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How to stop a panic attack

30 May 2017

What do you do in the moment when you are having a panic attack? It's hard to do anything when you feel like you are going to die. In this episode, Chris shares five practical ideas that you can use when you are having a panic attack to help bring it to an end.

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Hey, this is Chris Worfolk and welcome to the Worfolk Anxiety Podcast. Today I am going to give you five strategies to help stop a panic attack, and these aren't kind of long-term stand on your head be mindful stuff, this is stuff that you can really use in the moment, except [00:00:30] for maybe the first one. So we'll talk about that first, and then we'll get to some strategies that really you need to just punch straight in there. You don't have to do a long-delayed workout.

1. Cognitive behavioural therapy

Number one, which I think is really important is Cognitive Behavioural Therapy, CBT. One of the biggest problems I hear with CBT is the idea that you go to therapy and you learn all these techniques, but actually when it comes in the moment, and you're having [00:01:00] a panic attack, then you can't start doing all the strategies you've been given and the way that you re-write your thoughts, you just can't do them because all you can think about is, "Oh my God I'm going to die" and it's really difficult to focus on these thinking exercises right?You're absolutely right, the human mind doesn't have that much cognitive capacity and when you're thinking you're going to die, and you know, fight or flight is just going mad, then there's no way [00:01:30] that you're going to be able to go through all these four processes and give them as much attention as they need. But that's why CBT has the whole cognitive and the behavioural aspect. The techniques you learn is the cognitive stuff, but the behavioural stuff is really important as well. And that's essentially practising it. 

You're absolutely right, the human mind doesn't have that much cognitive capacity and when you're thinking you're going to die, and you know, fight or flight is just going mad, then there's no way [00:01:30] that you're going to be able to go through all these four processes and give them as much attention as they need. But that's why CBT has the whole cognitive and the behavioural aspect. The techniques you learn is the cognitive stuff, but the behavioural stuff is really important as well. And that's essentially practising it. 

CBT isn't something you go to for say, 12 weeks and you learn all these techniques, [00:02:00] and then you're done. That's really the start of the journey because you then need to go out and practise them. And if you think about it like playing sport, for example I play American Football and there's so much stuff to remember, like you've got to set your feet right and then run correctly and then turn right and get your hands up to catch the ball, and then make sure you turn around at the right time and then catch the ball and then keep running, and there's so much stuff to do and when you're in the moment, and there's [00:02:30] a live play, you're in an actual game, it's too much to remember there. Which is why when we practise, we break it down into really small drills, and we just drill that over and over, and over again until it's automatic, because then when you come to game time, actually doing the stuff we practised doesn't take any thought; it's automatic. 

Same thing with say, the military, the way they get soldiers to strip down a weapon just over and over again until they can do it in their sleep. Because when they're in a war [00:03:00] zone, they don't have time to try and remember how to do it, they just need to be able to do it without any thought.Driving, another good example. There's just too many things going on with gear changing, and clutch, and steering and looking down the road. All that stuff needs to be automatic so that you're just; you're changing gear without thinking about it, so you can concentrate on what everyone else on the road is doing. CBT is the same, which is why a good therapist [00:03:30] will get you out there doing exposure therapy, and maybe even trying to get you to cause a panic attack in the sessions. That's really common. And the reason they do that is because they can help you practise the cognitive techniques while you're having a panic attack. 

Driving, another good example. There's just too many things going on with gear changing, and clutch, and steering and looking down the road. All that stuff needs to be automatic so that you're just; you're changing gear without thinking about it, so you can concentrate on what everyone else on the road is doing. CBT is the same, which is why a good therapist [00:03:30] will get you out there doing exposure therapy, and maybe even trying to get you to cause a panic attack in the sessions. That's really common. And the reason they do that is because they can help you practise the cognitive techniques while you're having a panic attack. 

The benefit of doing that is that you can do it under a controlled condition and they can help you and if you do it enough, then when you go out into the real world and have your panic attack, then hopefully [00:04:00] the techniques will be automatic and they don't need any thinking, which is where a lot of people get stuck. That's number one, CBT, but more importantly, to do a lot of practice.

