Emotional Wellbeing

Mental Health

Mandy Kloppers

How to cope with a panic attack

There are many ways to cope with a panic attack. The trick is to find the best method that works for you. In this blog post, I will discuss the symptoms of a panic attack and give you ideas on how to cope with a panic attack.

Experiencing a panic attack is very frightening. You feel out of control and worry that you are unsafe. Thoughts such as, “What if I pass out?” are common – especially in public places, such as on public transport or in a restaurant.

Thoughts effect feelings and feelings effect behaviour

When you worry that you might have a panic attack, you become hypervigilant for any possible signs of an impending panic attack. This hypervigilance leads to anxiety and the more anxious we feel, the more anxiety symptoms emerge in the body. This int run reinforces the fear and anxiety and cycle worsens.

Symptoms of a panic attack

Heart attack sensation

Individuals experiencing a panic attack often report feeling as if they are having a heart attack. Usually, panic attacks aren’t a one-off so it might be useful to ask yourself:

“Did I have a heart attack the last time I felt this way?” If not, why is there any reason to think that it is different this time?

Feeling dizzy

Feeling dizzy is another common symptom. We breathe in oxygen and breathe out carbon dioxide. When you breathe quickly/ deeply, this flushes out the air and causes the level of carbon dioxide to drop. Your blood becomes more alkaline and this manifests in a physical manner. It causes dizziness, our heart rate increases, tingling may be felt, you may feel unreal or distanced from the experience.

Fear of going crazy

Often when people have a panic attack they think that they are starting to lose touch with reality and are going insane. This thought, naturally, will make anyone anxious. It is worth noting the difference between panic and severe mental illness. Panic attacks and other anxiety problems are very common and typically occur in the context of normal human experience while severe mental illnesses such as schizophrenia or bipolar disorder are rare.

Panic attacks do not cause either of these mental illnesses. People with panic are no more likely than anyone else to develop a severe mental illness.

Fear of fainting

It is very common for people to think that they are about to faint when they have a panic attack. When people faint they do so because their blood pressure is too low and not enough oxygen is getting to the brain. The most obvious consequence of fainting is that you fall over. Once we are lying down your heart is at the same level as the brain and no longer has to pump blood uphill. Also, your muscles relax releasing blood for your brain. As a result, your blood pressure quickly increases and you soon recover.

Fainting is another way your body protects you from harm.  Now, think about what happens during a panic attack: as soon as we become anxious our hearts beat much faster than usual, and our blood pressure increases. This is exactly the opposite of what happens when we faint.

It is very common to think that you may faint while panicking, but this does not happen.  There is one exception to this rule, which happens to people who have what we call a blood-injury phobia. These are people who have an extreme fear of blood, injuries, needles and surgery. Most people are frightened of these things, but the phobia involves a much more extreme fear than usual. People with this type of phobia react differently when they encounter their fear in that their blood pressure drops. This probably occurs because if your blood pressure drops, you would bleed less and are more likely survive if you have been severely injured. There is a specific technique called applied tension that increases blood pressure and that can be taught to people who have this type of phobia. However, unless you have this rare problem (and you would know it if you did), remind yourself that you are less likely to faint while panicking than you are at any other time.


The fear of losing control 

For some people, the catastrophic fear is that they will lose control when they become very anxious. They worry that they will run around wildly, hurting themselves or others in the process while shouting obscenities. According to the NHS National electronic Library of Mental Health, there never has been a documented case of anybody doing anything ‘out of control’ in this way while experiencing a panic attack. If you have been worried that you may lose control, then it may be helpful to ask yourself, “Did I really do something completely out of control the last time I had a panic attack?”


The fear of suffocating 

One of the most common symptoms of anxiety is to breathe rapidly so that you can get more oxygen for your muscles. We do this in order to prepare to fight or to run away from the danger as part of our fight-or-flight response. However, breathing too quickly, while not harmful, can worsen the symptoms of panic, such as feeling faint, tingling sensations, dizziness, and being out of breath. In fact, for many people, the worst symptoms of panic are a result of their breathing. This happens because the rapid breathing changes the Oxygen (O2) and Carbon Dioxide (CO2) levels in our blood. We inhale oxygen and exhale carbon dioxide. The balance is upset when we breathe too quickly than what is required by our bodies and we have too much oxygen in our bloodstreams.

