PANIC ATTACK: Finding Your Calm When Profound Fear Takes Over Your Mind & Body

 

A bird sitting on a tree is never afraid of the branch breaking because its trust is not on the branch but on its own wings. 

-Charlie Wardle

Panic attacks represent the quintessential experience of extreme overwhelm and terror in which your body, within minutes, autonomically (or automatically) arouses and springs into action, believing all is not well in the world and danger is lurking nearby. 

If you've experienced one, then you know exactly what this feels like. If you haven't, then appreciating the experience of "dread" at full throttle in the absence of an  identifiable "threat" will make you scratch your head, wondering how it can be possible for the nervous system to escalate so quickly and go into fear mode when there is no real danger or apparent cause. In contrast to anxiety, or anxious feelings, panic attacks are so insidious in that they can show up, uninvited, and certainly unwelcomed, at any time.  

Chronic Stress

In a world of constant notifications, distractions, long work days and weeks (that collapse into one another), global pandemic, and round-the-clock news coverage, to  name a few, it is no wonder so many today feel frazzled and overwhelmed. Stress management is key to overall well-being and an internal state of equanimity; a deep feeling of calm within your mind and body.  

Anxiety, panic, fear, and especially PANIC ATTACKS thrive in a stress-consumed body. As such, stress management should never be pushed aside with a lackadaisical attitude of I'll get to it when I can. 

Your self-care matters! It is understandable that things will come up to demand your immediate attention and will distract you from your best-care practices. It is not the stress that occurs every now-and-then that wreaks havoc, but the chronic, unrelenting stress that, over time,  robs you of your enthusiasm, joy and energy.

Panic attacks are common mental health challenges, impacting approximately 4% of adults around the globe and 11.2% in the United States. 

Panic Disorder

When panic attacks continue and include at least 4 of the 13 listed physical and cognitive symptoms, as presented in the Diagnostic & Statistical Manual of Mental Disorders-Fifth Edition-Text Revision (DSM-5-TR), and there is significant avoidance of and worry about having a recurrent attack in which the disturbance is not due to a substance or medical condition, then the diagnosis of panic disorder is issued. 

What Causes Panic Disorder? 

The etiology of panic disorder is not fully understood, but it is believed to be a combination of genetic, environmental, and psychological factors. 

Some risk factors for panic disorder include:

• Family history of anxiety or panic disorders
• History of trauma or abuse
• Chronic stress or major life changes

What Does a Panic Attack Feel Like?

It feels scary! Ubiquitous to the experience of a panic attack is the sense of impending doom and the simultaneous feeling that you are losing your mind. Generally, the symptoms peak quickly (within 10 minutes) as the surge of adrenaline levels spike by potentially 2 1/2 times or more, positioning your body into fight or flight, or freeze. As adrenaline floods your bloodstream, your blood sugar spikes and your breathing becomes more shallow, preparing your brain and body for heightened senses as you enter the high alert zone. 

It is not unusual to believe you are having a medical emergency, such as a heart attack, and find yourself driving or being transported to your local emergency room. 

Once you've been medically examined, the outcome typically involves the prescription for benzodiazepines and a brief mention of a lifestyle change to mitigate stress by the attending physician.  And brief it is! The emergency room physician will not have the time to sit with you and outline a personal stress-management plan or program.  This will now be your mission —> 

SO WHAT EXACTLY IS THIS LIFESTYLE CHANGE THAT HEALTHCARE PROFESSIONALS ADVISE? 

AND, WHAT CAN ONE DO IN THE MOMENT TO DECREASE THE EFFECTS OF THE ATTACK? 

FEELING BETTER

FEELING CALMER

Remember, one or a handful of panic attacks (spread across several years) does not meet the "frequency" requirement for a diagnosable anxiety disorder. There are millions of individuals who have experienced at least one panic attack in their lifetime. To meet diagnostic considerations, your panic attacks will need to be higher in frequency and intensity, and affect the quality of your daily life. With that said, there is a large caveat. 