2. Breathing into a paper bag

Let's get to some more practical stuff, so number two is to breathe into a paper bag, which is a bit of a cliché, but it really works. And the reason it works is that a panic attack often feels like we're not getting enough air [00:04:30] and so we breathe faster and the problem is that it's actually, it's too much oxygen and a lack of carbon dioxide, and so when we hyperventilate we're taking too much oxygen into the body and well we think we're taking not enough, so we breathe faster and faster, and that makes us feel worse, and so it makes us feel more desperate and it's a vicious cycle where we've got too much oxygen but we think we haven't got enough, so we keep breathing [00:05:00] faster and faster, and this just reduces the amount of carbon dioxide.

We actually, as humans, need some carbon dioxide. So the idea of breathing into the bag is that when you breathe out, you breathe out carbon dioxide, but if you breathe it into a bag, the next time you breathe in you will take some of that carbon dioxide back into your lungs, and that will help restore the balance and make you feel better and then eventually your whole panic will come down as the carbon [00:05:30] dioxide levels in your body are restored, and you'll feel better. 

That's number two, breathe into a paper bag. I really want to see what else you can do with that because it's quite embarrassing to take a paper bag in public, right? But it does work.

3. Use flashcards

Number three is use flash cards. Now I find two problems when I'm really anxious is that one, really believe myself in terms of thinking about the anxiety [00:06:00] feedback cycle and the fact that what I'm experiencing is just regular symptoms everyone gets, and two, it's really hard to remember that stuff. So what I have is just a series of little flash cards with things like, you know, "You've had a panic attack a hundred times before and never died, you're not going to die this time." Because there's something really reassuring about being able to read it.

You can tell yourself in your head that these things are true, but actually seeing it written down makes it so [00:06:30] much believable. So all these thoughts that you're trying to tell yourself when you're not having a panic attack but seem not to work when you are having a panic attack, try writing them down. You can write them on your phone, or you can actually write them down on some paper, stick them in your purse, whatever works for you, and then just try looking at them and trying to read them when you're having a panic attack. 

It's really difficult to read when you're having a panic attack obviously, [00:07:00] so keep them really short, really simple, but give that a go and see if it helps you. So that's number three, and number four is to use an app on your mobile phone.

4. Use a mobile phone app

There's a bunch of ones that do this, but I think the most helpful when you're having a panic attack is the ones that give you a controlled breathing exercise, so you want to find one, hopefully specifically designed for panic attacks that will help you give some structure [00:07:30] to your breathing and help you take deeper, more controlled, slower breaths and you don't have to think about it, you just open the app, set the app going, and the app will tell you what to do, and you just have to try and follow the instructions on the app. Hopefully, you're not having to try and work out, "Okay, right, I need to do this with my breath." The app will give you all the instructions audibly, and you can just follow that, and hopefully, that will make things easy for you. So number four, get an app [00:08:00] for your phone and use that to help your breathing when you're having a panic attack.

5. Have a friend help you

Okay, number five, the fifth one is get someone else to help you. This is if you're out with a friend or a family member, or someone you're comfortable talking about this stuff with, then maybe prep them in advance as to what helps because some things might help for you and they might not help for others, [00:08:30] and people want to help you because they love your, right? That's the thing we often forget in these debates, our friends and family love us, and they really want to help us most of the time.

They probably don't know what to do unless you're experienced with panic attacks. You probably don't know what to do, and even then, you don't know what helps you, what helps someone else, so if you can prep them in advance and say, "When I'm having a panic attack, these are the signs [00:09:00] so you'll know" to show them you're having a panic attack. It might be obvious for some people, other people maybe not so much, so it's good to cover the ground, and these are the things that really help me, so whether it's giving you space or whether it's talking to you, or whether it's handing you a paper bag or whatever. Whatever you find is useful to have someone there to support you, then tell them that in advance, get them prepped, and [00:09:30] then when the moment happens they'll be able to help you. 

This is a great way to do graded exposure because if you're really nervous about doing something, say you know, getting on a train, then being able to do it with someone you trust like a friend or a family member getting on the train, they can help you through it, and knowing that if you do have a panic attack they're there to support you. That can be a really nice step on that graded hierarchy. 

Summary

[00:10:00] Those are five suggestions to help you when you're having a panic attack. Number one, do a lot of practice with the CBT so that it's automatic so that you're not having to think about it, in a moment you just do it. Number two, breathe into a paper bag. It's a cliché, but it works. Number three, use flashcards. Have the things you want to tell yourself written down so you can read them off and it just becomes more believable. Number four, use a mobile phone app [00:10:30] to help you bring your breathing back down under control. And number five, get your friends and family in to help you. Hopefully, those will be some really useful techniques for you. Let me know how you get on with them, and I will speak to you again soon.