When the delicate balance between oxygen and carbon dioxide is upset, we tend to breathe even faster even though what we need is less oxygen, not more. This is why it is so common for people to breathe into a paper bag when they hyperventilate. Breathing into a paper bag means that you re-breathe the carbon dioxide that you exhale and this increases the level of carbon dioxide in your blood, restoring the correct balance.

So although we feel like we are out of breath, we actually have breathed in too much oxygen rather than too little. This is harmless, but uncomfortable. Breathing the carbon dioxide that we have exhaled into the paper bag restores the balance. However, a better way to restore this balance is to breathe in a controlled way, which will be explained in the next section.

People who worry about suffocating sometimes worry about being in small rooms, or hot rooms, or rooms without ventilation, because they fear that they will not get enough air. This fear may trigger a panic attack. The reality is that rooms that we encounter in everyday life are not airtight. Test this by asking a friend to spray some toilet spray around the edge of a closed door to see if the smell of the freshener leaks through. This will reveal that the air supply is in fact limitless – air flows in and out through the narrow smallest gaps more quickly than we need. Also, the temperature of the room makes no difference to how much oxygen is available to us – warm air is still just as rich in oxygen. Opening windows to let in the air may make us feel better, but this not necessary for us to breathe.


The fear of losing control of bowels or bladder 

Another common fear is that we will lose control of our bowels or bladder while panicking.  The question to ask yourself, again, is if it did not happen last time, why think that it will happen this time? You can cope with a panic attack more effectively when you are able to tell yourself that your fear has never come true.



The fear of vomiting 

Similarly, the fear of vomiting is often implicated in panic attacks, yet very few people ever claim to have vomited during a panic attack. We may feel bilious when anxious, but that does not mean that we will vomit. Think about how often you have felt bilious without vomiting.  It’s easier to cope with a panic attack when you consider some of the common misinterpretations that we make when we panic, not all of them. The section below will help you challenge these and any other thoughts that turn normal anxiety into panic.


How to manage a panic attack

Instead of fearing and fighting uncomfortable emotions and desperately trying to get rid of them, it is possible to learn how to sit with and tolerate emotional distress, such that we learn the emotion will pass and that we can cope.
This will involve identifying and challenging beliefs we hold about emotions, and learning to balance tolerating emotional discomfort when it does arise, with taking
action to improve our emotional experiences.

Know your triggers

It’s important to know what situations trigger you. Is it when you are on a train, during work meetings, in a restaurant? Generally, there will be a pattern where panic attacks begin. There may be a critical incident that occurred in the past that has contributed to the panic cycle. Understanding your triggers can help you cope with a panic attack and be more prepared.


Grounding techniques

These work for some people- deep breathing and focusing externally. When you focus on yourself (internally) you are more likely to be hypervigilant and ‘primed’ for a panic attack. Listen to audiotapes or music or make an effort to focus on your surroundings. Count the number of people wearing brown shoes for example.

Visualise a happy place

I like to imagine a beach with seagulls and the sound of the waves. It relaxes me. For some people, visualisation works really well. Your happy place can help you cope with a panic attack. It soothes the mind and can ease anxiety.

Approach rather than avoid

The worst thing you can do is to stay home and avoid going out. This will intensify your fear and leave you feeling powerless and helpless. Take baby steps to approach your fears. If your fear is that you will panic in front of a group of people, try standing near a group of strangers for 5 minutes. Increase that time as you gain more confidence, then move up to something a little more challenging, meeting up with a friend. Whatever your fear is, avoiding it completely will make you less confident in the long run. It may feel good at the time but longterm you will feel even more paralysed by your fears. Your quality of life will deteriorate the longer you avoid.

Challenge your thinking. Have your fears happened in the past? Often, people with panic disorder have never had the feared situation happen to them. The fear is irrational and new associations need to be made. This can be done through therapy as well as approach behaviour rather than avoiding.

It’s possible to cope with a panic attack and overcome your fears. If you have tried and been unsuccessful in reducing your anxiety, it may be a good idea to contact a counselor for support.

Mandy X


Photo by Brett Jordan on Unsplash