. Don’t try to ignore it, pretend it’s not there or tell yourself to “stop thinking about it” That doesn’t work! Simply acknowledge your fear. And acknowledge that you are not in danger.

Then acceptance comes in. The goal here is to get comfortable with being uncomfortable. Remember, acceptance does not mean liking it, wanting it or approving of it. Rather, it means acknowledging and accepting that it exists in the present moment in an open and non-judgmental way, instead of fighting it. You accept your fear, rather than fight it - just like you might accept a headache (you wouldn't fight back against it by banging your head against the wall). Working with your panic attacks is the key to overcoming them.

2. Wait and Watch (and maybe Work)

The next step involves ‘waiting’ – this is where you take pause and do your best to stay where you are without doing anything, in contrast to fleeing the scene, trying to find your safety person or struggling with how you’re feeling. Remember, the latter efforts to find relief only makes your panic worse.

Dr. Carbonell suggests that you don’t tell yourself that you CAN’T leave – this might make you feel trapped and that too will make things worse. Rather, try and postpone your urge to leave in order to find relief. Let relief come to you.

While you’re ‘waiting’, this is a really good opportunity to ‘watch’ how the panic works and how you respond to it, while you’re in the middle of it. Dr. Carbonell encourages his patients to fill out a panic diary during the attack that you can download here (with instructions here).

The ‘work’ part comes in if you’re in action while the panic attack comes on, like if you’re driving, for example, you’ll need to keep doing this.

3. Actions (to make yourself more comfortable)

As Dr. Carbonell explains, your job is not to end the panic attack (because it will end no matter what you do, so it’s best to do what you can to make it as comfortable as possible, rather than doing what makes it worse). Your job is to make yourself as comfortable as possible as you ride it out. He suggests a number of strategies to help you do this:

• Belly breathing (deep, diaphragmatic breathing – starting with an exhale!)

• Talk to yourself silently about what’s happening (i.e. “It’s okay to be afraid”, “This will end”, “This isn’t dangerous”, “Fine! Let’s have an attack, it’s good opportunity to practice my coping”)

• Be in the present and re-engage with whatever you were doing before the attack started

• Work with your body (i.e. go through progressive muscle relaxation of various body parts one at a time)

4. Repeat

If you feel better, but then start to panic again (this is normal, you may actually go through several cycles), simply repeat steps 1-3.

5. End

Remind yourself that your panic attack will end, because they always end.

Dr. Carbonell’s approach is an absolutely genius way to tackle your panic attacks – it eliminates of the things we do that make panic worse, while guiding you through all of the steps to make it better.

It takes practice, practice and more practice. But with time, patience and a ton of self-compassion, you will eventually get to a point where you determine for yourself that you are safe.

If you find yourself really struggling with panic attacks or you’ve been diagnosed with Panic Disorder, ‘Interoceptive Exposure Therapy’ (intentionally exposing yourself to panic so that you can practice responding effectively to it) is highly effective and usually a critical part of panic treatment.

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I specialize in the treatment of anxiety and panic. If you find yourself struggling with panic attacks or panic disorder, and you’re interested in learning more about what kind of help is available to you, I offer a complimentary 15-minute telephone or video conference consultation.

Please feel free to contact me to set up a time that works best for you.

What you can expect in our work together:

• Confidential, non-judgmental, and compassionate care

• Comprehensive assessment of your needs, goals and strengths

• Collaborative treatment planning rooted in evidence-based models

• Skill-building and development of effective coping strategies

• Home practice on a weekly basis to make sure you feel confident in applying the skills you are learning

I very much look forward to working alongside you on your journey toward wellness!