The key to overcoming panic attacks

The Key to
Overcoming Panic Attacks
The surest path to overcoming panic attacks is to
train yourself to respond to panic in accepting and
calming ways.
This article will show you a specific, simple, and
powerful set of tips for overcoming panic attacks.
You can also listen to a radio interview in which I
discuss these steps.
As you read the steps described below, think about
how they compare to what you usually do during a
panic attack. The Panic Trick tells us that your gut
instinct of how to respond to a panic attack will
likely be to do something that makes the problem
worse rather than better. The path to overcoming
panic attacks requires responses that are quite
different from what you usually do. If you keep
doing the same thing, you'll probably keep getting
the same result. If you seek anxiety relief, you
need to look for different methods.
Here's a five step process you can use to guide
your responses during a panic attack. The regular
use of this approach will go a long way towards
your goal of overcoming panic attacks. I have
adapted this, with some modifications of my own,
from Anxiety Disorders and Phobias: A Cognitive
Perspective , an excellent professional text by Beck,
Greenberg, and Emery.
The Five Steps of AWARE
The five steps to overcoming panic attacks are:
A cknowledge & Accept
W ait & Watch (and maybe, Work)
A ctions (to make myself more comfortable)
R epeat
E nd
Let's take a look at what each step entails.
Acknowledge & Accept
All progress starts here. This is the most
important single step to overcoming panic attacks.
Acknowledge
Here I acknowledge the present reality, that I'm
afraid and starting to panic. I won't try to ignore it,
or pretend it's not there. I won't struggle to
distract myself, tell myself to "stop thinking about
it!", or snap any rubber bands on my wrist.
I'm acknowledging simply that I am afraid, not that
I am in danger. The thought that I am in danger is
just another symptom of panic, not an important
or useful thought.
Accept
Here I accept the fact that I'm afraid at this
moment. I don't fight the feeling; ask God to take it
away; blame myself, or anybody else. I accept, as
best I can, that I'm afraid in the same way I would
accept a headache. I don't like headaches, but I
don't bang my head against the wall in an effort to
get rid of them, because that makes them worse.
Overcoming panic attacks begins with working
with, not against, my panic and anxiety symptoms.
How Can I Accept a Panic Attack?
What makes a panic attack acceptable (not
desirable, but acceptable) is that, while it feels
awful and fills me with dread, it isn't dangerous. It
won't kill me or make me crazy. Someone pointing
a gun at me, that's not acceptable. I might get hurt
or killed. If someone points a gun at me, I have to
do whatever I can to change that: run, hide, fight,
yell, bribe, or beg, because the consequence of
being shot is so terrible that I must try to avoid it.
On the other hand - a policeman giving me a
ticket, even if I don't deserve it, I can live with that,
and can hopefully keep my temper in check so I
don't make things worse for myself.
Accepting the symptoms, not resisting, is a
powerful step to overcoming panic attacks.
What Can a Panic Attack Do to Me?
It makes me feel afraid, that's what a panic attack
does. And, if I'm having a panic attack, I'm already
there! I'm already experiencing the worst that will
happen. I just need to ride it out. That's the surest
path to overcoming panic attacks.
Why should I accept a panic attack? Because the
more I resist panic, the worse it gets. The more I
develop the habit of acceptance, the more progress
I make toward my goal of overcoming panic
attacks.
That's Acknowledge & Accept. How does that
compare to what you usually do during a panic
attack?
Wait & Watch (and maybe, Work)
Wait
What I mean by "Wait" is this: don't just do
something, stand there. It's similar to the
suggestion "count to ten before you get mad".
One of the hallmarks of a panic attack is that it
temporarily robs you of your ability to think,
remember, and concentrate. This step will buy you
a little time to regain those abilities before you take
any action.
When you react before you have a chance to think
straight, what do you do? If you're like most
people, you probably flee, or struggle. You do
things that actually make it worse. This is what
people mean when they say things like "I know I'm
doing it to myself" and the harder I try, the worse
it gets.
Jumping into action too quickly is a big obstacle
to overcoming panic attacks.
So, even though you have a powerful urge to
leave, postpone that decision for a little bit. Don't
tell yourself you CAN'T leave - keep that option
open so you don't feel trapped - but put off the
decision about whether or not to leave. Stay in the
situation. You don't need to run away to get relief.
Let relief come to you.
