Panic Attack tips

1. Understanding panic

3. Conditioning and gradual change

2. The last straw effect

A panic attack is a very unpleasant sensation and it can be very frightening. But it is just another form of anxiety. It is one in which the sensations you experience in your body are more pronounced (but usually more short lived) than those you feel with lower level chronic anxiety. When you experience a panic attack your heart beats very fast. You experience a trembling sensation that is hard to control. For some people sweating is a feature. Sometimes people feel such a level of stress that they find it hard to speak, and they can also experience a sensation best described as feeling “rooted to the spot” or “paralysed with fear”. It is a horrible sensation but actually it is also a normal response to what you have told yourself is the threat. It is just that you have set the level of threat in your mind far higher than it is in reality. Your body is reacting logically to what you have told yourself. But most importantly it is something you can learn to control by resetting the level of threat.

2. The last straw effect

3. Conditioning and gradual change

2. The last straw effect

Panic often seems to spring unexpectedly out of nowhere. But that is never true. There can be a type of “last straw” effect in which the build up started days, weeks or even months earlier, but you didn’t notice. Maybe you booked a holiday a couple of months earlier and you then developed a panic attack while trying to board a plane. The build up could have started as far back as when you made the booking. Or perhaps you have a fear of socialising and were invited to a party a month earlier. You think it will be ok, but over the next weeks the thoughts are building up at the back of your mind, and the explosion of panic comes at the tipping point, on the day of the party. Or you were asked to make a presentation at work. You have a fear of public speaking. You push it to the back of your mind. You procrastinate. And suddenly on the day of the presentation you experience a panic attack. So in other words there can be an insidious build up over time that you do not notice until it explodes into panic. So question yourself now about the last time you felt panic. Trace back the path and the build up to it. No one goes from feeling totally calm and relaxed into full panic mode, unless there is a very real and immediate danger.

3. Conditioning and gradual change

Panic is not a disease. It is not something you inherit or catch, though you can learn it. It is caused either by what you tell yourself is the current level of threat, or by what you have been conditioned to respond to in the past, even if that is no longer a threat. Understanding conditioning can be an important aid to control panic. “Conditioning” is what happens when your mind makes a link between a situation and how you respond to it. It is how we learn many things and it is a very useful process. If a situation keeps repeating itself then that link strengthens so that every time you are in that same situation, you respond in the same way. As the link becomes stronger you start to respond not just when the situation recurs, but when you think that it is about to recur. Anticipating situations is a sign of good learning. But sometimes we can learn the wrong links. This is because gradually we start to respond to situations that are quite similar to the original one but are not exactly the same. We strengthen that link and then we move on to other situations that are one step away from that. Little by little, the situations we respond to change, so that in the end it is as if we have taken a dead end wrong path to nowhere, one step at a time. It is easy then to believe that there is no trigger and that panic is occurring outside our control. But in reality it is just a normal response to a lesson learnt in the past.

4. The thermostat technique

3. Conditioning and gradual change

Analysing the build up to a panic attack and then testing the degree of stress at each level is a good plan because it is easier to stop panic developing before it reaches its height. At the moment of panic it is hardest, but not impossible, to control the physical sensations. If you can be clearer to yourself about the build up and identify times of vulnerability, then you will know when and where to concentrate most effort to give you most control to prevent it ever happening. Think of it like a thermostat. If you control the build up of temperature and reset it when necessary then there will be no boiling over. Whereas a desire to avoid the circumstances altogether is understandable, that can interfere too much with normal life and prevent you participating in activities you need. Instead use the idea of keeping the temperature down through repeated stress testing at low levels and using physical relaxation to control each level. Once you assure yourself you can control pressure at one level then move to the next. Increase slowly, over many repeated efforts. Carefully test yourself in the easier situations and repeat the control measures in those. If one step seems too hard just go back a step and repeat that until you feel confident to move to the next. You can get some tips on how to make these steps on the Making Changes page.

5. Picture it and conquer it

4. The thermostat technique

5. Picture it and conquer it

When you deliberately visualise a stressful situation in a controlled way and recreate some low level feelings of panic, you can learn to control the way your body responds. It is essential that you have learnt and practiced some physical relaxation skills in advance (see the 6 Relaxation tips page) before you try this so that it works. Also you should be in a safe situation with support available in case you need it. You can then go on to use this technique and learn to control the panic. Start by writing out the sequence of events that often leads to you feeling panicky. What came before your last panic attack? Identify the first triggers. Was it when you left the house or a memory of something else? Is it there when you wake in the morning? Now visualise yourself retaking those first steps again. Re-live it. You want to recreate the feelings of stress so that you can learn to reduce them. Visualise it happening again until the first physical feelings of panic and discomfort appear. Then, push the images from your mind and focus instead on reducing the unpleasant physical sensation. Wait until you feel calm again. Then repeat this. Each time you do so you are gradually conditioning a new response to the situation that you feared. But this time you are conditioning (learning) a response of calm.
Once you have learnt to control one situation push yourself a little further in your imagination. Gradually take more and more steps in your mind's eye and, each time it feels too uncomfortable, stop visualising and focus instead on reducing and thereby controlling the feeling of panic. You probably need to do this a large number of times and do so gradually before you can fully build your confidence.

6. Break the circle

4. The thermostat technique

5. Picture it and conquer it

Fear of the fear. Once feelings of panic have happened a few times, and we agree it is a horrible sensation, then the fear of having a panic attack, particularly the fear of doing so in public, can itself become the source of the problem. The original fearful situation may have long passed but the fear of your reaction and of it recurring now becomes the trigger for more panic. When that is the case it can be harder for you to trace back the origins of your thinking and it can feel as if it is harder to control. But it is not. If, on questioning yourself, you think you are experiencing fear of the fear then use the same techniques on this page and on earlier pages to learn to take control. Analyse the situations, break them down into manageable steps, practice physical relaxation, use visualisation, and gradually build up your level of control over each step. Do this repeatedly over time. Try and work out what your fears are conditioned to. What situations trigger your panic? Then work out if your response is in proportion to the actual threat.