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Panic Disorder: Living with panic attacks and panic disorder

For those who experience panic attacks, life can be extremely difficult at times. People who have panic attacks often report that it feels like they are dying or having a heart attack. It can be described as a heightened state of arousal, with physical and cognitive symptoms of a racing heart, rapid breathing and extreme levels of anxiety. The following is a step by step guide on what you can do if someone you know is having a panic attack.

Step 1: Check their medical history

This is extremely important as the symptoms of panic attacks can be very similar to asthma, stroke and heart attack. Ask the person if they have a family history of any of these conditions. If they do get asthma, ask them if they have their puffer with them, and if not to go grab it. If in any doubt about whether it could be one of these life-threatening situations, it’s best to call an ambulance.
Ask them if they have had panic attacks before. If yes, remind them that they are temporary, and like all of the other times, they will pass in time.

Step 2: Acknowledge and reassure their fears and symptoms

It is important that the person having the panic attack feels comfortable expressing their feelings to you. Ask them what physical symptoms they are experiencing right now. Make sure you remain calm, and continue to reassure them that everything will be okay. Speak in a relaxed and soothing voice. If you feel it is appropriate, you may wish to hold their hands (if not on the phone); however this will depend on how well you know the person, and will have to be made as a judgement call. Remind them that this state of panic is only temporary, that they are not going to die, and that this will pass in time. Most importantly, just be there for them. Your presence will do more than you know.

Step 3: Dealing with the symptoms

There are a few strategies that can be employed to help a panic attack pass by. The most common and effective are breathing techniques, however a few others are suggested here, if needed.

Controlling your breathing
During a panic attack, one’s breathing is rapid and leads to too much oxygen build up. This in turn leads to symptoms of dizziness and confusion. If you are with a person who is having an attack, start to do some breathing exercises with them. Tell them to concentrate on slowing their breathing down; get them to take one breath in, count to 3 slowly, and then exhale as much of their breath as they can (don’t inhale again for 1-2 seconds). Part of what perpetuates the oxygen build up is shallow breathing. Exhaling fully will help mitigate this.

Another thing to try is to get the person to lay on their back. Doing this naturally relaxes the diaphragm, and helps one to recognise when the feeling of all of their breath escaping. This will help to ease the tension that the person experiencing the attack might be holding onto around their belly. It’s good to try to encourage lying down, but should the person be resistant to this, don’t force it upon them. An alternative can be for them to place their fingers at the bottom of their ribcage while they are breathing. This will have a similar effect, whereby the person having the attack will be able to feel the sensation of their diaphragm relaxing, and be able to lock onto this more easily.

Continue the process of breathing in, holding for 3 seconds, exhaling fully, and holding for 1-2 seconds, until the person feels relaxed and grounded once again.

Counting strategies
Focussing on breathing is an effective strategy for most, but for some people, it can make things worse. If this is the case, distraction methods may be a better approach. This could include getting the person to count backwards from 100 by 7 (or any unusual number). These numbers are arbitrary. The point of this method is to distract the person until the symptoms have eased.

similarly, anything else that the person can use as a distraction is also viable, particularly using their senses.

Focusing on the body
Mindfulness techniques can also be implemented as an alternative intervention. One such mindfulness technique is body scanning; bringing the person back into the present by focussing on bodily sensations (other than breathing if this is unhelpful). To achieve this, start by closing your eyes. Then, systematically go through all the sensations in their body.

You might like to start at the feet, focus on the feeling of your feet touching the ground. Wiggle your toes or move your ankles slightly if you need to. Next move up to the shins or knees, again moving slightly if you find that helps you to notice them more easily. Try to spend about 5-10 seconds on each of these body parts, and continue passing by all of your joints, and eventually focussing on the head. You might like to focus on the feeling of your eyes moving under your eyelids, or your tongue inside your mouth at this point.

Step 4: Reflecting on the experience

Once the attack has settled, you might like to explore the experience with the person. Only explore as far as the person is comfortable with, but reflecting on the positives can be a helpful thing to avoid future attacks occurring, or to help feel more prepared if another attack comes on. You can bring up the fact that they survived it, and that it always passes in time. You may also wish to explore what interventions they found helpful; breathing techniques, focussing on the diaphragm relaxing, distracting themselves, or specific thoughts.

This may be something to be very gentle with, but you might like to get them to think about what could have triggered them. Were they thinking or doing something directly before the attack came on? Was the attack brought on by focusing on their heart rate? Were they in a particular situation, such as a noisy or crowded environment when it happened?

Step 5: Speaking to a Psychologist

Seeking professional help is always a good idea if you are a sufferer of panic attacks. There are two approaches that will likely be used in combination. 1. Working on the symptoms and strategies for coping with attacks. 2. Focussing on triggers, and trying to resolve them. The second point is always much more difficult than the first, and will involve a lot more support and effort. Phobias are usually treated with exposure therapy, and so if panic attacks are linked to a specific thought or worry, gradual exposure to this stimulus can be a pathway to resolving the issue. For example, if someone found that panic attacks were triggered by being on their own, gradually getting the person used to being on their own for a little bit at a time might be helpful. The psychologist might start with having the person sit by themselves for 5 minutes whilst they step out of the room. Once they are able to achieve 5 minutes alone, they might push for 10 or 15, and so on. Gradually empowering the client by allowing them to see that they can face their fears and get passed it is the eventual recovery goal.

Concluding remarks

These steps have been outlined for a helper, or a friend or family member to follow to help out a victim of panic attacks. However, that does not mean you can’t try to apply these steps for yourself if you are experiencing an attack. That being said, if you can feel a panic attack coming on, try to call someone, or ask for someone to sit with you if you are out. It can be difficult to think rationally in the midst of an attack, so having someone else to keep you grounded is often a good idea. Ideally, ask someone you know who is familiar with panic attacks and can remind you of all the steps mentioned above.

Alternatively, you can call ADAVIC, or other support or crisis lines such as Beyondblue or Lifeline. The people who work here are familiar with panic disorder and will be able to assist you.

See below numbers:

ADAVIC – (03) 9853-8089 from Wednesday to Friday

BeyondBlue – 1300-22-4636

Lifeline – 13 14 11

Written by Michael, ADAVIC Volunteer



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