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Instructions on Managing Panic Attacks

Managing Panic Attacks

These instructions are not meant to diagnose or treat any condition. They are intended only for Dr. Ostoja’s clients, as those are the only persons that Dr. Ostoja has had the opportunity to interview. Dr. Ostoja usually collaborates with a physician to rule out any potential underlying medical condition before making the recommendations below.

  • Please remember that your panic attack symptoms are produced by hyperventilation (if you have been evaluated by aphysician and all other causes have been ruled out)
  • Hyperventilation refers to shallow and rapid breathing, often in reaction to stress
  • A “good” way to hyperventilate is to exhale rapidly and forcefully… which is what most of us do when we get stressed out…
  • So slow down and try to hear yourself breathe in and out of your nose as slowly but comfortably as you can
  • You start breathing rapidly in response ot stress because your body thinks it’s facing danger: fight or flight
  • If you were really running (fleeing) or fighting, you would need more oxygen
  • But if you are sitting, that extra oxygen produces your symptoms
  • Symptoms often include difficulty breathing, chest pain, sweating, nausea, tingling in the fingers or toes, dizziness, lump in throat and fears
  • You might become afraid that you are having a heart attack, die, or go crazy
  • These are very common fears in people suffering from panic attacks
  • In one study, ordinary people were given a medicine that made their hearts race. Half of the participants were told that the medicine would make their hearts race, and half that it would relax them. Can you guess which participants got more frightened and uncomfortable once their hearts started to race? (see below)
  • Since you don’t understand why your body is behaving the way it does (you don’t know that these are symptoms of hyperventilation), you GET SCARED OF THE SYMPTOMS and you begin to hope that they will never happen again
  • We call this FEAR OF FEAR (fear of being afraid again)
  • You may even learn to avoid situations where you think you might have another panic attack or leave places where you experience panic attacks (AVOIDANCE)
  • AVOIDANCE MAKES THE FEAR WORSE
  • Every time you wish the panic attack would not happen, or you try to stop it from happening, your fear grows bigger and you avoid more (VICIOUS CYCLE)
  • Usually, as soon as you start feeling the symptoms of a panic attack, you tense up, and try to fight them, but that only makes things worse, because you start to breathe faster, the adrenaline kicks in, and all this makes the symptoms worse!
  • The key to treatment is to BREAK THE VICIOUS CYCLE OF FEAR OF FEAR:
    • understand what produces the symptoms in the first place (rapid breathing)
    • reframe it as “unpleasant” but not deadly
    • remind yourself that it’s just your breathing and you won’t die
    • do not fight the panic attack (you get better at it with practice)
    • ride it out like a surfer rides a wave (let the symptoms happen – same as you would do with coughing or sneezing)
    • do not catastrophize or overinterpret the meaning of symptoms (you probably don’t get afraid that you will cough up your stomach, or sneeze out your brains – even though it may FEEL LIKE IT – you KNOW better)
    • your INTREPRETATION of the symptoms is critical; remind yourself that your rapid breathing and your anxiosu thoughts are producing the feeling of panic; interrupt it with slow nose breathing, preferrably intot he abdomen
    • remind yourself that avoidance is not your friend
    • with the help of your therapist and family, start returning to your usual activities slowly and DO NOT LEAVE UNTIL THE PANIC IS OVER
    • if you escape/leave before the panic is over, you can make the fear worse
    • that’s why it often helps to start small and work your way up to bigger challenges, but persevere at it! RECLAIM YOUR LIFE FROM PANIC!
    • (Answer about the study: the participants who were told they would feel relaxed but were given a medicine that made their hearts race felt more panicked because they didn’t understand what was going on and misinterpreted the harmless symptom of heart racing as meaning that something was wrong. The participants who knew that the medicine would make their hearts race had the correct interpretation and therefore did not become anxious).

WHEN YOU ARE HAVING A PANIC ATTACK (and you have been evaluated by a physician and told there is no physiological basis to your heart pounding or other symptoms):

 Remind yourself that the symptoms are produced by your breathing

  • Remind yourself that the symptoms are harmless!!!
  • The symptoms are unpleasant but will gradually decrease
  • DO NOT FIGHT THE SYMPTOMS
  • Talk to yourself calmly
  • Joke about the symptoms, LAUGH IF YOU CAN
  • Tell the symptoms they will not scare you!!!
  • Don’t give the symptoms the power to scare you!
  • Stay in the situation – DO NOT ESCAPE until you feel calmer
  • Try not to wish that the symptoms go away!
  • If you can, get up an do jumping jacks
  • Try to have a nonchalant attitude toward the symptoms (oh, here you are again, what a nuisance, but, oh well, just wait them out; oh here comes the nausea, bother, it will pass; oh here is the fast breathing, no big deal…)
  • Try not to criticize yourself or feel embarrassed. A lot of people have panic attacks!
  • Panic attacks are very scary, but are also one of the easiest anxiety problems to treat, if you do the work!!!
  • Practice abdominal breathing daily (see instructions below). BECOME A CHRONIC ABDOMINAL BREATHER.

 Recommended reading: Claire Weeks, Hope and Help for Your Nerves.

 Diaphragmatic breathing

  • Lie comfortably on your back
  • Wear lose clothing around your waist
  • Place one hand on your chest and one on your abdomen
  • Begin breathing comfortably, without changing anything
  • Observe your breathing
  • Observe your hands and their movement
  • If you can, breathe in and out through your nose
  • Now imagine that you have a balloon in your belly
  • As you inhale through your nose, allow the air to travel down to your belly and fill the balloon with air
  • As you exhale, relax the muscles of your abdomen and let the balloon in your belly shrink gently
  • This takes some practice
  • Initially, you may notice both of your hands moving up and down with your breath
  • As you get better at pulling the air into your belly, the hand on your chest can move less
  • Try to breathe as slowly as is comfortable
  • Gradually, you will be able to extend your breath
  • Exhale slowly through your nose or pursed lips
  • Imagine a pleasant scene, an ocean or mountain stream
  • Keep noticing what it feels like to have the air enter through your nose, through your throat, trachea, chest, and all the way to your belly
  • The hand on your belly should be moving up and down with each breath
  • Practice this regularly, twice a day for 5-10 minutes in the morning and at night before going to sleep
  • Use this breathing while riding out a panic attack