How can you stop a panic attack?

Image of the side of a building looking from below.

Have you ever had a panic attack? Are you trying to avoid having another?

In terms of intensity, anxiety can range from a mild case of butterflies about an upcoming presentation at work, to a mix of fear and catastrophic thoughts that keep you up at night, to the experience of panic. The most intense level of anxiety, panic can literally feel like you are going to die. You may not be able to breathe, your heart may be pounding, and you may feel like you are going to pass out. 

If you have experienced a panic attack even just once, you know that the experience stays with you. In fact, often what turns a panic attack into a panic disorder is when you start avoiding situations that you fear might lead to another panic attack. Life can start to feel less full and rich as you eliminate scenarios and experiences that might be problematic.

What can you do to stop or prevent a panic attack?

The idea is to start feeling like you are in control of the panic attack, rather than the other way around. The panic response is triggered by perceived danger. The good news is that there are strategies that you can use to let your nervous system know that the situation is not dangerous and that it can turn off the panic response. If you have had a panic attack or fear that you will have one, creating and testing out strategies can be very helpful. Here are some things to try:

Understand what a panic attack is and isn't.

A panic attack is a cluster of intense symptoms that can feel like you are dying, but you aren't actually dying. I'm not denying that the symptoms aren't real - they are! It is important to consider, however, that the symptoms of a panic attack mimic symptoms of other conditions. Certainly you can get yourself checked out by a physician if it helps with peace of mind. At the same time, it can be helpful to consider the symptoms as those of a panic attack, rather than something else - you aren't having a heart attack, you aren't suffocating, you aren't dying. You aren't actually in danger. You are having a panic response. 

Don't believe everything you are thinking.

Remember that the thoughts that accompany a panic attack are not necessarily true. "I am dying," "I can't breath," "I am trapped," etc. may not be based in reality but can still be very upsetting. It can be helpful to try shifting from reacting to your thoughts to becoming an observer of your thoughts. Write down the thoughts you remember from previous panic attacks. Notice when these thoughts come into your head and see if you can label them as thoughts. See if you can identify these as more symptoms of the panic attack rather than the truth about what is happening to you. These are just thoughts - symptoms of a panic attack - they are not your reality.

Relaxation breathing is your friend.

There are lots of breathing exercises out there and they serve two purposes. First, using relaxation breathing can shift you out of hyperventilation mode, which often happens in panic attacks. Second, relaxation breathing tells your nervous system that it is OK to relax, that there is not a real danger present. I recommend practicing relaxation breathing regularly so that it becomes a regular habit for you.

Ground yourself.

One of the best tools for dealing with a panic attack is to use your senses to shift your attention away from the overwhelming panic symptoms and back into your present reality. There are a lot of ways to do this. Grab your keys in your pocket and grip them strongly enough to really feel them pressing against your skin (don't grip too tightly and hurt yourself!). Grab a door knob or railing to feel something real. Push your feet into the floor and see what it feels like to literally ground yourself. A great trick (if available) is to put an ice cube in your mouth - the intense cold and slight pain will shift your attention away from the panic symptoms. 

Practice positive self talk.

Identify statements that can help you through the panic attack. "This is not real - it is just a panic attack." I can get through this." "I will be OK." Say these in advance of anxiety and panic inducing situations along with relaxation breathing.

Try to stay in the situation.

One of the most difficult aspects of having a panic attack is that you start avoiding situations that are important to you. As much as possible, see if you can stay in the situation rather than flee or avoid. This could mean staying on a crowded train, standing next to a window in a high rise building, or remaining in any other situation that triggers panic for you. Use some of the grounding techniques mentioned here to stay present and remind yourself that these are just panic symptoms. The idea is to train your mind that the symptoms will reside and you will be OK.

It can be helpful to identify and practice these strategies in advance so that they are second nature to you. 

How do you manage panic in the long term?

Therapy can be very helpful for panic attacks. Identifying and reworking or replacing problematic thoughts is often a very effective tool for reducing symptoms, as is learning how to deal with intense feelings in more helpful ways. It can also be useful to identify ways to systematically reintroduce important activities and scenarios in your life that you have avoided because of panic.