Introduction

Feeling anxious is a common human response to a difficult situation but sometimes anxiety can be severe and can lead to panic. Severe panic can feel extreme and take the form of panic attack – approximately 10% of the population will experience a panic attack during their lifetime.

People who suffer with panic tend to perceive their physical symptoms as very threatening. Paying attention to the threat increases the fear and anxiety. Changes in breathing take place as a result and the body prepares for action by automatically oxygenating the blood (hyperventilating) which causes an imbalance of gases in the blood. Four or more of the following symptoms develop abruptly during a panic attack:

• Palpitations
• Sweating
• Trembling or shaking
• Sensations of shortness of breath
• Feeling of choking
• Chest pain
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed or faint
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or ‘going crazy’
• Numbness or tingling sensations (parenthesis)
• Chills or hot flushes

Panic is often associated with other types of psychological difficulty: low mood, sleep disturbance, loss of sexual interest, feelings of hopelessness, health anxiety, worthlessness, a loss of pleasure in activities, agitation and suicidal thoughts.

Common beliefs in panic disorder include:

• I am going crazy
• I am having a heart attack
• I will stop breathing and die
• People will realise and make fun of me

People often feel trapped and overwhelmed by the experience of a panic attack which can lead to avoidance of situations. Others develop routines (safety behaviours) to help them feel more at ease in fearful situations, such as ensuring they are always accompanied. Some try to control their panic usng alcohol or sedatives as self-medication.

Moving out of Panic Attacks

It is useful to learn how to manage in the event of a panic attack: breathing is the key. Becoming aware of the pace of your breaths in and out and controlling them is essential. If you can take charge of your breathing and slow it down, your body cannot, physically, go into full-blown panic. Try to:

• Focus on your breathing and slow it down (perhaps breathe into a paper bag to rebalance the gases). Try a simple breathing exercise such as breathing in through your nose for the count of 4, holding for the count of 4 then breathing out through your mouth for the count of 4 and repeat as necessary. Aim for smooth, slow breaths rather than deep inhalations.
• Reminding yourself the panic attack will end and is not actually dangerous
• Imagine someone offering calm encouragement
• Focus on the present, become aware of your surroundings

After an attack it can be useful to log the event in detail to help you notice any patterns (time, place, situation, thoughts, etc) and to help gain mastery over feeling out of control. Ensure you are looking after yourself well (eating healthily and sleeping regularly) and minimising stress levels.

Getting Support

It may be helpful to seek medical advice and support if the panic attacks are frequent and severe. If panic is impacting on your capacity to function fully, you may consider using Cognitive Behavioral Therapy (CBT). It may be useful to explore the underlying causes for the panic attacks, perhaps with a Counselor.