The challenge with having just one panic attack is that it sets you up quite strategically for another unless you ruthlessly confront it at its inception or as early as possible. Why? Because anxiety is rooted in fear and its  superpower is AVOIDANCE!  Face the fear and anxiety diminishes. 

Over time and with repeat exposure, the feared activity may actually transform itself into a "looking-forward to" attitude. 

For example, an initial fear of flying may, over time, result in a passion for travel, especially air travel in which you look forward to your next booked flights and vacation destinations. 

Rather than to over-estimate the problem & under-estimate yourself, flip this around & you will be on the path to ending your personal relationship with debilitating anxiety.

AVOIDANCE: Anxiety's Super Power 

If you have experienced a panic attack, you will, in all likelihood, do everything in your power to avoid ever having another one, and this avoidance is the key super power to anxiety's hold on a person. 

Whether driving on highways, boarding an airplane, scheduling routine medical check-ups, giving a presentation, etc., there will be a feeling, a thought, and then a decision as to whether you will attempt this again, or not! Anxiety and panic attacks cannot take root when you face your fear(s). However, without proper intervention and support, facing certain fears will be highly unlikely. 

When anxious, there is a sense of urgency of wanting or needing to use a technique that will immediately work, and although the ones offered in this article are solid strategies, they, unfortunately, are not guarantees that the attack will stop in a timely manner. The challenge here is to simultaneously experience the discomfort and access a deeper, more rhythmic and diaphragmatic breath. Paying attention to your breathing is key to enhancing your emotional state, and the more you practice this type of breathing outside of a panic situation (such as in yoga), the more available it will be for you when in a crisis. 

Is there anything you can do in the moment to decrease the attack's intensity or make it go away altogether? YES! 

When You Need Relief NOW!

There are things you can do in the midst of a panic attack that may prove helpful. These include diaphragmatic breathing, grounding techniques, humming or chanting a mantra (in partnership with an aromatherapy scent) and/or listening to a sound or song that your nervous system finds soothing. The good news is that panic attacks can be exponentially shortened! When you keep this in mind, you will have a less challenging time managing its BIG feeling. 

Practice and preparation will go a long way. Familiarize yourself with these techniques beforehand. You will not want to learn how to implement these when the feelings of panic are emerging within. And again, remember, a long-term stress management lifestyle is key to the regulation of anxiety and panic symptoms and/or disorders. 

CHANCE FAVORS THE PREPARED MIND

-Louis Pasteur

BREATHE

Ujjayi (Sanskrit for "victorious") is the most commonly used breathing technique in many forms of yoga and is often referred to as "ocean" breath. It helps soothe the nervous system and calms the mind. Accessing this breath can occur from a seated or a standing position. 

To access this breath: 

1.  Begin by breathing naturally for a few cycles. When ready, seal your lips and breathe in and out through your nose. 

2.  Inhale to contract the diaphragm to create space for your lungs to expand, and when you exhale, relax the diaphragm and gently push the air from your lungs. Think in terms of fogging a mirror. 

3.  Slowly and mindfully begin to lengthen each inhale and exhale to a count of 4.

4.  To further elongate the breath, bring your attention to the back of your throat muscles and constrict them in order to hear a soft roar such as the sound of the ocean's waves crashing. 

5.  If you lose your ujjayi breath, just simply (without judgement), return to it. 

Click link for more information about accessing this breath —> pranayama

GROUNDING TECHNIQUE

Grounding techniques are immediately available strategies that can help in managing the intensity and frequency of overwhelming emotions and feelings of distress, such as a panic attack. It allows you (and your brain) to step away from the negative thoughts and feelings through a distraction method using your 5 senses. This method includes firmly situating your feet on the ground, taking slow, deep breaths (as described above), acknowledging aloud or silently (if in a room with others) what is observed in the present environment, and reminding yourself that you are safe. 

