They can be intense to go through, but panic attacks are a normal and natural human experience and a valid reaction to overwhelming stress. Up to 35% of the population have experienced a panic attack in their lifetime, according to Better Health Channel. If you’ve experienced sexual trauma, this is a common PTSD symptom. If you know your triggers and warning signs, it’s easier to bring yourself back into homeostasis the earlier you catch it. But, if for whatever reason you are caught by a panic attack, I hope the following coping skills for panic attacks in this article help you recover quickly and smoothly.
Don’t panic. You’re having a panic attack.
Containing the panic attack
Keep it simple: Tell yourself, “I’m having a panic attack.” This is an easy first step that can help contain the experience. The simplicity of naming what’s happening (I call it “Pooh Bear Wisdom”) can counter the onslaught of overwhelming feelings and physical sensations. It changes it from, “I don’t know what’s going on! Panic!” to “Ok, this is what’s happening.” It takes it from the unknown to the known, which is easier to handle.
Remember impermanence: “This too shall pass.” Panic attacks at their peak last a few minutes to about 20 minutes, occasionally up to an hour. You may have an “emotional hangover” afterwards, or in other words a period of time of sensitivity, tenderness, or depletion. But, the amount of time you’ll spend in the acute experience of the panic attack is relatively brief. Panic attacks can have scary symptoms, like racing heart, difficulty breathing, chest pain, feelings of fear, but you can't die from the panic attack itself. This experience, like everything else in life, has a beginning, middle, and end.
Ride the wave: Let your body do what it naturally does, without causing harm. Your body is a brilliant intuitive healer if you know how to listen to it. You may witness your breath hyperventilate and then naturally, or with some gentle coaxing, shift to gulping breath then slower deeper breaths. Your breath may cycle a few times in this way as the experience comes in waves.
In addition, there may be movement impulses from your body that, as long as they don’t cause harm, can be helpful to follow.
All emotions have a beginning, middle, and end, similar to a wave. The crescendo has the most amount of energy. Sometimes it’s helpful to discharge the energy and sometimes helpful to be like a boat riding the emotional wave until it passes. During a panic attack, it can feel so big that something big also needs to happen. However, it’s more likely that simplicity is needed as a remedy. See step #5 for safely discharging energy
Take a mental step back from your thoughts and let the thought spiral roll. With gentle curiosity, be a witness to the kinds of thoughts you’re having. Just because you’re having a thought doesn’t mean it’s true. The thoughts later may offer you insight into important needs/boundaries you’ve been ignoring. In addition, offer yourself positive, self-soothing counter thoughts as well. If you need help with stubborn negative thought patterns, Cognitive Behavioral Therapy offers easy and accessible ways to challenge negative thought patterns. Or, imagining what a loved one may say to you.
The above four steps are about not panicking about the panic attack. In other words, using mindfulness to orient your core/wise self and contain the experience. The following 3 steps are action steps you can take as well.
Action oriented coping skills for a panic attack
Safely discharge energy. Walk, run, dig your feet into the earth, stomp your feet, punch a pillow, scream, cry, rock, wring a towel, leave the room, visualize distressing energy going into the earth to be recycled, etc.
Use ice cubes or cold water to lower your heart rate. Splash cold water on your face or press an ice cube on your wrists, back of neck, and behind the ears. The intense cold sensations signals to your body to lower the heart rate and activate the parasympathetic system to conserve oxygen. This is called the "diving reflex," a biological response to help mammals stay underwater longer.
Ground yourself in the present by engaging your senses. A classic psychotherapy skill is naming:
5 things you can see
4 things you can hear
3 things you can touch
2 things you can smell
1 thing you can taste
The order doesn’t matter, this sequence just correlates to what people’s general most to least engaged senses are and is a cute way to remember this skill. You could also just focus on one point of sensation contact, such as the feel of breathing cold air into your lungs. Some people use sharp sensations like squeezing an ice cube, snapping a hairband, or digging nails into their arms to get their focused attention when their mind is spiraling. Whatever works for you, engage your senses to ground in the present.
Offer yourself a soothing touch. This may look like hugging yourself, placing your hands over your heart, holding your hand, placing a hand on your neck, pressing an acupressure point, etc.
Co-regulation. If you have a safe person with you, it's possible they can help you ground and calm down. This is called "co-regulation." Some people find reassuring touch helpful, such as a hand on the shoulder, on the back behind the heart, or on the knee. Hearing the person's voice or logical reassurance could help to orient you to the here and now, phrases like, "you're ok," "I'm here with you," "It's going to be ok," "you're safe here." Making eye contact, receiving a hug, or breathing together are a few other ways to co-regulate. Sometimes just the presence of another safe person in the room is enough without them doing anything. If panic attacks happen to you regularly, you can talk to your safe person about what are helpful phrases or gestures for you, or if you prefer to be left alone until it passes.
Lastly, once the panic attack waves have passed and you are on land again, the following 3 steps are great after care
Aftercare following a panic attack
Connect with someone. If you were alone when this happened, let a trusted person in your life know you just went through this and receive their expression of care. You may want to talk about what’s been going on in your life that led up to it, or just enjoy hearing their voice as a grounding distraction. If you have a partner, you may want to let them know what they can do to help you if they are ever with you during a panic attack.
Engage in soothing, low stimulus activity. Drinking tea, listening to calming music, gentle movement, drawing, listening to spiritual talks, hugs, cuddles, time with a beloved animal, etc. Your body needs time to recalibrate from the adrenaline dump that just happened and your mind needs soothing after an onslaught of fearful thoughts.
Reflect on your experience and offer care for your self-esteem. What was happening just before the panic attack started? What kinds of thoughts, feelings, and physical sensations were you having? Did any one thing in particular set it off? What were the different phases of build up to the panic attack? What’s something you can do going forward to prevent another one? And lastly, what are you telling yourself about yourself? Did a self-deprecating thought contribute to the experience? Or are you shaming yourself for having had a panic attack? The panic attack may be offering you valuable insight for something you are needing or missing in your life.
Individual therapy is of course a great place to process what led to the panic attack, gain tools to work through them, and create a prevention plan. Reach out for help anytime, you don't have to go though it alone.
If you are in crisis, the Colorado Crisis Services hotline is open 24/7.
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Sources:
Better Health Channel. (2022). Panic attack. Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/panic-attack
GoodRx Health. (2023). Can panic attacks kill you? Retrieved from https://www.goodrx.com/conditions/panic-disorder/can-panic-attacks-kill-you
PositivePsychology.com. (2017). 9 essential CBT techniques and tools. Retrieved from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/#9-essential-cbt-techniques-and-tools
Talkspace. (2019). Anxiety attack vs. panic attack: Which one are you having? Retrieved from https://www.talkspace.com/mental-health/conditions/articles/anxiety-attack-vs-panic-attack-one/
University of Virginia. (2023). Does dunking your head in water ease anxiety? Ask the professors diving with mice. Retrieved from https://news.virginia.edu/content/does-dunking-your-head-water-ease-anxiety-ask-professors-diving-mice#:~:text=Holding%20your%20breath%20and%20putting%20cold%20water
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