What should you do when experiencing an anxiety or panic attack?

Are you reading this because you’ve been experiencing anxiety or panic attacks or supporting someone with these? Then please keep reading, because knowing the right things to do will help you or them get through and learn how to manage better the next time.

I’ve written this with two narratives. One is directed to the person going through a fight or flight response, and the other is for a companion assisting a person going through it. The narrative to the companion is also good knowledge, if you’re taking yourself through the process alone. It shows why each step is done.  If you’re reading this while having an attack, just read the bullet points and come back to the whys another time.

  • The first thing, if safe to do so, is to stop whatever it is you might be doing. This process is going to take a good few minutes.

Stopping may seem easy and will be easier for some than others. Please remember, though, if you are supporting someone, everything in their body and mind is on high alert and perceiving imminent danger. Go slowly, and be as patient as you can be. When you’re talking with them, slow down your sentences and talk in a calm voice. Let them know you’re happy to stay with them.

  • Now concentrate on your breathing, making your out breath longer than your in breath. If this is difficult, start by only thinking about your out breaths, making them slow and long. You can be sure your breaths in will come naturally.

Asking them to concentrate on their breathing, as above, not only helps bring their focus onto something different, but will also slow their breathing down, which also helps slow their heart rate.

As they do this, reassure them in a slow and calm voice, tell them they are doing well and to take their time, continuing to concentrate on their breathing.

  • Next, we are going to concentrate and focus on what the floor feels like through your feet. If you’re at home, you might want to take off your shoes, but you don’t have to. Wiggle your toes and feet so that you can feel the connection with the floor, at the same time still keeping your out breaths longer than the in.

All too often, someone going through a panic attack can feel like they are floating away. Here, we’re keeping your companion grounded. As they do this, let them know they are doing well.

  • Take your time. When you’re ready, I would like you to take a moment and slowly ask yourself the following questions:

“Physically, where am I at this moment in time?”

“What is the time and date?”
(If you don’t know the exact time or date, it’s OK, today at this moment is just as good.)

“At this moment in time, am I safe?”

It’s very important you’re only thinking about this moment in time when you ask yourself the above questions. Take your time, and slowly go over them again.

  • Now I would like you to put the answers together in one sentence and to say it out loud. For example:

‘At this moment in time, I’m in my office at the Latton Bush Centre. The time and date is 9.45am on Thursday 17th December 2020, and at this moment I’m safe’

Or

‘At this moment in time, I’m in my office at the Latton Bush Centre, and now at this moment today, I’m safe.’

These questions may seem very simplistic or even somewhat patronising, but please understand they’re very important to ask in such a way in order to ground someone in the state of fight or flight.

It might help here to understand that the fight or flight response is a survival instinct that’s instigated by the unconscious mind on detection of a threat. This is in spite of the conscious part knowing there isn’t a threat.  So, seeing as we’re getting the conscious mind to reconcile with the unconscious mind, it’s very important we keep the language very simple and don’t work with negative words. For example, we should never use the term, ‘You’re not in danger’ because, when reconciling with an unconscious mind, it will hear ‘danger’ first, and is therefore more likely to  perceive a threat.

  • Take your time and bring your focus back to your breathing. You might just want to focus only on your out breath, or you might be ready to take this to the next level. Remember, there’s plenty of time.

When you’re ready and if you’re able, take your next breath in through your nose, then release long and slow through your mouth. There’s no rush, and if it feels uncomfortable then just concentrate on making your out breath longer than your breath in.

If possible, breathing in through the nose will give the right shot of air to the lungs. Breaths through the mouth can contain too much air, which will also make its way to the stomach. This can enhance a sick feeling that’s already likely to be there as a symptom of the fight or flight response.

There’s no need to move them on to the next level of breathing through their nose if this is uncomfortable. They’ll still reach a state of calm if they continue to make their out breath longer then their breath in. Keep telling them they are doing well. Tell them this moment will soon pass.

Keep remembering to assist with a slow calm voice — even though they should be starting to calm, it’s really important to keep giving them time to focus. For some, this might be enough, but others will need to continue and keep repeating, always coming back to their breathing.

  • Next, I’d like you to fix your concentration onto one object: a cushion or a piece of clothing, even a plant or any object you can touch. In your own time, use all your senses to investigate this object. Take a moment on each of the following:

Think about what it looks like.

Think about what it feels like.

Does it have a sound when you move it or raise it to your ears?

Really focus on what it is you’ve chosen to study. It’s OK to take a good few moments with each sense. While you do this, keep your out breath longer than your in.

