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Posts Tagged ‘Panic attacks’

It comes on with little or no warning – a tightness in the chest perhaps, a churning feeling in the abdomen…  Within minutes you are gasping for breath, your heart is pounding, you are struggling to breathe, sweating, shaking, dizzy and faint.  Your chest feels like it is about to burst, you are terrified that you are about to die, your pulse rate has taken off like a rocket, everyone is staring at you.

Eventually it passes off, leaving you feeling weak, sick and exhausted for hours, sometimes for days.  You are terrified that it will happen again, but know that it probably will.

Panic attack.

Panic attack, or panic disorder affects around 1% to 2% of the population, (or so I’m told, that seems a bit high to me, frankly but …)  They usually begin during teenage years, or early 20’s and women are about twice as likely to be affected as men.

These are my tips and strategies for managing panic attacks:

1.  A principle:

The principle I usually suggest to panic attack sufferers is this:  Gain a little control, even if it is only a very little bit of control.  Once this is established, the attacks don’t seem quite as fearsome and from a small beginning you can establish greater degrees of control until you can diminish the attacks to zero.

2.  It won’t kill you!

In the midst of an attack, it is all too easy to believe that you are about to die.  The attacks are terrifying and you feel your heart is about to burst or you will suffocate.  But you have survived each attack (or you wouldn’t be here!) and you will survive the next one.  People don’t die from panic attacks.  Even knowing this, is a small amount of control – “I am not going to die from this.”

3.  It will pass.

Hard to remind yourself of this in the midst of an attack, but again, as with #2 above, they do pass, (otherwise you would be in a permanent state of panic attack.)    Have a look at my post on this site – This Too Will Pass.  Begin to remind yourself – it won’t kill me; it will pass, I will survive.  A little more control.

4.  Manage your thoughts (self-talk.)

Have a look at my post on this site: Managing Unhelpful Thoughts.  Our internal dialogue (self talk) is very powerful.  If you have the sort of self-talk that goes: “Oh God, here I go again. I can’t stand this, I’m losing control, I’m going crazy, I can’t breath, I’m going to die, everyone is staring at me ….” then you are setting yourself up to make a bad experience so much worse.  If by contrast, you are able to say to yourself something like: “Bugger it, another panic attack, OK, I will survive it, it will pass off, come on get it over with, I can manage it, who gives a **** if anyone is watching me …” then you are much more likely to maintain an edge of control and feel better about yourself for doing so.  Become more aware of unhelpful thinking and incorporate positive management strategies into your daily life.

5.  Breathe!

Sometimes panicky feelings can be caused by poor breathing.  Either gasping too much air, or breathing too shallowly and too fast, alters the chemical composition of our blood, causing dizziness, nausea, chest pains and the like.  Learning to breathe properly can avert this.  Have a look at the information here on Hyperventilation Syndrome.  Have a look also at this information on Yoga Breathing, which is a good form of breathing to learn and cultivate.  When you have learned to breathe well and steadily, incorporate it into your daily routines.  Take the time to remind yourself, until breathing properly becomes a habit.

6.  Mindfulness/Meditation

Have a look at my post on this site: Calmness Through Mindfulness.  Meditation is very similar to mindfulness, but with a somewhat different focus and purpose.  An excellent on-line book on meditation is Mindfulness in Plain English, by Henepola Gunaratana.

Many people who suffer from anxiety and panic attacks spend much of their time locked into unpleasant memories of the past, or imagining an unpleasant future, or away in a fantasy world imagining unpleasant things that might happen.  Well, as Mark Twain famously said: “I’ve had a lot of problems in my life, most of which never happened.”

Mindfulness and meditation are means of bringing our mind into the present and keeping it there.  They are also means of developing states of calmness, both physical and mental, maintaining that calmness through times of trouble and stress and discerning what is real from what is imaginary.  A very pertinent feature of mindfulness is the realisation that any sort of thought can come up in our mind, but we don’t have to accept it as real, or react to it. 

Here again, is the development of control.  If we can be aware of and manage what is happening in our mind, we develop insight and calmness and our thoughts and our body-reactions are much less likely to spin out of control.

7.  Relaxation

This is closely allied to mindfulness/meditation.  Being able to physically relax gives us control of body and mind and alters our systemic levels of harmful stress chemicals such as cortisol.

There are all sorts of relaxation methods: listening to music (thrash metal, death metal and rap not recommended!) Tai Chi, Progressive Muscle Relaxation, to name a few.  My own method is to take a good full yoga breath, hold it for a few seconds, then imagine the tension in my body being breathed out.  I mentally move my awareness through my body, breathing out tension, moving my awareness finally to my face, lips and eyes, making sometimes subtle movements of small muscles that take away an amazing amount of tightness.

8.  Traumas and triggers.

There is a high association between trauma and panic disorder.  Sexual, physical, emotional abuse, Post Traumatic Stress Disorder, often contribute to the triggering of a panic attack.  Other people, however have attacks that are not related to trauma.  Sometimes a particular situation, or memory is enough to trigger an attack.  Going to a supermarket, where there are crowds of people, for example, is quite common in setting off an attack for some people.

If you know your specific trigger, a procedure called systematic desensitization  may help.  The idea is that you slowly expose yourself to increasing amounts of the situation you find stressful until you can manage it without freaking out.  The key is start small and go slowly!  I recently saw someone who had a tremendous fear of (injection) needles.  I started with “I could go down-stairs and get a syringe – how do you feel about that?”  We spent quite some time dealing with feelings, emotions, physical reactions, self-talk and getting everything under control.  Then, with my client’s permission, I went down-stairs and got a syringe.  Coming back, I said, “It’s in my pocket.  How do you feel?  Same procedure.  Then I put it on the far corner of the desk.  How do you feel?  Eventually, they were comfortable touching it, taking the cap off, looking at the business end etc.  Slowly, respectfully, carefully, dealing completely with what came up at each stage.  It works.

(I am very wary of a technique called flooding.  As the name might suggest this consists of surrounding the person with the stimulus they find scary, flooding them with it until they simply get used to it and stop freaking.  I think this is potentially harmful for serious problems.  Besides, I’ve worked with guys in the prisons who could pull my arms off if I annoyed them!) 

You may well need professional help for traumas.  If you see a counsellor or psychologist, do make sure that they are actively working with you on your problem and giving you strategies and insights.  Fairly recently I have seen two people who spent years in vague, waffly, hand patting “therapy,” costing thousands of dollars and leaving them no better at the end of it than when they started. 

9.  Co-opt your existing skills.

Often, the people I see have very good skills, the principles of which they could make use of to assist in managing their panic attacks.  One man was the driver of big rigs.  He could drive the largest of trucks calmly and competently through the worst of road or traffic situations,  I suggested to him that he take these skills and apply their principles to the management of his anxiety/panic.  He found that he could practically and usefully do so.  So can you! 

10.  Medication.

Medication can be very helpful, but beware, it can also be the proverbial double edged sword.  It is also clear to me that a medication that one person may find helpful, may be of little use to another person and may even make the problem worse.  Consult with your medical adviser and listen to what your mind/body is telling you.

Anti-depressants:

      Tricyclic anti-depressants (TCI’s).    Examples: Amitriptyline, Nortriptyline.  These have been around for a long time and are said to be helpful.  I don’t see a lot of evidence, mainly, I think because they are not so often used nowadays.  They have quite a few side effects and are dangerous in overdose.

      The Selective Serotonin Re-uptake Inhibitors, (SSRI”S)  Examples: Prozac, Citalopram, Aropax etc.  These have less side effects and are not so dangerous in overdose.  They can be helpful.  Note, however that some side effects can make the problem worse.  If you take them, monitor what is happening for you.  Most anti-depressants don’t begin to have a full effect until you have been taking them for three to four weeks. (NB – mixing TCI’s and SSRI’s can be very dangerous.) 

The newer generation meds in this family, the selective serotonin/ noradrenaline (norepinephrine) re-uptake inhibitors such as Effexor/Venlafaxine also seem to be helpful

      Benzodiazepines.  Examples: Valium (diazepam) Clonazepam, Lorazepam, Oxazepam, Alprazolam etc etc.  There are dozens of them.  Some of these will deal with anxiety/panic, right enough, but beware – they are addictive.  They can produce a nasty addiction which can be very hard to shake.  The ideal nowadays is that they should not be used for longer than about a fortnight, but they are often (in my sometimes less than humble opinion) prescribed much too readily and for too long.

      Alcohol, Cannabis, Opiates.  Using these to manage anxiety/panic is asking for trouble.  If you have problems with these substances, seek professional advice. 

So, medication can be helpful, but my suggestion is to use medication in conjunction with the sort of psychological strategies that I have been outlining above, so that you can eventually either minimise your reliance on meds, or eliminate them entirely. 

End notes:

I re-state my principle outlined above:  Gain some control, even if it is a little bit, then expand that control as your confidence grows until it overtakes and manages the panic disorder.

Here is another principle:  Don’t wait until you are having an attack before trying to work with these strategies – that will not be particularly effective.  The very time you need to implement these techniques is when you are feeling OK.  Developing calmness, developing control, exploring your own body/mind connection, learning to turn down the stresses before they get out of control is the essence of prevention. 

Remember the rabbit from Alice in Wonderland?

“I’m late, I’m late for a very important date.  No time to say hello, goodbye, I’m late, I’m late, I’m late.  I’m late, I’m late and when I wave, I lose the time I save…….”

Slow down, bunny. Breathe. Be calm. Relax.  Smell the flowers.  They’ll wait for you!

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