5.  Acknowledge five things you see.

4.  Acknowledge four things you can touch.

3.  Acknowledge three things you can hear.

2.  Acknowledge two things you can smell.

1.  Acknowledge one thing you can taste. 

AROMATHERAPY

Aromatherapy is the use of essential oils or other aromatic plant compounds for healing and wellness. Essential oils and their use date back to ancient times. Certain fragrances have been shown to have a clinically quantifiable effect on mood, and may help facilitate feelings of calm and relaxation through its primary processing pathway, the olfactory system. 

The olfactory bulb (an essential structure of the olfactory system) is directly connected to the amygdala and hippocampus, which explains why smells and fragrances are often powerfully connected to specific memories. 

For purposes of relaxation, lavender is typically the aromatherapy expert’s go-to scent. Other essential oils for relaxation include, but are not limited to: 

• Rose
• Valerian
• Peppermint
• Jasmine
• Chamomile
• Ylang ylang

It is recommended that you invest in pure essential oils and a good diffuser for maximum benefits. 

MANTRA

A mantra is a repeated mono or multisyllabic sound. By just simply humming, whether a tune or the equivalent of the Om mantra (familiar to yoga practitioners), the VAGUS NERVE will be stimulated. Since it is the fundamental regulator of the parasympathetic nervous system (PNS), its stimulation is directly associated with the achievement of relaxation. 

The mantra's power is derived from the sound vibration it produces when audibly expressed, similar to the feeling we get when visiting a temple or church where chanting or prayer are heard in the background (perhaps in an ancient language), or the healing sounds emanating from singing bowls. 

Few would not be moved or affected by these energetic vibrational sounds, as they typically evoke a calming and peaceful feeling deep within our nervous system. A mantra enhances focus and presence, while drowning out mindless chatter. 

Prepare a mantra ahead of time. Find a quote or a self-calming phrase that feels authentic to you. 

Here are some examples of a personal and perhaps signature message: 

Peace within me; peace surrounds me!

Faith over fear!

I am calm!

I got this! 

Tranquility resides deep within me!

The AROMATHERAPY-MANTRA COMBO

Combining an aromatherapy with a mantra can have profound effects. For example, if you pair the scent of lavender with the repetitive expression of I am peaceful, it will not take long before your brain wires these two connections. What does this mean? Well, when you smell lavender, you may  find yourself feeling peaceful ( or at least the mantra will be generated) and when you chant your mantra, you may find yourself believing you smell lavender nearby. 

NEURONS THAT FIRE TOGETHER, WIRE TOGETHER

HEALING MUSIC & SOUND

Music and sounds evoke and often intensify emotions.  Depending on the type of music you are listening to, you can feel energized, mellow, happy, sad, nostalgic, aroused, loving, angry, powerful, peaceful and/or a combination of any of these emotions. 

Centuries ago, people understood that sounds have the potential to create calm and serenity. The ancient Greeks used music as a treatment for mental disorders, and believed in its healing benefits to the body, as did the ancient Egyptians, Aborigines in Australia and Tibetan monks. Gregorian chants, used in Christian liturgy, use the solfeggio frequencies, which was believed to lift chanters and listeners to a higher realm of consciousness and enlightenment. 

You may have specific songs that help change your mood. Music has the power to do this instantaneously. Perhaps, create a playlist of easily accessible songs and music that you can listen to when you need to feel calm, confident, energized, happy, etc. 

Quiet your mind. 

Energize your body. 

Reclaim your sense of peace. 

The Long-Term Plan

What can you start doing today to ward off future panic attacks? 

Manage your stress level. 

This cannot be over-stated! 

Anything and everything you do to manage the deleterious effects of chronic stress will go a long way in pushing future panic attacks further and further away. Here are some excellent ways to manage stress: 

MINDFULNESS

Mindfulness, the act of paying attention to the present moment with a non-judgmental attitude, is the anti-dote to stressful and mindless living, that robs you of your joie de vivre.  

When tackling, or better yet mindfully approaching, a daunting to-do list, take a long, deep diaphragmatic breath and complete one item at a time. Move on to the next after the completion of the previous item. This will immediately evoke a feeling of calm. 

We all think better, more creatively, and more efficiently when calm. Calm truly is a super-power. 

