Panic attacks can be terrifying and life-altering if they are not controlled! Often they are so scary that every detail of someone’s first attack becomes etched permanently in their mind.  Are you wondering how to stop a panic attack? Let me tell you what to do during a panic attack so that you can learn how to control panic attacks instead of them controlling you.

Panic attacks cause a sudden intense fear when no danger is present or there is no identifiable trigger. This fear triggers your bodies emergency system to be activated causing the physical fight or flight reactions. Your body reacts as if you were under attack and fighting for your life.

Panic attacks can strike at any time and without warning. Because of this, people begin to fear when and where an attack could happen again. They no longer feel in control of their body and begin to limit what they do because of it. If this is allowed to continue, their world can keep getting smaller until they prefer not to leave the house.

Symptoms of a panic attack generally peak in a few minutes. They are usually brief but can last hours in some people. After they are over people feel exhausted as if they have just climbed a mountain or run a race.

A patient description of their experience of panic disorder:

“One day, without any warning or reason, a feeling of terrible anxiety came crashing down on me. I felt like I couldn’t get enough air, no matter how hard I breathed. My heart was pounding out of my chest, and I thought I might die. I was sweating and felt dizzy. I felt like I had no control over these feelings and like I was drowning and couldn’t think straight.

“After what seemed like an eternity, my breathing slowed and I eventually let go of the fear and my racing thoughts, but I was totally drained and exhausted. These attacks started to occur every couple of weeks, and I thought I was losing my mind. My friend saw how I was struggling and told me to call my doctor for help.”

Common symptoms of a panic attack:

• Sense of impending doom or danger
• Fear of loss of control or death
• Rapid, pounding heart rate
• Sweating
• Trembling or shaking
• Shortness of breath or tightness in your throat
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness, lightheadedness or faintness
• Numbness or tingling sensation
• Feeling of unreality or detachment

This is how she describes a panic attack: 

Panic feels like losing control. Everything seems like it is happening at once and at the same time, time stands still. My only thought is: “I have to get away!”. Everything is crashing down and I have 1 million thoughts and emotions rushing through my mind. I feel completely overwhelmed. There are no reasons, no explanations… just fear, and anxiety.

It feels like you are dying of anxiety- drowning and falling at the same time. I can’t breathe, my heart is racing, I’m shaking, and feel dizzy and sick. At the same time, I feel like I can’t move, can’t think straight, but can’t stop thinking either. I feel like I’m not in control of my brain anymore, and am losing power over my body.  Panic slowly overtakes my mind and I feel in that moment there is nothing I can do but watch myself fall apart. It feels surreal, disconnected from the world, and the only thing that exists is you and your anxiety.

Afterwards, everything seems like a bad dream. I realize I got a panic attack over nothing and I, once more, let my anxiety take control. I feel weak and embarrassed for being scared out of my mind and not being able to stop it.

What NOT to do if you think you are about to have a panic attack:

People with anxiety can be oversensitive to normal bodily sensations. When panic starts, it will make it worse if you hyperfocus on things like your heart rate and breathing. Hyperfocusing fuels the panic attack so it continues to grow.

Here is an example of hyperfocus to make it easy to see how our thinking can propagate a panic attack:

“My heart is going fast. I wonder what’s happening! Am I having a heart attack? I do feel like my chest is getting tight. Am I having a panic attack? What if I pass out? I’m starting to feel a little dizzy! My hands are getting numb and I feel like I can’t breathe! What if I throw up? What if I’m dying?”
Instead of interrupting the anxiety and working to calm oneself, hyperfocus does the exact opposite. The more you focus on how fast your heart is beating the more anxious you will get and the faster it will beat. When anxious, people often tense their body and either hyperventilate or restrict breathing. The breathing changes can then cause the tingling in your limbs which further serve to convince you that you are having a heart attack. This snowball of physical sensation can keep going until you exhaust yourself and the panic passes.

What causes that tingly sensation during a panic attack?

During breathing, you breathe in oxygen (O2) and exhale carbon dioxide (CO2). If you breathe too fast or too slow you end up disrupting the balance between the amount of O2 and CO2 in your body. This leads to many of the physical sensations that happen during a panic attack.

Hyperventilation:

During hyperventilation, the body breathes out too much CO2. This causes changes in your body (blood pH rises causing respiratory alkalosis) which result in the symptoms of dizziness, tingling in your lips, hands and feet, headache, weakness, fainting, and seizures.

Hypoventilation:

Some people restrict their breathing during a panic attack by either holding their breath or by breathing in a short and shallow manner. Hypoventilation can also cause lightheadedness or dizziness. Restricting breathing leads to an increase of CO2 causing blood pH to fall and a respiratory acidosis.

5 Ways to Interrupt a Panic Attack:

1. Distraction!

If you are sitting on the couch watching tv and you start to feel the beginnings of a panic attack don’t continue to sit there and think about it.

Get up and do something else! Don’t remain in the same environment if you can change it.

• Go wash the dishes in another room.
• Grab the vacuum and vigorously clean.
• Call a friend and ask them how they are.
• Leave the house or the office to get some fresh air.
• Leave your desk and go splash water on your face.
• Walk quickly around the block (or from room to room) while counting how many steps it takes to get from point A to point B.

2. Breathe properly!

This is very important! If you control hyper- or hypoventilation, you can control the pins and needles sensation. Hyperventilation can cause the sensation of shortness of breath so people breathe deeper and then make the situation worse.

Inhale slowly through your nose by pushing your abdomen out for 5-7 seconds. Hold your breath for a few seconds and then exhale through your mouth slowly. It is important to make sure your abdomen is expanding and not just your chest.

3. Exercise!

When feeling panic it can be effective to match the intensity of the anxiety with physical exercise.

• Go outside and do some sprints,
• walk vigorously around the block,
• do 100 jumping jacks,
• or walk up and down the stairs until the feeling passes.

I find gentle exercise less effective because it is easier to still focus on how you are feeling while you are doing it. Intense exercise can make it difficult to think about anything else and therefore can be a very effective distraction.

Exercise can also help your muscles relax. When having anxiety and panic people often tense all their muscles leading to some of the feelings of chest discomfort.

4. Shift your focus:

Pick any item and study it intensely. Give yourself something objective to fixate on instead of focusing on your bodily sensations. Describe every detail of the item. When you finish one item move on to describe other items.

Here is an example of studying a plant:

• What are the leaves like?
• Does it have smooth edges?
• What is the color?
• Are some new leaves sprouting?
• What does it feel like when you touch different parts of it?

The exercise of shifting your focus can help bring you back to the moment and away from focusing on physical sensations.

5. Progressive muscle relaxation:

Progressive muscle relaxation is a great tool for panic because it is active and requires focus to complete. It is an exercise that can relax your mind and body through slowly tensing and then relaxing each muscle group.

Start at one end and work your way throughout your entire body.

• Tense your muscle as hard as you can and hold it for 5-10 seconds.
• Feel the sensation that happens as you are tightening the muscle.
• Once you relax, feel the muscles relaxing and the tension dissipating.
• Relax for 20-30 seconds before moving on to the next muscle group.

Next time you feel the start of a panic attack use these tools to interrupt it: distraction, breathing properly, exercise, shifting your focus, and progressive muscle relaxation. Don’t let anxiety and fear of a panic attack take control. The time spent fearing panic is never time well-spent. Anxiety and panic attacks are treatable so get help if you need it.