Panic Attacks: What are they and what we can do about them?

A couple of months ago I woke up in the middle of the night unable to breathe. My heart was beating so fast, I could hear it in my ears. I felt a huge wave of heat pass through my body like I was burning myself from the inside out. I thought I was going to die because it was my first real experience of encountering something so utterly terrifying. I couldn’t find a possible explanation for why my body was acting the way it was. The fear of the experience itself was enough to kill me. I later learnt that it was a panic attack. Until then I had no idea what a panic attack felt like. I live with anxiety and I suffer from the usual dose of anxiety attacks. However, nothing prepared me for the harrowing experience I would face because of panic attacks.

My experience with panic attacks lasted for a couple of months. I have incredible respect and kindness for people who have dealt with panic disorders for years. It wasn’t a day in the park. The whole experience was a lonely one. I say this because panic attack as a term is so common in our popular vocabulary. But when it comes to actually understanding what the experience is about, very few of us actually grasp it. Panic attack is not similar to anxiety attack that hits you when you feel nervous about something. Panic attacks are so intense that your entire system feels as if it is dysregulated. Worse of all, it comes with no warning. There is no point in understanding triggers because panic attacks can happen in normal situations with absolutely no threats around us. This post aims to provide a primer on how to identify panic attacks and what you can do if you are experiencing one.

Common Signs of Panic Attacks:

  • Rapid Heartbeat.
  • Feeling like you can’t breathe (You actually can).
  • Hot Flashes.
  • Having a Fight or Freeze response (feeling like you cannot move).
  • De-realization or Dissociation – Feeling like your surrounding is not real, feeling stuck in your body, feeling like you are trapped inside a bubble. In this state you might feel like reality is foggy and distorted. Your mind feels like it is floating in an unreal world.
  • Uncontrollable Thoughts – A large number of intrusive, catastrophic thoughts that flood your mind; you seem to be having no control over them.
  • Avoidant behaviour – While not a sign of panic attack itself, avoidance of certain activities due to fear of having a panic attack in the middle of the activity and the fear of feeling helpless at such a moment, leads to avoiding those activities altogether. For example, I had a panic attack while inside my bathroom. After this incident, I avoided using my bathroom for the fear of being trapped inside while experiencing some life threatening danger.

How to Handle Panic Attacks:

If you think you are having a panic attack try the following methods and figure out what works best for you.

Breathe: This might sound simple, but this is one of the most effective means to bring you back from a panicked state. When we are panicked, it might feel like we cannot breathe. We also might feel like it takes immense effort to breathe. Something that happens by default, without your awareness now feels like it needs all the effort in the world. It is a debilitating feeling to be there. However, bringing back your attention to breathing, and slowly inhaling and exhaling can help in slowing down your racing mind. Belly breathing or diaphragmatic breathing is a simple technique that can help in activating your vagus nerve while allowing your lungs to expand and take in more oxygen. This in turn relaxes your body, putting an end to the fight or flight response. I feel breathing is the most effective method because it can be done anywhere with minimal effort. Whether you are in the middle of a crowded market or on your bed unable to move your limbs, you can always count on breathing to relax yourself.

Ground: Dissociation is one scary aspect of having a panic attack. It is when we stop being present in the reality. Our mind is racing across time and space, trying to grasp solutions for problems that it conjures up over no time. Most of these problems are not relevant or real. To the anxious mind, the difference between actual problem and imagined problem is blurred. A state of dissociation feels like reality is overwhelming and you are disconnected from it. Practicing grounding exercises can bring you back in connection with reality. Instead of being preoccupied with a future, anticipated failure, the mind needs to engage with what is present right now. One of the most popular grounding exercises is the 5-4-3-2-1 technique that engages all your 5 senses. You notice five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste. Through all of the above exercises, try to involve your senses as deeply as possible, describing the texture, taste or smell of the objects in detail.

Be Mindful: Mindfulness is meditative. Bringing your attention to any action you are doing, gently observing it with no impulsiveness and just being open to connecting yourself to everything around you feels like you are part of a grander scheme of things. By bringing your full awareness to anything you are doing, you feel part of the present –a living entity sensing, feeling and experiencing life as it is. It might be extremely hard to be slow down and be mindful while you are frantically trying to do something. It might seem frivolous to pay attention to senses you generally won’t mind ignoring. Mindfulness isn’t easy. It is a practice that needs continuous effort. Maybe you will fail in the first few attempts; maybe you might feel more anxious that you aren’t able to be mindful, maybe it feels like it is not helping. Whatever the reason, mindfulness can be hard to practice in a world that is already built on attention economy – we are always distracted by the next big thing and it feels like we are reaching a sensory overload. The trick is to consistently try to bring your full awareness to any activity you are doing. One of the best activities that I like doing is eating a piece of fruit – exploring its textures with my tongue, allowing the juices to slowly fill my mouth and just savouring it for a long time. It is an extremely pleasurable activity that makes me feel ecstatic. Just bringing awareness to the seemingly mundane things helps you slow down, be more present and appreciate the world for what it is.

Exercise: Next to breathing, exercise is the second thing that you can physically engage yourself in while handling panic attacks. Anything that makes your body move, increases your heart rate and makes you feel breathless is a good place to start. After a fast run, you might feel all the classic signs of a panic attack – pounding heart, gasping for breath, sweating and feeling like you are falling apart. Exercise is a good way to spend all the built up stress hormones in our body – instead of panting while at rest, you might as well pant while being physically active.

Channel the energy into creativity: Understanding what happens inside your body while you are experiencing a panic attack provides some useful tools to manage it. It is a fascinating process – when you are panicked, adrenaline rushes through your body, increasing your heart rate, making you breathe rapidly so that increased oxygen can pump through your muscles. It is a state where your senses are heightened, your blood sugar is high and you are full of energy to sprint at the sight of any danger. Ironically, you are more alive and alert than you have ever been – it feels like a superpower, the amount of energy your body can produces. However, you feel like you are dying. That is what fear does to you. Spending this ample energy in activities that need them is a healthy way to spend all the energy.

Challenge avoidant behaviour: The worst side of having a panic disorder is avoiding activities out of fear. Some might go on to develop phobias if the avoidant behaviour is not addressed. When I was having back to back panic attacks, I felt an intense fear of moving anywhere outside my room. Even walking in to the kitchen felt like I might faint in there. I couldn’t even imagine leaving my house. I feared walking outside, having a panic attack, fainting and making an embarrassment out of myself. I was worried about what I would do if I had an episode in public. Will people notice? Would they have to call an ambulance if things go out of hand? What if I die in the middle of the road and get run over by a car? The fearful thoughts were endless. The idea of leaving my house made me anxious which in turn made me more anxious that I cannot do the most basic things. It was a hellish cycle of avoidance and anxiety. The best thing to do at such a situation is to face your fears. Once we expose ourselves to situations that cause us panic, we slowly realise that those situations are not that bad after all. It takes a lot of mental effort and time, but the avoidant behaviour gradually improves only by facing the fears. So if you feel like you are going to die by climbing a flight of stairs, just climb it, feel the panic rushing through your body, sit with it and realise that you didn’t actually die.

Embrace it: While your body is already using up all its energy in preparing itself for an unknown danger, you might feel exhausted and spent. It might feel tiresome to fight against panic attacks. In such a situation, recognising that you are having a panic attack and letting it pass through your body without fighting it is effective enough. When you realise that you are not dying, that you are only feeling uncomfortable, and that that feeling would pass, you just let the panic response be there. Eventually your body uses up all its energy, it gets tired and the panic attack ends. No panic attack is going to last forever. Just living with the discomfort, while doing any activity that your non-panicked self would do is one way to just let it go. The key thing to remember is that a panicked body is still a functional body.  

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