What do you do during a panic attack?

[Rheyeheh]

I’ve always had general anxiety…for as long as I remember. But panic attacks have been a newish thing for me the last year or so. They’re becoming more and more frequent, just about every day at the moment.

I’ve tried keeping busy / carrying on as if nothing is happening. I’ve tried laying down on the floor with some music on and not trying to fight or run just letting it happen …I understand that this is what you’re supposed to do / let the feelings wash over you but for some reason this makes it a lot worse for me.

Deep breathing makes it worse as I become hyper aware of my breathing and it seems to make me feel more lightheaded.

During the panic attack I fear I have an underlying health problem and will drop dead so often get urge to go to a&e and have done twice before but nothing wrong with me except low iron and occasional low blood pressure. I think the low bp actually gives me a panic attack as the feeling isn’t nice.

The best thing I’ve found is going in the garden and feeling my feet on the ground / the fresh air etc but this isn’t always possible. I have a lot of panic attacks In situations where I feel I can’t easily ‘escape’ like during teams work meetings or in the car driving or stood stuck in a queue etc.

I’ve had to stop working for a month and can barely function at the moment. I’m doing therapy and have been for a long time …maybe it’s not working. No medication as I want to try and address the underlying problem but may have to resort so that if I can’t

Panic attacks happen and continue to happen because you catastrophically misinterpret physical symptoms i.e. noticing your breathing, then thinking you're going to have a panic attack because you are breathing faster, feeling like you can't breathe, believing you're going to die. Believing you're going to die tells your brain you're in danger and floods you with more adrenaline and makes your heart pump blood and oxygen to all your muscles for fight for flight, this makes it all feel like it's escalating and getting worse. Panic attacks usually peak within 10-20 minutes.

Helpful to know that you cannot die from a panic attack? The best thing you can do for a panic attack is research - get to understand the WHY and the WHAT of a panic attack. Psycho-education usually does the trick for most people and if it doesn't stop them completely at least stops you from being afraid of them.

I'm interested in what kind of therapy you're having? Usually they recommend CBT for panic. To learn some thought challenging, so that instead of thinking "I'm going to die" you learn to replace that thought with something like "panic attacks are frightening and uncomfortable but I know it will pass and I'll be okay" (because it always is and always does and always has and yet dying has never occurred).

I'm not sure if recommend letting the feelings wash over you in a way that means all there is to focus on is the feelings.

I haven't had a panic attack for years thankfully but when I did, I needed something to concentrate on in order to distract the attack. I found counting in French really helped.

Panic attacks are awful

@IVFKinster i think because I do have some physical health issues (low iron and low BP..the latter is still being investigated) this is why I can’t snap out of it as I keep thinking ‘what if they’re not just panic attacks etc’. However I do wonder if I’ve now got health anxiety and even if I get the all clear I’m going to be wondering what if. I understand the symptoms panic attacks can cause and why but I also know they’re identical to some medical problems so there’s always that voice in the back of my head. I have major death anxiety after watching a close relative die very unpeacefully earlier this year and just can’t snap out of it.

im doing psychodynamic / psychoanalytic therapy I think it’s called. I have tried CBT earlier in the year and it did work very quickly but it then came back a few months later. Because my memory is rubbish I seem to have forgotten what I learned at CBT so need to buy a book I think and re-read as it was effective

Get Clare weekes no more panic books

I think if CBT worked for you before I'd encourage you to try it again as it works really well for health anxiety as well. You can Google the thought challenging technique specifically for the panic or download a panic disorder workbook from somewhere like Exeter university to remind yourself how it works if you're interested and have done it before 😊

It does sound a little like health anxiety. Panic and health anxiety are much harder to control when you have real physical health symptoms. It's not about snapping out of it though - that's unfair to think it's just a case of you NOT snapping out of it. Definitely not that easy. It's about learning not to catastrophise which it's okay to need some support to learn to do. 😊 I hope you get the right support for your anxieties - there is hope out there!

I'm very sorry about the loss of your relative. Understandable that your anxiety has been shaken by it.

Dr Claire weekes is amazing. Like you if I have a panic attack thinking about breathing makes it worse.

Dr weekes book self help for your nerves is amazing..truly. she saved me.

My panic attacks generally happen in very busy supermarkets. I tend to stand still, shut my eyes and breathe. When I've calmed a bit, I get whatever I remember I want and get out as quickly as possible.
I also have a sunflower lanyard which means people understand why I'm randomly standing still with my eyes shut.

Panic attacks are the result of breathing too fast and too shallow. This in turn gets rid of too much carbon dioxide from the blood leading to the ph increasing. It’s actually the carbon dioxide level rather than oxygen that is the gas the brain monitors.
When you have too little carbon dioxide you feel dizzy and your fingers, toes and lips will start to tingle.
The best way to treat panic attack is to hold your breath for a count of 15 then control your breathing/slow breathing right down to allow the carbon dioxide levels to increase again.
It may seem counterintuitive but it is how we get patients to calm down. Working as a dentist, I’ve seen a fair few panic attacks. Nowadays I spot them before they reach critical level.

A faint is a straight forward shutdown of blood supply to the brain so the body faints in order to get the head on the floor and improve blood supply. it happens very quickly, panic attacks build over quite a long time.

The TIPP skill is really good for panic attacks
https://dbtforlife.com/2020/12/14/explore-dbt-ice-and-anxiety-using-cold-water/

This one talks specifically about using cold water. When out in public, you can hold a bottle of cold water against your temples or run cold water over your wrists.

But TIPP is four main strategies:

• Temperature (the cold water)
• Intense Exercise
• Paced breathing
• paired muscle relaxation

The exercise one obviously can be a challenge in public and can feel really contradictory when your breathing is all over the place, but it does work. It can be anything - jumping jacks, squats etc. Usually more of a strategy to use at home though!

Breathing exercises and muscle relaxation do work but you need to practice when you're feeling fine so that they kick in more easily when you're panicking. We can't learn new skills when we're panicking.

If you're struggling with breathing exercises, think of yourself blowing out a candle and then smelling a flower to draw your breath in slowly.
If you're at home or around small children, blow bubbles. It sounds really weird but it makes you slow your breathing down without thinking about it. Plus it entertains small kids while you're actually managing your panic!

Slow my breathing and walk off somewhere calm (park, garden, quiet space like a library or emptyish shop with distracting things in it, or in a pinch just hide in the loos)

Thanks everyone for all the advice, some good ideas here I haven’t heard of before and others I have but had forgotten. I think it’s hard to remember when in the midst of bad anxiety. It’s the worst feeling the world and just want it to stop (which I know of course makes it keep happening)

I used to be just the same ... the panic would come over me and I have presented at a and e 3 times convinced I was having a heart attack . I used to think I was gonna die in the night and suffer terrible health anxiety . I used to find talking to someone on the phone helped me enormously taking my mind off it . That was the only thing that really worked for me . Propananol has been my life saver and I've recently started on HRT and I feel this has helped also .
Good luck whatever you decide panic is horrific and I hope you find peace very soon x