Panic attacks: how to help your mind

We already figured out how to help ourselves through breathing exercises if a panic attack suddenly strikes. We know how to breathe correctly without drowning in the waves of a panic reaction. This is good… But in order to return to the normal state, this is not enough. Therefore, today we will learn how to work on our thoughts that are responsible for the panic tsunami.

The first thing that you need to do when the panic state occurs and paralyzes you with fear and thoughts “it will be exactly like the last time” is to remind yourself that this is just a temporary state, and it will pass soon. A panic attack is a short-lived state. It usually lasts between a few minutes to half an hour. If you keep in mind that this horror will not last forever and will end soon – it will be much easier for you. 

Sometimes, Katherine experiences panic attacks. Now, she is working on this issue with her psychotherapist. The PAs became less frequent and less severe. But Katherine remembers that the scariest thing for her during the attack is the thought that this horror will never end, that this time she will not survive the ordeal. When the attack starts, she thinks that she is going crazy and that she will have schizophrenia. That she will go cuckoo and start walking in the streets half-naked feeding imaginary birds. That she will lose her job and her established lifestyle. That she will stop recognizing people and they will “lock her up” in an insane asylum. That’s it, her life is over… After such thoughts, she is not able to calm herself down. 

Her first meeting with the psychotherapist brought a big relief. Katherine learned that panic attacks never lead to a mental illness or to death, even though this is the most common fear among the people who experience them. It is just an illusion. Then, Katherine learned that the sequence of the events she is painting in her mind (half-naked on the street, ending up with a mental illness) has nothing to do with reality, but it significantly amplifies the symptoms of the panic attack. 

Saul is “guilty” of the same thing. He gets fixated on the physiological reactions of his body and closely monitors them. Therefore, he perceives an increased heartbeat as a symptom of a heart attack. Not surprisingly, when he feels that his heart is beating faster, he starts panicking. He gets covered with sweat, his arms and legs get cold, there is a knot in his stomach, and of course, his heart starts beating faster. The circle is complete. 

If you catch yourself doing something like this, it is important to stop building up this chain of events and bring yourself to reality. Now, Saul knows that a fast heartbeat is caused by his anxiety. When he is feeling that his heart is “stopping” – it is just a fantasy amplified by his fear. And in general, small lapses in the heartbeat happen often, and they usually don’t cause any harm. 

Question your negative thoughts. Doubt them: “Is it true that a faster heartbeat leads to a heart attack?” Rebut this thought: “I visited a cardiologist – I have no problems with my heart. Therefore, these physiological symptoms are caused by my anxiety, my worry, and my fantasies about my imminent death”. 

Analyze what are you afraid of the most during a PA? And if a PA happens, remind yourself that this is just your scary fantasy, and nothing else. 

Turn on rationalization: last time during a PA you felt horrible, but you survived… And the time before last – also. So why would something be different this time? 

Use the techniques for diverting your attention. PA has a huge ego, and it likes to take the center stage. When you turn your attention to something else – it gets upset and leaves. Therefore, stop focusing on your own sensations, even it is hard to do. Trust us, your body will handle them on its own, without your active involvement. 

Isabelle used to imagine that during PAs her respiration can suddenly stop, and she tried to control it, always checking whether she is still breathing. This took a lot of energy and effort. Turns out, the more she checked if her breathing is OK, the more she was suffocating. And then Isabelle would try even harder. 

Some processes in the human body don’t need any conscious effort – it even hinders them. Respiration is one of such processes. Think about it: when you are sleeping you are still breathing, even though you are not thinking about how to do it correctly. 

Therefore, you need to switch your attention. If you are outside, you can observe other people, count all the windows in the buildings around you, note 10 sounds that you are hearing now, then note 10 sensations that you are feeling. 

Try to turn your attention from your internal images to external objects. Talk to someone, observe people around you (you can describe their clothing, create stories about them, mentally try different hats on them). 

If you are afraid that during a PA you will not be able to recall any of the techniques, make small cards with the techniques and carry them with you, so that you could use them if needed. 

