How to recognise and manage a panic attack

“It felt like I was having a heart attack. I thought I was going to die!”

Claire sat across from me in the therapy room of my clinic, her face anxious, her hands gripping the sides of the chair. Her life, along with her successful dance and fitness business had been turned upside down two weeks earlier when she’d been rushed to hospital.

“I was just getting ready to leave for work”, she continued, “scanning through the morning’s post while I put on my coat. There was a letter from my bank. I thought it was just a statement or something at first, but it wasn’t. It was saying that I was $800 into my overdraft and there wasn’t enough money in the account to process my outstanding mortgage payments.”

“It didn’t make sense. How could that have happened without my noticing? My mind was racing, trying to think where that money could have gone … I looked down at the letter again and all of a sudden this … feeling just came over me. It was like this great rush of panic had just swallowed me up; I was shaking and sweating uncontrollably, my heart was banging like it was going to burst out of my chest and I could barely keep my mind together as I struggled and struggled for breath.”

“My partner must have heard me freaking out; he ran in, saw what was happening and called an ambulance. I felt numb. None of it seemed real. I could almost watch myself sitting there in the back of the ambulance. It didn’t look like me.”

“When we got to the emergency room they checked my heart and my blood pressure but couldn’t find anything wrong – nothing to suggest I’d had a heart attack or anything. So, I tried to just put it out of my mind and focus on dealing with my money issues. I hoped that might be the end of it.”

“But then, a couple of days later, it happened again when I heard the post dropping through my mailbox. I stood at the top of the stairs looking down at the little pile of letters and the whole thing started again … the panic, the shaking, the feeling that I was going to explode or drop dead. I couldn’t understand what was going on, or what was wrong with me. It happened again the day after that. Since then I haven’t been able to face opening any letters in case it’s more bad news. I’ve stopped checking my bank statements online too. Even thinking about what could be waiting for me there makes me feel totally sick.”

If I had a dollar for every time a client told me they felt like they were having a heart attack I could close my clinic and never work another day in my life! But, it’s understandable. If you suddenly start experiencing an incredible sense of panic, your heart starts pounding like mad and your breathing is going crazy, it’s natural you’d think something really bad is happening.

For soloists and business-people the suddenness of a panic attack and the loss of control can be totally de-railing, and it can have a serious impact on your life and your work.

For Claire, it wasn’t just her finances that suffered; she found herself unable to perform the dance classes that were her livelihood. The heightened heart rate and breathing that came from running the class was too similar to the symptoms she’d felt and she was afraid if she took part in any strenuous exercise it could trigger another episode.

How to recognise a panic attack

When I first met Claire she’d been told her experiences may be related to panic attacks, but she still didn’t really know what that meant. The first thing we worked on was helping her recognise the symptoms, and understanding that they aren’t a sign of any impending catastrophe.

Symptoms of a panic attack include:

• Intense feelings of panic and stress
• Trembling and shaking
• Sweating
• Increased heart rate
• Difficulty breathing
• Numbness or tingling in your hands and feet
• Feeling dizzy or light-headed
• Chest pain
• Fear that you are dying
• Dissociation or feeling detached from yourself

A lot of these symptoms are common to both panic attacks and heart attacks. However, there are a couple of noticeable differences*:

• Heart attacks often entail a gradually increasing feeling of pain that starts in the chest and spreads to the arms and other areas of the body.
• In panic attacks, the pain tends to be localised to the chest and is sudden or stabbing in nature. In a panic attack you may also hear and feel your heart beating in your head, whereas in a heart attack you typically would not.

Understanding and managing the problem

Panic attacks can be made worse or even triggered outright by your thoughts and reaction to the physical symptoms. i.e. You feel your heart racing or the tightness in your chest, and you think that something terrible is happening, which increases your anxiety and causes the physical sensations to escalate. People who have suffered from panic attacks often fear future attacks, and this fear of the physical symptoms only makes future attacks more likely.

The good news is that understanding the real nature of a panic attack is therefore half the battle. Once you know you aren’t going to drop dead or spontaneously catch fire every time your heart starts beating a little strangely, you might find that your emotional response to the attack is much less severe.

Claire resolved to understand her symptoms and refused to let them control her life, and this was the first crucial step in recovery. While we worked on using Cognitive Behavioural Therapy to identify and change the thoughts that were leading to, and escalating, her panic attacks, Claire used the following strategies to help manage panic attacks as they were happening:

• Breathing exercises: Taking deep, regular breaths can slow your heart rate down and feeds back to your body that you are not in a state of worry, helping reduce feelings of panic.
• Focussing on the moment: Reining in your attention to focus solely on something right in front of you, such as a physical object, so that your thoughts can’t escalate and lead to further panic.
• Knowing the triggers: Panic attacks can be brought on by specific situations (in Claire’s case receiving letters or thinking about her finances). Knowing what these are, avoiding them where possible and confronting them gradually, in a relaxed way, can reduce the impact they have.
• Muscle relaxation: Stretching or clenching and unclenching muscles in your arms and legs can take your mind of what is happening and helps produce physical relaxation, which cycles round into mental relaxation.
• Mindfulness: Practices like mindfulness and meditation are great for calming your mind and becoming aware of your physical sensations without reacting to them fearfully.
• Accept the situation: Rather than producing more stress by trying to fight against your panic attack, just accept that it is happening and that it is a temporary state that will pass.

Creating a panic-free lifestyle

Recognising and managing the symptoms of a panic attack on a moment-to-moment basis can be really helpful. But long-term recovery only comes when you create a life for yourself where panic has nothing to take hold of. This means finding ways to deal with stress and cutting down on behaviours and thought patterns that lead to anxiety by making time for all of the following in your daily routine:

• Fun and relaxation
• Enough sleep
• Healthy eating
• Exercise
• Talking about your worries and stress with trusted friends/partners
• Planning for the future

It can also mean cutting down on or eliminating the sources of stress in your life. For Claire, meeting her anxiety head-on and re-connecting with her financial problems was the toughest part of her journey but it was the final blow in the fight with her panic attacks, and she made a full recovery.

In summary

Panic attacks can hit anyone. Knowing how to recognise and manage the symptoms can make them far less terrifying and thereby reduce the chances of them becoming a recurring problem. But, while an attack may seem like it’s coming out of the blue, there’s often an underlying component of stress or worry that brought it on.

You’re probably tired of reading this but making the effort to safeguard your life against anxiety with the above methods will do you a world of good. And no, “I’m too busy” and “That’s not how my lifestyle works” are not valid excuses. Trust me, I’ve heard them all before.

Get serious about looking after yourself now, and here’s hoping you might never need to know what a panic attack feels like.