Panic and severe anxiety attacks
Some people experience feelings of panic or extreme anxiety occasionally; for other people such feelings occur daily. However, even one bout of panic is too much. There is no more frightening and exhausting experience than an attack of this nature.
Let me reassure you of two things.
- You are not going mad because you experience bouts of panic. Attacks of panic can be so traumatic that you may think you are losing your mind, but you are not. You are in the temporary grip of a severe nervous reaction due to your current state of mental, and possibly physical, exhaustion and oversensitiveness. Your nervous system is temporarily playing up or out of gear. Because of your anxiety about this you are reacting with panic.
- You can and will come out of this phase of your life. Eventually, you will be able to deal quite effectively with feelings of panic and fear. You will get on top of them and they will give you no more trouble. Many of my former clients are now leading panic- free lives as a result of successfully applying the methods explained in this step. Previously they experienced frequent and debilitating attacks of panic and severe anxiety, which terrified them and limited their ability to live life to the full.
If we are in a general state of anxiety (as distinct from occasionally feeling anxious about something in particular, which is a normal part of human experience) or suffering from depression, even mild depression, we are particularly prone to panic. We will also be oversensitive and prone to overreact. Panic attacks occur when we are low on nervous (and often physical) energy and in a state of tension. Add to this any emotional bruises from early childhood or adolescent stresses, and the combination of factors can create the climate in which panic is most likely to occur.
Panic attacks are unpredictable
Attacks of panic and anxiety are unpredictable. Not only do they occur when we least expect them, but they often occur some time after the stressful situation or event. In that case, our nervous system is still reacting to the past stress.
Attacks can take different forms. Some of us shake, some feel very hot or cold, some feel faint, have trouble breathing, experience a sudden severe headache, feel ill or vomit. The many and varied physical manifestations of panic attacks are always accompanied by awful feelings of fear and excessive anxiety. Some of us experience panic only on the emotional level - we may feel terrible, but we don’t have any physical symptoms. As many of my clients have said: ‘I don’t know what I am frightened of, but when I have a panic attack I feel absolutely terrified’.
Panic has no set pattern. It can occur daily or occasionally. It can be mild or so severe that it causes us to be in a state of absolute terror and leaves us unable to function normally. It can come when we are in a specific situation - crowds, open spaces, lifts or any situation that stresses us.
The source of the panic and the form it takes have little influence on the ways of treating it, as the principles of treatment don’t change.
Whether we experience panic or not is probably related to various factors including our tolerance of stress, the sensitivity of our nervous system, the development of our coping mechanisms, and biochemical variables that are not yet completely understood.
The likelihood of panic attacks is increased by stress, which we may have experienced in the past and which can date from childhood. That stress can be reinforced or reactivated when we experience similar feelings of stress in adulthood. The memories of early feelings are locked inside us, even though the events that caused the feelings are long forgotten.
Fear of anxiety and panic
Either present stress or a reaction to past stress causes a panic attack, and the fear of how we are going to cope when it hits feeds panic. This fear is separate from the anxiety or panic itself, and occurs before either sets in. If we dread the coming of panic, we add to the stress we are already exposed to.
A client once said that she was frightened of the dark and of being alone in the house at night. Her husband had a new job that required him to work nightshifts. The client was very afraid of how she was going to feel when alone at night - she even worried about it during the day and at night when her husband was at home, not working.
Anyone who has ever feared a panic attack will identify with this story. The way to add to and prolong a feeling of panic is to feed it with fear.
Once we lose our fear of panic or anxiety attacks, the attacks seem to occur less frequently, and eventually not at all. If we have a weapon to deal with our fear of panic, we eventually reach the stage of having an ‘I don’t care whether it happens’ attitude. Then panic either disappears entirely or ceases to be a problem.
A young nurse who had been suffering badly from daily panic attacks said about this program: ‘It’s like having an anti-panic weapon in my head. It’s there at all times for me to use when and if I need it. Knowing this gives me the confidence not to care whether I am going to have an attack, because I know that I can handle it’.
How to handle panic and excessive anxiety
The trick is to accept, relax and let it pass. This trick is the antipanic weapon you can carry in your mind. It will be available to you wherever and whenever you need it.
The first step in coping with panic is to accept its existence. If you get upset at the thought of panic, get anxious about it, pretend it is not happening or try to fight it with rigid self-control, you will worsen and prolong the attack.
For example, by having thoughts such as ‘If only I am strong and controlled enough, I can beat it’ or ‘It is my own fault that these attacks occur. I must develop more self-control’ you actually make matters worse for yourself.
It is quite natural to react like this. However, it is not the way to overcome panic. Reacting this way feeds panic and keeps it going, often making it more intense. Being anxious about anxiety adds stress to stress. It becomes a vicious circle. Also, as happens when we dwell on negative thoughts (see Step 1), being anxious about anxiety relates and ties the anxiety to us rather than allowing us to stand back from it and look at our fears objectively.