Additional strategies to bring about a calmer and more mindful state of mind would be to pause and ask yourself key, self-reflection questions. 

 

Take a moment and ask questions such as: 

• Do I feel connected to the present activity?

• Is this present activity energizing me or depleting me of my energy?

• How am I feeling right now?

• When I listen to my body, what is it telling me I need?

• What am I paying attention to at this moment? 

• What is the rhythm of my life right now? Too fast, too slow? Smooth, irregular? 

What about Mindfulness Meditation? 

The enigmatic practice of meditation, rooted in deep cultural and spiritual history as a pathway toward enlightenment, has found itself in modern times more commonly used to manage stress and induce relaxation. 

Whereas meditation is a system intended to bring about a heightened state of awareness and focused attention, mindfulness describes a specific manner of living that is cultivated through this system. Meditation is a process that allows you to slow down; to go inwardly, accessing deeper insights. In contrast to at time-out, it's more of a time-in. The more you access this state, the easier it will be to evoke the relaxation response when needed. 

The following popular Zen saying comes to mind: 

"You should sit in meditation for 20 minutes a day. 

Unless you are too busy, then you should sit for an hour."

NATURE

Engaging with nature nourishes your soul. Your body, hard-wired to the natural environment, needs fresh air and sunshine. Few today are reporting feeling energized, focused, and a general sense of well-being, and rates of feeling burned-out are exponentially escalating. This will increase feelings of anxiety. 

Although we find peace and tranquility in natural locations, we are unfortunately spending less time outdoors, tapping into nature's rhythm and bountiful health offerings, and more time indoors, in isolation, and in front of screens. 

Whether you take your lunch break strolling through a nearby park, or spend your week-ends swimming or kayaking in a lake or ocean, or dropping a line at your favorite fishing hole, going outside and experiencing fresh air will do wonders for your nervous system and spirit. 

EXERCISE

There is a large body of evidence supporting physical activity's effects on the management of mental health challenges, including panic attacks and related anxiety disorders. Yoga, cardio-type workouts and resistance training, also known as strength or weight training, have been shown to ameliorate symptomatology of depression and improve mood and energy.  You earn bonus points if you combine your workout with nature. YOUR BODY CRAVES MOVEMENT! 

Productivity, focus, and clarity soar when you and your body feel calm and connected, while fatigue, inattentiveness, and irritability elevate when you and your body feel dysregulated, disconnected, and fearful (or anxious). Exercise is a significant contributor to inner calmness. Aim for a minimum of 150 minutes per week. 

YOGA

The practice of yoga is STRONGLY recommended for overall health. Yoga is a mind-body practice that combines physical movement via poses, controlled breathing, and meditation to achieve a heightened state of relaxation. 

The consistent practice of yoga yields compounding results, meaning each and every time you participate in this moving meditation, you are decreasing the negative effects of stress. 

I especially love Yin yoga for overall health and relaxation. Yin targets the deep connective tissues, such as fascia, ligaments, and joints, and poses are held for a longer period of time. By stretching and deepening into the poses, the body experiences a restoration of a healthy flow of energy. 

NUTRITION

Numerous studies have documented the effects of a healthful diet on mental health and energy functioning. 

If you are already in the habit of eating real food, mostly plant based, and in reasonable caloric portions, then continue. If not, then this may be a good time to re-assess your diet and make changes that are best for you. Dietary supplementation may be helpful, and is individual to each person’s needs.  Avoid overly processed foods and sugar. Both can spike stress levels and fatigue, and increase susceptibility to disease.  

Magnesium

Magnesium is a vital mineral that helps your body facilitate many critical functions. It is involved in, but not limited to, nerve function, blood sugar, and blood pressure.  Magnesium has been shown to promote relaxation. In supplement form, it's known by some in the nutrition circles as the "Chill Pill."

Whether or not to include a magnesium supplement and what kind and how much will be best determined in collaboration with your physician, dietician, nutritionist, or other healthcare professional skilled in supplementation and anxiety disorders. For those who would rather get their intake through food, here is a delicious assortment of foods to incorporate into your diet. 