Watch
Use the occasion to observe how the panic works,
and how you respond to it. The best way to do this
is to fill out a panic diary. The diary is a
questionnaire which helps you notice important
aspects of a panic attack, so you can respond
more effectively over time. Feel free to download
and reproduce it for your own personal use. You
can also download a set of instructions .
My patients often report that just filling out a diary
helps them to calm down. How does this work?
It's not that they're distracted from the subject of
panic, because the diary questions are all about
panic. It helps you get a little distance from your
emotions. It works because, while you complete a
diary, you're in the role of an observer, rather than
feeling like a victim.
The best way to use the diary is to fill it out during
the attack, rather than after. If you're in a situation
where writing is impractical, perhaps while driving
a car, you can: use a digital recorder; have your
support person read the questions to you and
record your answers; or pull over for a few
minutes to write.
What About "Work"?
If you're in a relatively passive situation during the
panic attack - a passenger in a vehicle, getting
your hair cut, or waiting in a waiting room - "Wait
& Watch" is all you need. If you're in a more active
role - driving a car or giving a presentation - then
you also need to attend to the "Work" of
conducting that activity. Do "Wait & Watch", but
also remain engaged in your task.
That's "Wait & Watch (and maybe, Work)". How
does that compare to what you usually do during a
panic attack?
Actions (to make myself more comfortable)
At this point, you've already gone through the two
most important steps to overcoming panic attacks.
These steps, and all the steps necessary to
overcome panic disorder and phobia, are covered
in much more detail in my Panic Attacks
Workbook .
What's Your Job During an Attack?
It's not your job to bring the panic attack to an
end; that will happen no matter what you do.
Your job now is to see if you can make yourself a
little more comfortable, while you wait for the
attack to end.
Here are a few techniques that my patients have
found particularly useful in overcoming panic
attacks.
Belly Breathing
Regardless of what else you do, do belly breathing .
It's also known as diaphragmatic breathing, but I
think "belly breathing" is more descriptive. Many
people think they know how to do deep breathing,
but don't do it correctly, so they don't get good
results. A good belly breathing technique is a very
powerful tool in the work of overcoming panic
attacks!
How to Talk to Yourself
Talk to yourself (silently!) about what is happening,
and what you need to do. One question my
patients find very helpful is this: is it Danger or
Discomfort? . Some of the other responses my
patients like include the following:
1. Fine, let's have an attack! It's a good chance to
practice my coping techniques.
2. Answer your "what if...?" fears by saying "So
what? I'll get afraid, then calm down again."
3. It's okay to be afraid.
Get Involved in the Present
People don't panic in the present. People panic
when they imagine something bad happening to
them in the future or in the past. This is why your
panic attacks are almost always accompanied by
some "what if...?" thought. If a dog just bit my leg,
I don't say "what if a dogbite?". The reason you
say "what if...?" is because what you fear is not
actually happening!
Get back into the activity you were engaged in
prior to the attack, and become involved with the
people and objects around you. If you're in a store,
resume shopping, reading labels, comparing
prices, asking questions, etc. It will move you
closer to your goal of overcoming panic attacks
when you bring your focus and energy back to the
present environment. By this I mean, work with
what is around you.
Work with Your Body
Identify, and relax, the parts of your body that get
most tense during a panic attack. This typically
involves first tensing, and then relaxing, the
muscles of your jaw, neck, shoulders, back and
legs. Do not allow yourself to stand rigid, muscles
tensed, and holding your breath. That just makes
you feel worse! If you feel like you "can't move a
muscle", start with just one finger!
That's "Actions (to make myself more
comfortable)". How does that compare with what
you usually do during a panic attack?
Repeat
This step is here because you might start feeling
better, then feel another wave of panic. Your first
reaction might then be to think "Oh No, it didn't
work!". The Repeat step is here to remind you that
it's OK if that happens. Just take it from the top
again . It's not unusual or dangerous. You may go
through several cycles, and you just need to repeat
the AWARE steps again, as often as you need.
How does that compare with what you usually do?
End
This is here to remind you that your panic attack
will end; that all panic attacks end; that they end
regardless of how you respond; that it's not your
job to make the attack end; and that your only job
is to make yourself as comfortable as possible
while waiting for the attack to end.
Hasn't those statements been true for you? Don't
try to take my word for it. Review your own history
of panic attacks and see.
And maybe the next time you panic, when you
notice yourself thinking, once again, "Will this ever
end?", you'll find yourself answering, "YES!"