Instead of fearing panic attacks, we must distance ourselves from them. You can do this by realising that a combination of tension (mental and physical) and nervous exhaustion create the climate for these attacks. Our nervous system can work in a strange way and its operation can result in extremely strong symptoms - it is certainly not just ‘all in the mind’, as some people might say. The symptoms that your nervous system is producing are having a strong effect on you.
However, there are two very important facts about these symptoms.
- These feelings of anxiety and panic cannot harm you.
- These feelings will not last.
These facts comfort people who feel that they are going to die or go mad, or at least be physically or mentally harmed by panic attacks. These things will not happen, no matter how bad you feel during an attack. Your attack is like a toothless tiger - it seems ferocious but it has no power. Try to see your attacks in this light.
An elderly client told me that the thought of a toothless tiger makes her laugh, and laughing immediately reduces the intensity of the panic attack.
When you regard your panic only as a nuisance, and so lose your fear of it, you will begin to get on top of it. Attacks will lessen in intensity and frequency. A young client told me that he has got into the habit of saying to himself aloud, when he feels an attack approaching, ‘Here we go again, what a bore’. He then takes some deep breaths and sits quietly waiting for it to pass. Since adopting this attitude his panic attacks have been reduced to a third of their previous scale.
Accept what is happening. Don’t get upset about it. In asking you to accept your attacks, I am not asking you to like them. There are many things in our lives which we do not like, but we accept them and live through them. Be very low-key and relaxed in your acceptance, not tense. Do not challenge yourself to see how well you can accept. Don’t strain yourself at all. Acceptance is a passive thing. Just let the anxious moment pass.
It is important to apply this method at the first sign of an attack (there is usually a warning of a few seconds). It is far easier to fore-stall and thus prevent anxiety or a panic attack with your own anti-panic weapon, than to have to go through an attack. If you wait until you are really into an attack, it is a little more difficult to deal with - although you can certainly deal with it effectively.
We can all handle something that is going to last only a short time.
I have known people who, once they learned about the method of accept–relax–let it pass, never had another attack. The only way I can explain this is by assuming that once they knew that they were equipped to deal with an attack, they could overcome their fear of an attack.
This is the second step in coping with panic and anxiety. The better you have mastered the skill of relaxation, the more effectively it will work for you. If you practise relaxation daily, you will have it at your fingertips.
Once you have accepted the attack, very quickly apply instant relaxation. Take a deep breath - let go - feel yourself relaxing both mentally and physically. It is easier to do this sitting down (you can feel yourself slumping in your chair), but you can also do it standing up if you have to. Leaning against something will encourage the relaxation process.
Applying instant relaxation at the mental and physical levels is just as important as the first step: acceptance. Each step on its own is important but incomplete. Together, the three steps form a powerful weapon, which works to overcome your attacks when properly used. The quicker you apply your instant relaxation after the first step - acceptance - the better. It should all happen in a fast process, a natural and smooth progression from one step to the next with no breaks. The more proficient you become in instant relaxation (some people practise it four to six times a day to start with), the easier it will be to flow smoothly and quickly from the first step to the second.
Let it pass
This is the third and final component of your anti-panic weapon.
By ‘let it pass’ I mean let it blow over. As soon as you feel that you have relaxed mentally and physically, take this final step. Once more, it is a smooth and speedy flowing from acceptance to relaxation to letting it pass. When you have practised this method for a reasonable time, you will find that there are no discernible starts and stops between steps. It will seem as though you are applying them simultaneously. Letting it pass simply means that you remain utterly accepting and relaxed while the next couple of minutes (or seconds) pass.
If you have difficulty passively accepting this third step, then very slowly and calmly feed in words and phrases like the following examples.
I am calmly floating through and beyond this panic -
I am gently drifting out of it - I am in a flow of gentle
waters that carry me out and beyond it.
I am moving through this tunnel and the light on the
other end is close - I will soon have passed out of
this - I am peaceful, calm, tranquil, at rest, utterly
relaxed - I am accepting and relaxed - I can peacefully
wait for a few minutes until my fears leave me.
If you are alone and can say these phrases aloud, so much the better. The sound of your own voice telling you what to do in a calm and confident manner will really put you in control. If you are with other people, don’t worry - just soundlessly send the same messages to yourself.
It is normal not to be successful every time
Even after you have mastered the techniques described in Step 2, you may find that occasionally they don’t work for you. There can be a number of reasons for this, including overtiredness or the fact that you are so tense that you cannot relax. The main thing is not to worry about it. It is perfectly normal not to succeed all the time.
The next time the method will probably work as well as ever.
If you experience problems for a number of days, try to identify which part of your anti-panic weapon is ineffective. Are you really accepting your feelings? Are you relaxed? Are you really letting it pass? Has there been a blockage in the fast and natural flow from one step to another? Have you missed the first warning signs and delayed using your weapon?
What is important is that you regard accept–relax–let it pass as your personal weapon against panic and severe bouts of anxiety.
Use this weapon with confidence. It has worked for many people, some of whom felt worse than you do, and there is no reason why it should not work well for you.