Foods that are rich in magnesium include: 

Dark chocolate

Leafy greens

Legumes

Avocados

Bananas

Fatty fish

Cashews, Brazil nuts & Almonds

Pumpkin, Flax & Chia Seeds

Caffeine

Limit caffeine intake (if anxious), especially coffee and/or caffeinated soft drinks. Instead, enjoy tea (caffeinated and herbal). Caffeinated teas, such as black and green, offer a balance of energy level, while also delivering a calming effect. If you have high blood pressure or tend to feel jittery and yet desire caffeine, black and/or green tea may be a better alternative. 

SLEEP

The circadian cycle, or rhythm, is an internal, natural process that regulates your sleep-wake cycle. It  typically repeats every 24-hours.  Lack of restorative sleep can give rise to feelings and sensations in the body that mimic anxiety. 

To maximize physical and mental health benefits, you need sleep; especially RESTORATIVE SLEEP. 

Offered here are important tips for getting the best, and most restorative, sleep needed for energy and emotional balance. 

• Your bedroom should be cool and dark, and free from distracting noise and devices. Some find white noise or background sounds of nature soothing. 
• Dim the lights and reduce screen time a few hours before going to bed. This prepares your brain and body ready for sleep. 
• Establish a relaxing bedtime routine. A nightly meditation practice can do wonders for stress management. 
• Attempt to go to bed and wake up at the same time each day. 

MASSAGE

Perhaps one of the oldest healing practices, the benefits of massage therapy are plentiful. Kneading and/or manipulating muscles and other soft tissues improves well-being and health, and significantly reduces irritability and anxiety deep within the body. 

Massage therapy has been known to lower blood pressure, decrease pain and tension, and relieve stress. One of its key benefits is in its immediate ability to naturally release endorphins and decrease adrenalin. This results in a state of deep relaxation. 

Schedule a 60 or 90 minute massage and reap the benefits of a tranquil body and mind. You earn bonus points if you schedule a succession of massage sessions for the rest of the year.  Put them on the schedule and they will be something you will regularly look forward to, knowing you are actively taking care of your body and health.  

PSYCHOTHERAPY

Anxiety disorders are highly treatable. If struggling, reach out and ask for help; professional help. You don't have to do this alone. Whether you are in  need of a few sessions in which a professional perspective is helpful, or a little more support, such as when going through a major life transition, one of the best gifts you can give yourself is the gift of healing. 

Seek a psychotherapist who is knowledgeable and experienced in treating anxiety and anxiety related disorders. 

Various types of talk-therapy as well as trauma therapy have been shown to be effective in treating anxiety and anxiety related conditions. Depending on the intervention you and your therapist collaboratively agree upon, these therapies help to identify and change negative thought and physiological patterns that contribute to or exacerbate panic attacks. 

If your therapist believes your symptoms may be helped with medication, then a  referral to a prescribing physician will be discussed with and recommended for you. If medication is recommended, it will in all likelihood fall into the following categories: 

Antidepressants, particularly selective serotonin re-uptake inhibitors (SSRIs), are commonly prescribed to help regulate mood and reduce the frequency of panic attacks.

Benzodiazepines, which are fast-acting anti-anxiety medications, may also be used in the short-term to manage acute panic attacks.

Long-term strategies to mitigate the recurrence  of panic attacks involve creating a lifestyle that supports physical and mental health, such as living aligned with your purpose, exercising, eating nutrient-dense foods, obtaining restorative sleep, and engaging a mindfulness mindset or practice. 

The information presented in this blog is intended for general knowledge and is not a substitute for medical advice or treatment. As with most things in life, there isn't a magic pill or "cure-all" but there are strategies to help regain control of your life. Consult with your healthcare professional to ensure that you are taking responsible steps to ameliorate signs and symptoms of an anxiety disorder. 

REFERENCE

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

https://www.healthline.com/health/anxiety/lavender-for-anxiety#science

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