The good news is that panic attacks are very treatable, you may find that your panic attacks have already started to reduce by first having begun to recognise and understand panic attacks, and accept that they are not harmful.

As we have seen, panic affects your body, your mind and your behaviour. It makes sense to try to deal with each of these. You may find some techniques more helpful than others. Not everyone finds the same things helpful. Also, if you have been having panic attacks for a while, it may take some time for these techniques to work. Don't expect miracles straight away, but keep at it, you should see the benefits soon, when you've found the techniques that work best for you.

Your Body
There are at least two things you can do to help with the physical symptoms of anxiety: relaxation and controlled breathing. These techniques are helpful for a number of reasons:

It is best to practise regularly when you are not anxious, to begin with. Look on it as getting in to training. You would not run the Great North Run without training for a while first!

Relaxation
People relax in many different ways. It might be that looking at your lifestyle would be helpful. What do you do to relax? Write down six things you do, or could do to relax. For example, swimming, reading, walking. As well as finding ways of relaxing in an everyday way, there are special relaxation techniques which can help with the specific symptoms of panic. We have already seen that one of the things that happens when you panic is your muscles tense up. To help yourself you should try to relax your muscles whenever you start to feel anxious. Relaxing in this sense is, different to the everyday ways of relaxing like putting your feet up with a cup of tea (which is just as important!). It is a skill, to be learnt and practised. There are relaxation tapes and sometimes classes which can help. Yoga classes can also be helpful. Your doctor may be able to lend you a relaxation tape, please ask. Relaxation tapes teach you to go through the main muscle groups in your body tensing and relaxing your muscles. The tape will come with instructions and some people find them very helpful. For further details on relaxation please see the leaflet in this series on "Coping with Stress".

Remember - Relaxation can help to reduce symptoms of panic, but it is not preventing something terrible happening - because nothing terrible is going to happen whether you relax or not.

Controlled Breathing
As we saw earlier, when someone becomes frightened they start to breathe more quickly, so that oxygen is pumped more quickly round the body. However, breathing to fast, deeply or irregularly can lead to more symptoms of panic, such as faintness, tingling and dizziness. If breathing can be controlled during panic, these symptoms may be reduced and so the vicious circle described earlier can be broken.

By breathing calmly and slowly for at least 3 minutes, the alarm bell should stop ringing. This is not as easy as it sounds. Sometimes, mid-panic, focusing on breathing can make things worse. Also, as one of the effects of over-breathing is that you feel you need more air, it is difficult to do something which feels like you are getting less!

Remember - Even if you didn't control your breathing, nothing awful is going to happen.

Your Mind
There are at least four things you can do to help with the way your mind adds to panic attacks:

  1. Stop focusing on your body
    Try to notice whether you are focusing on your symptoms, or scanning your body for something wrong. There really is no need to do this and it makes the problem far worse. It may be helpful to use the next technique to help you stop the habit. In particular, focus on what is going on outside rather than inside you.
  2. Distract yourself from frightening thoughts
    This is a very simple but effective technique. Again, you need to keep distracting yourself for at least three minutes for the symptoms to reduce. There are lots of ways you can distract yourself. For example, look at other people, and try to think what they do for a job. Count the number of red doors you see on the way home. Listen very carefully to someone talking. You can also try thinking of a pleasant scene in your mind, or an object, like a flower or your favourite car. Really concentrate on it. You can ry doing sums in your mind, or singing a song. The important thing is that your attention is taken off your body and on to something else. Use what works best for you.
    Distraction really does work. Have you ever been in the middle of a panic attack when something happened that totally took over your attention, for example the phone ringing, or a child falling over.
    Remember - Distraction breaks the vicious circle, but it is important to remember that distraction is not preventing something terrible from happening. In fact, as distraction works, this is evidence that nothing awful was going to happen after all. For example, could the fact that the phone rang really have prevented a heart attack?
  3. Question and test our frightening thoughts
    Sometimes, rather than distracting yourself from your anxious thoughts it is more helpful to challenge them. In the long run, it is most helpful to challenge your worrying thoughts, so that you no longer believe them. Another name for this is thought challenging. To do this you need to do two things:

Once you are aware of your thoughts and pictures in your mind, ask yourself:

If you can come up with more realistic helpful thoughts, write them down and keep them with you. It is often much more difficult to come up with these thoughts when you are actually panicking. Some examples of unrealistic and unhelpful thoughts, with more realistic alternatives are given below.

Unhelpful or unrealistic thoughts More realistic thought
I am having a heart attack I have had this feeling many times and am still here
I am going to faint People having panic attacks are unlikely to faint. I have not fainted before
I am going mad The feeling I am experiencing are panic - they are nothing like going mad
I will make a fool of myself Having panicked before and no-one has even noticed people are busy getting on with their own thing
  1. Try to work out whether something else is making you tense

    Whilst it is really useful to challenge thoughts in this way, probably the best way is to challenge the thoughts through the things we do, which is the next section. Before looking at how we can alter our behaviour to help reduce panic, it is useful to look at one other way in which your mind may be contributing to panic. Not through unhelpful anxious thoughts, but because there may be other things bothering you, as mentioned earlier. Remember that panic can arise as a result of difficult feelings not being dealt with. It may be helpful to work out whether anything like that is bothering you. Is there anything from your past that you haven't sorted out that is praying on your mind? Are there difficulties in your relationship? Do you feel angry or sad? Has someone or something upset you or is something troubling you? Panic is less likely to happen if your face up to emotional difficulties, either through talking to a friend or a professional counsellor for example your doctor, nurse, practice counsellor, psychologist.

Behaviour
Finally, challenging what you do is probably the most helpful way of overcoming panic. We have already talked about how avoidance, escape and safety behaviours keep panic going. It makes sense then that to reduce panic you need to reduce these behaviours.

Put simply, what you need to do now is test out the situations you fear most to prove to yourself that what is written here is time: panic attack cannot harm you. This is best done, not all at once, but in a planned way. Its probably best to start off with a small experiment. It's probably best to start off with a small experiment. It's difficult to believe something just by reading it, what you really need to do little by little to prove to yourself what is really going on. It is important to remember that whatever you do or don't do, the panic attack will stop. Just like any other alarm would.

First of all, work out what your behaviours you need to tackle are:

Safety behaviour and purpose What you do instead What did you learn?
Lie down when panic comes on to prevent heart attack Run up and down stairs I did not have a heart attack event though I ran up and down the stairs
Lean on shopping trolley to prevent fainting Walk without trolley, use basket instead I did not faint even without the trolley

By testing out your fears in this way, and finding out that your worst fear never happen you will gradually become more and more confident. Your panic attacks should become fewer and fewer and less strong when they do come.

SUMMARY: Coping with Panic.

Whilst the techniques in this leaflet should help you to get better by yourself, sometimes you may need professional help too. If you feel you may need professional help, talk to your GP who might be able to help, or who may refer you on to someone else who can.

Some useful organisations and help lines are: