Fear and Avoidance of a Panic Attack
Panic attacks are terrifying and debilitating. You cannot breathe, your head spins, your limbs are buzzing with energy, and you are sweating like a pig. At the time you believe that you are going to die, but you don’t. You are sure that you have something physically wrong with you (perhaps your heart or lungs), but the doctors can find no cause for all of this.
Without any explanation for this, you start to do some of the following things –
- You avoid things because you are terrified that the panic attacks could come on at any moment,
- You become overly dependent on someone for things that you once could do alone,
- You become isolated, physically, and emotionally.
Each time you look back and realize that this is your mind playing tricks with you, rather than a serious physical health concern.
But there is hope for change. With a bit of guidance, we can help you to –
- Feel the panic less intensely,
- Experience panic attacks less frequently,
- Regain a sense of control over your life,
- Stop avoiding things that you fear might trigger a panic attack, and
- Accept the occasional panic attack.
To plan for the next panic attack, here are some things to consider –
- Physical health? – Are there any physical reasons why you experienced the symptoms of shortness of breath, a spinning head, or sweatiness. It is worth ruling out any physical health issues, and it is worth reflecting on any substances or stimulants that may contribute to this (caffeine, excess sugar, nicotine, etc).
- Psycho-education – After you have ruled out any physical health issues, it can help to understand why you experience a panic attack. Your brain has an alarm system to alert you when things go wrong. You need that alarm system, so your blood can pump faster and get the heck out of there if there is an actual threat. So, in a way, we should be thankful for this alarm system, because without it we would be in trouble. We just need to find ways to reset the alarm, so that it doesn’t keep going off for no reason.
- Simple as ABC. Knowledge is power, so you need to track when the panic attacks occur, and why. A simple log called the ABC log can help you record the following –
- A is for Activating Event – For example, you were at the supermarket and you started to panic because you thought people were staring at you, and that made your heart race because you feared you might trip and fall and embarrass yourself, and then your mind started to think about getting COVID because you noticed some people not wearing their masks properly, and then you feared that you were going to pass out in front of everyone, which would be mortifying.
- B is for Beliefs and assumptions – In this example, you assume people are staring at you, and even noticing you in the first place. You are probably also assuming that they are thinking negatively of you. You are also assuming that you are at high risk of COVID, and you are assuming that people will judge you for tripping or passing out.
- C is for Consequences. This is where you would record the behavioral and emotional consequences. For example, you may end up leaving the supermarket and returning home without any of the groceries, and along with the panic and anxiety, you are frustrated at yourself for letting your fear of the supermarket get to you.
- I challenge you to a duel. Once you have recorded the when, where and whys of your panic attacks (in the form of your ABC log), I can help you to identify unhelpful thought patterns and challenge your assumptions. For example, I could help you to develop a more compassionate voice instead of that harsh critic who assumes that everyone is judging you. I could also challenge your tendency to catastrophize, and I would do this in two ways –
- Firstly, how likely is it that the ‘catastrophe’ is going to happen? Give it a percentage: Is it ten percent likely, fifty, seventy, or one hundred percent likely?
- Secondly, how bad is that supposed ‘catastrophe’? On a scale of 0-100, how distressing would it be to trip over? It may initially feel like an 80 or 90, but when you compare it with other things that could go wrong (for example, a loved one dying), you may realize that the fear of tripping over is actually a 10 out of 100.
- Only when you stop and realize that this is something that is not very likely to occur, and/or even if it did, isn’t as distressing as other things, you can start to gain perspective. You can then train your body to react more proportionately (and save the heart pumping and sweating for the stuff that is almost certainly happening, and likely to cause a 90 or 100 level of distress).
- Calm your body, ease your mind. In previous blogs I have outlined the various ways to calm your body, which in turn will ease your mind, and help you to assess a situation more rationally. Here are just a few examples (with links to the relevant exercises) –
- Exposure and positive coping statements. Panic and anxiety are made worse when we avoid what makes us anxious. Gradually, slowly, stop avoiding the things that are triggering your anxiety. For example, if you get anxious around people in a supermarket, you could start by imagining each stage of going to the supermarket. You can develop positive coping statements such as ‘I am strong enough to handle this’, and you can use the above-mentioned body-calming exercises to prepare yourself. Once you have imagined each stage of the event, and you have kept your anxiety levels within a reasonable range, try one stage of the exposure. For example, drive to the supermarket parking lot. Try the next stage and the next, continuing to use your body-calming exercises and positive coping statements, until you have conducted a successful trip to the supermarket with only moderate anxiety.
- Stop, Look, and Listen. One of the most helpful things about panic and anxiety is to focus outwards, away from your own bodily sensations. Panic is often fueled when we feel a racing heart or sweaty palms, and then our mind starts to race, and then we focus even more on our thoughts and bodily sensations. Try and take a moment to focus outwards, and even describe everything and everyone you see.
- Mind your Mindfulness. I have covered the basic principles of Mindfulness in other articles, but in brief, these include –
- Using present-moment awareness to anchor yourself in the present, not fearing a future unknown. Usually, you would use your breathing, but if you have found that this makes your panic attacks worse, focus on the texture of your clothes or skin as you gently touch your arms and legs. Or focus on the colors and textures of objects around you.
- Non-judgmental acceptance of whatever anxious emotions and thoughts may be arising. Don’t give them fuel by following them; just let them drift away like bubbles.
- The Past is Present. Sometimes things that have happened in your past can have an impact on your panic attacks in the present. For example, I once worked with someone who grew up in a household where anger was not tolerated. As a result, this client worked hard to repress their anger at every opportunity. The trouble was that all this repressed energy had to go somewhere, and they ended up having panic attacks instead of assertively communicating their anger. We had to slowly work through this conditioning and they eventually learned that feeling angry was an acceptable emotion.
- Plan for relapse. You aren’t going to manage this perfectly the very first time, so this means you might experience another panic attack. Make plans for this, and reflect on what you learned, rather than making it into a catastrophe. Some people find it helpful to make a list of the above-mentioned strategies and carry that list around with them (either on their phone or on a small card in their pocket). This will be a personalized list of strategies that you have found helpful – there is no one-size fits all. For example, the list might include:
- Positive coping statement: ‘Solid feet set apart, solid mind and solid heart’
- Focus on the colors and textures of your surroundings
- Square breathing (and remembering to pause between sets, and notice that pause)
Panic attacks are scary at the time, but they do not have to rule your life. There are simple tools for you to use and regain control of your life, and if these do not help, there are treatments such as EMDR (Eye Movement Desensitization and Reprocessing therapy) that can help. Either way, you do not have to continue to struggle.
Chris Warren-Dickins LLB MA LPC
+1 (201) 779-6917