You’re on the bus on your way to university or work. The bus is crowded, the windows are closed, and you’re all breathing the same musty air. Worst of all, there’s still ways to go until the next bus stop and your final destination.
Suddenly, you feel like the space around you is closing in. There’s a heavy weight in your chest, your face is burning hot, your limbs feel like they’re not your own, you’re breathing hard; or are you breathing at all?
Thoughts filter through your head: this isn’t right. I’m not okay, I’m not okay, I’m not okay. Am I going to die? Am I having a heart attack?
Most likely, you’re not (but you should know the signs). What you’re experiencing is a panic attack.
What is a panic attack?
A panic attack is a rush of physical and mental sensations that overwhelm your body in a matter of minutes. It’s a feeling of a loss of control over your mind and body. It can be frightening, it can be distressing, and especially in the moment, it can be debilitating. It’s usually a mixture of the following symptoms:
A racing heartbeat
Sweating
Trembling or shaking
Shortness of breath, feeling of choking
Chest pain
Nausea or a churning stomach
Feeling dizzy, unsteady, lightheaded, or faint
Numbness or a tingling sensation (pins and needles)
Chills or hot flushes
Dry mouth
Ringing in your ears
A need to go to the toilet
Fear of losing control or “going crazy”
Feeling like you're not connected to your body
A feeling of dread or a fear of dying
More often than not, it occurs out of nowhere, with no special triggers or with a trigger that goes unnoticed and then hits you like a truck. If you’re dealing with recurring triggers, you might look into specific phobias (such as fear of flying or fear of insects).
The American Psychological Association describes that the difference between anxiety and a panic attack is that, while anxiety may range from mild to severe symptoms, panic attacks are significantly more intense and last a shorter amount of time. Anxiety can precede a panic attack, but it doesn’t necessarily have to. A panic attack can get you anywhere, even when you’re the most unassuming: like during sleep, hanging out with friends, or during a period of relaxation.
But you are not alone. If you stop and look around – in that crowded bus, the busy town square, rows of cars lined up in traffic – about one in twenty people will experience a panic attack in their lifetime. Research tells us that panic attacks affect women more than men.
Panic attacks as a whole are a frightening experience and you are not alone in the way you experience it. But, the good news, as you’ve already come to know, is that even they will pass. Statistically speaking, panic attacks shouldn’t last longer than 5 - 30 minutes because your body can’t handle the strain for longer than that, meaning your muscles should start to relax from that point onward, making the sensation easier to handle, even if the time before that might seem like an eternity.
So, it’s a waiting game, but a waiting game that you can make easier for yourself.
So what can you do when it happens?
How to deal with panic attacks?
The gold standard for long term dealing with panic attacks is exposure therapy. To get better and not be mortally afraid of the thing that brings you an inordinate amount of panic, you need to actively expose yourself to it.
Yes, I know how that sounds.
The good news is that it’s not as simple as that and there are rules to it, hence the term “therapy” stuck to it. Doing it without a proper introduction and structure, i.e. not arming yourself with tools and healthy coping mechanisms beforehand, can make your situation worse, and we don’t want that! There are new modern ways to the approach of exposure therapy, using digital tools like Virtual Reality Exposure Therapy.
But it’s easy to talk about the long term and how you should arm yourself in times of need when the reality of actually experiencing a panic attack can be quite different. Usually all logic and rational thoughts are thrown out the window, and you’re left with a one-track mind that can only focus on the horror the body and mind are currently putting it through.
How to deal with panic attacks in the moment?
Recognition and Acknowledgement
The very first step is becoming aware that you’re having a panic attack. It is not a heart attack. You will not suffocate. It is not life threatening. Recognize the aforementioned symptoms for what they are: a panic attack.
Once you’ve recognized it, acknowledge it.
It’s here. It’s happening. There is no quick fix. The only real fix is riding it through.
