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7 steps for getting through a panic attack

A blueprint for managing a panic attack as it's happening.
Image: A woman sits at her desk with eyes closed
If you’re experiencing a full-blown panic attack, consciously make an effort to breathe slowly and deeply. PeopleImages / Getty Images

"It feels like I'm dying." Those are the words people use to describe what a panic attack feels like. The process of addressing and managing them is a journey — there's no immediate cure or course of action that will stop a panic attack in its tracks.

It takes time, patience and dedication to identify your unique triggers. However, there are steps that serve as preemptive measures to help shorten the duration of a panic attack when it is occurring, and reduce the frequency and severity of your anxiety in the long term.

Step 1: Ground Yourself and Then Write a Quick Note

This takes practice, but when your anxiety begins taking over, experts say being present and reasonable can help shorten the duration.

“When I get in the middle of my ‘what-if snowball,’ at some point I'm able to back off,” says Elaine, a 32-year-old mother in Indiana, who has been diagnosed with panic disorder. “I sometimes have to actually tell myself to stop out loud. I've said, ‘Stop, Elaine. That's ridiculous.’ When I take a second to really evaluate whether or not what I'm thinking is reasonable, I am able to recognize it's not and just move on.”

In cases where she cannot recognize whether her thoughts or anxiety is normal, she physically writes down a note and discusses it with her therapist.

Studies show that people who wrote about emotionally charged episodes were happier, less depressed and less anxious.

Which science says is a smart move. Writing down your fears can actually help reduce them, and ease the anxiety that accompanies them. One study published in the journal Psychological Science found that writing thoughts down and physically throwing them in the garbage can be an effective way to clear your mind.

Other research has shown that writing about a traumatic or emotional experiences over several weeks or months is an effective technique for decreasing worries in depressed individuals. Research conducted by James Pennebaker, a professor at the University of Texas, found that the people who wrote about emotionally charged episodes were happier, less depressed and less anxious, and reported better relationships, improved memory and more success at work.

So keep a notebook and pen in your car, by your bedside, and in your purse for when anxious thoughts begin to creep up.

Step 2: Focus on Your Breath

If you’re experiencing a full-blown panic attack, consciously make an effort to breathe slowly and deeply. Your breathing should be methodical and controlled completely by you — which is often easier said than done, as panic attacks are often accompanied by hyperventilation.

Dr. Andrew Weil calls breathing the most effective relaxation technique. “Practicing regular, mindful breathing exercise can be calming and energizing and can even help with stress-related health problems ranging from panic attacks to digestive disorders,” he says. And there is clinical evidence to support the use of yoga (deep) breathing in the treatment of depression, anxiety, post-traumatic stress disorder, and for victims of mass disasters. Research conducted by Southern Methodist University actually found that a treatment program that teaches people who suffer from panic disorder how to normalize their breathing was actually more effective than cognitive therapy at reducing both symptoms of panic and hyperventilation.

"Most panic-disorder patients report they are terrified of physical symptoms such as shortness of breath or dizziness," says Alicia E. Meuret, psychologist and panic disorder expert at Southern Methodist University. "In our study, [the breathing training] was proved an effective and powerful treatment that reduces the panic by means of normalizing respiratory physiology."

Have a few breathing exercise on deck to use to slow your breathing during an attack. A simple one to try is: breathe in for four counts, hold for four counts, and release for four counts. While breathing, actively remind yourself that the panic attack will pass, and that you are going to be okay.

Step 3: Identify a Point Person

Annette said that one of the things that has helped her through attacks is having what she calls “a panic attack point person.” This may be your therapist, a family member or spouse, or a good friend. Whoever it is, this person should be familiar with your anxiety history, and should be someone you feel you can rely on.

“It's important to have people in your life who don't judge you and know what works for you when you are having an episode,” says Annette, a 43-year-old woman in Oregon who has been diagnosed with panic disorder. “I'm so lucky to have a couple people who are always there for me and treat me with respect and dignity when I need it most.”

Step 4: Be Kind to Yourself

It’s the default to feel down when struggling, but do your best to be kind to yourself. Understand that anxiety and panic management is a journey, and look for the positives in your experience with managing anxiety in your day to day life.

“Living with an anxiety disorder doesn’t have to lessen your quality of life. You can get back all of the things you feel like you have lost. I can drive wherever I want. I travel on my own and have gone climbing and zip lining. My life is usually exhilarating instead of terrifying,” says Annette. “In ways, anxiety offers its own gifts. It makes you vigilant about self-care, and demands that you pay attention to signs and symptoms. I’m more in tune with myself both emotionally and physically because of my anxiety and that has made me more conscious about how I treat others.”

Step 5: Regain Control with Meditation

Meditation is another common intervention that can be helpful not only as a preventative measure to reduce anxiety on an ongoing basis, but also as a tool to re-establish your relationship with your thoughts, which becomes important during an attack.

“It can help clients become an observing witness to the fluctuations of thought, realize they are not controlled by them, and consequently reduce symptoms,” says Meredith Strauss, a psychotherapist and licensed clinical social worker who specializes in treating anxiety and depression. “By focusing on the breath, or the mantra, clients are distracted from disturbing thoughts dictated by the mind. They also learn to become non-judgmental of negative and distracting thoughts as they become a witness to their own thinking.”

She also notes there are meditation apps available that help calm an anxious and overactive mind. Also, writing thoughts in a journal can also help the client vent and understand the origin of their feelings.”

Step 6: Find Activities That Reduce Stress

It’s important to incorporate activities into your routine that help reduce stress, and its effects on the body.

Exercise releases endorphins, a natural chemical that makes you feel happy, into the body. Consistent exercise has been linked to a reduction in stress and tension, an improvement in sleep, and a more stabilized mood. In conjunction with therapy and prescribed medication, exercise can provide you with additional control over your anxiety and panic disorder.

Combinations of hand movements and mantras can help the patient immediately reduce anxiety.

Strauss recommends yoga, specifically, for its ability to calm and ground a person who’s been triggered or may feel a panic attack coming on.

“Yoga is an excellent tool that often helps people understand how the mind and body are linked. Body awareness helps us understand the body’s response to anxiety and how to ease those symptoms,” she says. “Certain combinations of hand movements, called mudras in yoga, combined with a mantra can help the patient almost immediately reduce anxiety.”

Hand movement examples include putting your palms together in a prayer-like motion, and touching your thumb to your pinky and ring fingers. “If people have trouble with the Sanskrit syllables, I redirect them to simply chant, ‘I am O-K,’ and this seems to work just as well,” says Strauss.

Step 7: Find a Therapist to Help You Cope

If anxiety impedes your ability to live a healthy, productive life, it’s essential to seek professional help to curtail the progressive nature of anxiety and panic disorders. There, you can help determine the root causes and take effective steps toward management. Psychotherapy — which address mental disorders via psychological instead of medical means — is a common treatment, notes Strauss.

“There are often limiting negative beliefs that contribute to the genesis of anxiety, and psychotherapy can help the client track and challenge the automatic thoughts that accompany the emotions of anxiety and fear,” she explains. “It’s important that one tries to learn the skills to cope with anxiety in addition to consider the use of medication. Treatment modalities like Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Internal Family Systems, EMDR, Mindfulness Based Stress Reduction and Interpersonal Therapy can all be used to help the client become increasingly more aware of what triggers anxiety.”

Over time, you will be better equipped to identify these negative thought patterns as they arise, and be able to nip them in the bud, instead of having them spiral out of control.

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