Exercise “Smile”. When you feel that a PA is occurring, try to smile. Yes, this is not a joke! And yes, we understand that you don’t feel like laughing. But when you laugh or smile, you use certain muscles of your face. If you put on a “happy mask” when you are feeling anxious and keep it for a few minutes, your facial muscles will send appropriate signals to your brain, and your tension will go down. Your brain interprets this signal as an indication that everything is fine. Smile a lot, straighten your back, breathe evenly, try to relax your muscles. 

By the way, about the muscles: during PAs, they always contract. Therefore, you can move around, engage in some strenuous physical activity, walk around, do some exercises, try muscle relaxation techniques. 

The thing is that when you get scared, your body will ready itself for a fight or a flight. All the muscles in your body get tense, and your brain receives the danger signal. If you can trick your body and relax the muscles, the anxiety will go away. Mentally, focus on all your muscle groups, starting from the face. Relax your face (forehead, cheeks, eyes, mouth, jaw), neck, arms, stomach, back, legs. Mentally move around your body, releasing the tension in the muscles. You can visualize as if you are removing a clasp from a tense muscle. It is impossible to be nervous and relaxed at the same time. 

Use the visualization techniques. When a PA is just starting, try to imagine yourself in a magical place where you feel good. It can be a beach, a cozy cabin by the river, where you spent your last long weekend, mountains – anything… Picture any weather – feel the breeze on your face, warm sunshine on your body. Try to make this visualization even more realistic by adding colors, sounds, smells, etc. If you practice this often, it will be easier for you to “travel” to this peaceful and harmonious place when you need it. 

Method “Observer”. Try to become an observer of your emotions, instead of the “main character”. Just notice them, write them down in a notepad, as if you were a researcher collecting data. Observe how your feelings change, how emotions evolve, what physical sensations you are experiencing. As if you escaped a tornado and watching it from afar. It can no longer harm you, even though it looks scary. 

Finally, a task for an extra credit. If you have been dealing with PAs for a long time trying to avoid dreadful attacks and would like to change your approach, you can use this non-conventional method. It may not work for everyone from the first try. But if you succeed, there is a chance that you will say goodbye to PAs forever. 

If you already understand the origins of your fear and understand how and why you are getting these physiological symptoms – you can take a risk and face it. Yes, this is practically a face-off. But if you are desperate – why not? 

Victor Frankl invented this method, and it helps a lot of people! The thing is that if you are trying to avoid a panic attack, it is chasing you. 

If you stop running and turn around to face your fear – it has no reason to run after you. 

If a person wishes for the event that they are really scared of, it will be impossible for the symptoms to appear. As a result, after a few tries, the person may get rid of their fear. 

Try to change your strategy – stop resisting your fear and trying to block it. Right the opposite – open all the doors and invite it over. 

“So, you came? Come on in. Here is my heart beating faster, my legs trembling, and my hands got all sweaty – so be it! I am tired of it! What should I be afraid of? That my heart will stop? Ok, let it stop. Right here, right now – I am waiting! Well?” 

It is impossible to be angry and fearful at the same time. Anger and defiance will help you and your fear suddenly will retreat, instead of consuming you, as usual. 

The catastrophizing techniques are helpful too. During the attack, you think that everything can get worse. You can try to think of the most horrible outcome. You don’t try to run away, to hide, but bravely think about what may happen and what will be your actions, and what will happen to you. When you find the courage not to avoid, you will find that the most terrible nightmare will not happen in any case. You can really deal with anything.  

To summarize, here are the main methods that will help you return to reality when a PA is pulling you into its dark whirlwind: 

• Remind yourself that this is just a state. It will not last long, it will end soon. PA doesn’t cause permanent damage, you are not ill, nothing bad will happen to you. 
  
• Normalize your breathing. See the techniques in the previous lesson. 
  
• Relax you the muscles of your body and face. 
  
• Concentrate on external objects. Switch your attention from “internal” to “external”. 
  
• Rationalization techniques: what am I thinking? What am I afraid of? What proof do I have for this thought? Rebuttal. Use catastrophizing and the “observer” methods, that will allow you to investigate the zone of PA instead of avoiding it.