If the panic attacks are recurrent it might be worth remembering that nothing bad happened during the previous ones. You survived those, you are still here, you will survive this one, too; you just need to ride it out.
This isn’t your first rodeo, you did it before and you can do it again.
Breathing
After you’ve recognized and acknowledged that you are going through a panic attack and that there’s no escaping it, now we can get into the things that will make the whole process a little more manageable.
First, you should bring awareness to your breathing. What’s the state of your breath? Too fast, too shallow, non-existent? No matter the state it’s in, it most likely isn’t right, and you feel like your body decided to forget how to do the one thing that should come naturally.
Ideally, your breathing should be slow and deep, so that it allows oxygen to absorb in your blood and move through your body, relaxing it.
There are various breathing exercise guides you can try and implement, but all of them function on the same principle:
Start with a full, slow inhale through the nose, now – hold.
Then, release, exhaling slowly through the mouth.
Repeat.
You can try the square method (4 seconds inhale, hold for 4 seconds, 4 seconds exhale, hold for 4 seconds) or the 4-7-8 breathing (inhale for a count of 4 seconds, hold for a count of 7, exhale for a count of 8).
Whether you’re standing up or in the position to lie down, try belly breathing. Bring one hand to your stomach, and the other to your chest. The key here is that through belly breathing your stomach is the one that should be expanding unlike your chest, providing a much deeper breathing experience.
No matter what you choose and how you do it, you should aim for consistency once you’ve gotten a hang of it.
You can also seek the benefits of mindfulness and mindful breathing on anxiety.
Distraction, distraction, distraction
Now you’ve recognized and acknowledged your panic attack and you’re making a conscious effort to control your breathing. What else can you do to make the process more bearable?
There are various methods and tools that can help take your mind off of the sensation that you might not think of in the moment. After all, having a panic attack gives you tunnel vision and it can feel like you’re grasping and flailing in the dark. But knowing beforehand just what you might do in the moment might help you remember and apply some of these suggestions.
It's important to note that each of these will be different to you, and hopefully you will find options that will work better for you than others, and that is okay. We are here to experiment and find the best alternative so that you might get to the end of that horrible sensation in the least awful way.
Visualization
Studies have shown that visualization is a very powerful tool. Most often used in sports psychology by professional athletes, it also has many applications in day-to-day life.
You may recall a happy memory, a happy place: it can be the beach or the mountains, your childhood home, something that brings you joy and relaxation. You may also think about the rest of your plans for the day and week, and visualize how you will successfully accomplish them.
Visualization is a technique, and like all techniques, it is something that can be practiced. You most likely won’t be able to conjure your happy place at the drop of a hat. In fact, the idea of it might even seem frustrating, especially while you’re already going through something overwhelming and distracting like a panic attack. So we’ll start with the little things, the details, and you can gradually expand from there. For example, let’s imagine a beach.
I see the sea, blue and glistening, the sun reflecting off the gentle waves. I hear a seagull in the distance – now there are two, singing in tandem. I take a big inhale through the nose, what do I smell? The salty air, the fresh breeze. The warm sun is heating my face with my eyes closed. Underneath my feet, I feel smooth sand. Or are these rough pebbles?
And with that, I’ve managed to transport myself to my happy place.
Counting backwards
One of the simplest methods of distraction is counting backwards. It’s usually done by counting backwards from 100 and subtracting by measures of 3s or 7s until you reach 0.
The idea here is that the task is easy but difficult enough to engage your mind in so that it focuses less on the sensations you’re experiencing.
The 5, 4, 3, 2, 1 method
Another method that you can use, and this one is neat because it requires the use of all your senses, is the 5, 4, 3, 2, 1 method.
You start by noting 5 things that you can see: a tree, the sky, a building, your computer.
Then, 4 things you can physically feel: the phone in your hand, your feet on the ground, the fabric of your pants or your jacket.
3 things you can hear: outside traffic, the sound of your washing machine, people chattering.
2 things you can smell: coffee, hand cream, the brisk air.
1 thing you can taste: gum, candy, fresh air.
It sounds simple enough, but in the moment you will probably have a hard time focusing, and by the time you get to the one thing you can taste, your panic attack might already significantly subside.
Your phone is your friend
Sometimes, your phone can be a lifeline in more ways than one.
If you’re more of a visual person then this might help more while counting backwards and naming objects might help less, because it’s missing an anchor. Your phone can be your anchor.
An easy logic-based game on your phone can help a lot. Examples like sudoku, minesweeper, solitaire, or anything that you might like.
A game like that will occupy your mind and take the attention away from your intrusive thoughts that are urging you to “freak out” and “lose it”. And while your mind is getting distracted, you can focus on your breathing: inhale through the nose, exhale through the mouth. Familiarize yourself with the game and soon enough it will be there for you in all your times of need.
Having a safe person
If this persists, it’s always beneficial to have a strong support system, but it might also be good to have a “safe person” – a person that you can lean on if you start having a panic attack. You can text them or you can call them, and if they’re already there with you, they can hold your hand and help count your breathing.
Having a person like that is beneficial because that person knows what’s happening to you, they will not judge you, and most importantly – they will not panic. They can be someone that won’t bring awareness to the panic attack but rather ask about your day or talk about theirs, depending on your current needs.
It's hard to explain the sensation of a panic attack to someone who has never experienced it. But even then, a person can be taught ways to aid you in your predicament. Proper communication is important!
But be careful – there is a crucial difference between leaning on someone and becoming dependent on them. If you can’t do daily activities without the presence of your safe person, then it becomes less support, and more of a crutch. It will help you in the moment, but it will make managing anxiety, both for you and that person, more difficult in the long run.
Chewing gum – a quick method
Your jaw is most likely clenched and you’re too focused on your breathing (or the lack, thereof). One thing that you can do when you feel a panic attack coming on is to shock one of your senses with an overwhelming sensation of your own making, like a piece of mint gum or a sour candy. It will give your jaw something to focus on instead of mindlessly grinding your teeth while the flavor will light up your taste buds and senses.
It can also help with the symptoms of a dry mouth and it might regulate your breathing in the sense that you will start chewing the gum automatically, even if your breathing isn’t automatic anymore. The instinct to swallow will override the irregular breathing, at least enough for you to notice and help regulate it.
Mild physical exercise
The thing with panic attacks is that your body is preparing you for an escape from imminent danger, think: our ancestors being chased by a predator. Logically, if a lion was chasing you, your heart rate would be up and your senses would be heightened. In the car, on the way to work, not as much.
If you’re in the position, take a walk, do a few jumping jacks, or any sort of mild physical activity that might get your blood pumping if it wasn’t already from the panic attack, and the reaction will tell your mind: look, logically my heart rate is up and I’m out of breath because of the exercise, there’s nothing to worry about. Just be careful not to overdo it, that’s why the mild and moderate approach is important!
Repeat a mantra
While you’re working on your breathing and distracting yourself with one of these methods (You’re doing such a good job, by the way!), it might also help to anchor yourself with a sentence, or a word, a mantra if you will. Things like:
This will pass.
I will be okay.
I have survived this before, and I will survive again.
Or any variation that might help you and keep you grounded, holding out till that sweet sweet moment when you finally start feeling the release.
In conclusion
While panic attacks might not be life-threatening, they are a scary and terrifying experience and rightfully so, but remember that you are not alone and there are ways to deal with this. There are many people dealing and going through the same thing as you on a daily basis and we all go through it together.
If the symptoms persist you may want to look into panic disorder, as well as consult your doctor or mental health professional in case there is an organic cause to this experience.
Prefer to work on your own in the privacy of your own home? That’s where oVRcome’s Panic Disorder and Agoraphobia Program comes in so you can do exposure therapy wherever and whenever, suits you best.