Here we’re introducing a distraction from patterns of thinking that could easily reinitiate the fight or flight response. Keep telling your companion they’re doing well. Let them know you’re still there and that you’re both doing well.

Things you might want to do to help along the way. You might want to ask your companion where they want you to be. They might want you close, or they might feel safer having you at a distance.

It’s very likely they’ll be feeling hot, so ask them if they want a window open or to move closer to the window.  If they do need you to do something, try not to rush but move calmly.

  • It’s very likely, if you’ve followed the above instructions, you’ll be feeling a lot calmer. However, no two people are the same. If you need to, go back to the beginning and go through this process again.

When someone has gone through an anxiety or panic attack, they’ll often feel like they have just made a fuss about nothing. Yet the feelings, physical and emotional, are extremely strong. Try to remember that, just because you can’t fully understand the trigger or understand why you or they were so frightened, it doesn’t mean this was a fuss about nothing.  

You might find this exercise is enough to reduce, control or manage future anxiety. If not. I’d recommend seeking some counselling privately or through your GP.

What Is Anxiety

In simple terms, anxiety is a preconception that something bad is just about to happen. It’s the very same device that puts our body and mind into high alert. However, while this is a simple description, there’s much more to be known about different degrees of anxiety, along with the hows and whys in which it operates.

As a counsellor, it’s a little upsetting that even in the twenty first century very few people have any true understanding of what anxiety is. This has seemed to make it almost a taboo subject. For instance, if I were to say I have anxiety, many would automatically assume I had a mental illness like something out of the 197’s film ‘One Flew Over the Cuckoo’s Nest’. In fact, many anxieties are very normal parts of our everyday living.

Take, for instance, going to a job interview, or public speaking for the first time. Maybe even having an over-optimistic to-do list that leads to being overwhelmed. Or how about the one-off misconceptions that we’re in danger?

Take this example: whilst you’re walking out in the dark, two youths come running over to you shouting. At first your preconception is that you’re in danger, and your heart starts racing. As they get closer, you realise they’re shouting at the person behind you, that they all know each other, and all is well. Your heart is still racing, but there’s a relief that you read the situation wrong.

In any example like this, there’s the potential for our bodies to go into the fight or flight response that constitutes anxiety. There’s a misconception that all anxiety is bad, but in truth we wouldn’t survive without the very mechanism that keeps us alive.

I want to share my knowledge of anxiety and spread it as far as it will go, because while there’s a general misconception that all anxiety is a mental illness, normal anxiety isn’t being validated. People are experiencing normally fearful situations and concluding there’s something wrong with them. Anxiety as a result of stress alone is very typical of this, and the solution is to understand anxiety, along with addressing the balance of stressors to create a restful and healthy lifestyle.

What happens in the fight or flight response of anxiety is really quite intense. I’ve known many to take themselves off to A&E with the believe they’re going to die of a heart or asthma attack, only to learn they’ve been experiencing a panic attack. This always upsets me, not because someone has been mistaken, but because there are so few people to explain to them that what’s just happened in their body is quite normal, even though it feels completely abnormal.

So now let me tell you exactly what can happen to your body when it’s in a state of anxiety. The perception of grave danger will accelerate the heart rate and blood pressure. Along with this, there’s a great urgency to take in more oxygen. Oxygenated blood is drained from areas that need it less and is directed to the muscles. This is why some can look pale in colour, while the muscles are tense and rigid.

Meanwhile, in the brain activity is greatly sharpened, and senses are heightened to be on the lookout for danger. This can cause your thoughts to race. The perception of time will be slowed down, and often the ability to remember events correctly is diminished, while some memories of the event stay sharp and vivid.

Also, at the same time as the brain, heart and lung functions, the body will want to lighten its load. This is why you can feel you need to use the loo and feel sick at the same time. Many people report tightening around the chest or feel they can’t breathe. Some feel their heart pounding, some feel they’re going to lose control of their bodily functions, and some will feel their mind is leaving their body. So it’s very easy to understand why many will land on the A&E department.  

Just think of what we could achieve if every young person could learn from school age about anxiety and what happens in our bodies during the fight or flight response. I believe over half the population with anxiety would experience it less intensely and that it wouldn’t be recurring.

I hope this gives you a better understanding of what anxiety is, and that you might share the knowledge or help to validate someone who is feeling anxious. Let’s get better as a nation at understanding anxiety, so that together we can downsize many a problematic anxiety to a normal anxiety.