PRACTICE FOR REDUCING PANIC Panic Attacks, Panic Disorder & Agoraphobia

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1 PRACTICE FOR REDUCING PANIC Panic Attacks, Panic Disorder & Agoraphobia Panic disorder is an anxiety disorder where individuals experience repeated panic attacks. The normal physical sensations of anxiety are experienced as "dangerous" to the individual who then believes the symptoms mean they are going to die (go crazy, heart attack, suffocate, faint, etc.). Naturally, no one wants to experience the extreme discomfort of having panic attacks, so we start to avoid situations where they might occur, and then "fear the fear". Our fear becomes focused on avoiding the panic attack. Avoidance can lead to Agoraphobia (from the Latin for fear of open spaces), where we avoid certain places because of the fear of a panic attack and or not being able to escape, which eventually may keep us from going out at all. The Vicious Cycle of Panic Write down your Trigger Events, Thoughts-Images, & Behavior: Cognitive Behavior Therapy (CBT) CBT focuses on learning to challenge the unhelpful thoughts and beliefs, and gradually making changes in our behavior so that we learn that the feared consequences do not happen, and that it is the anxiety that makes us feel the way we do. In order to break the vicious cycle of repeated panic attacks and/or agoraphobia, we need to change the way we think, and change what we do. Firstly, we can learn about how any anxiety affects our body. This is the body's normal response to danger (or believing we're in danger):

2 The Physiology of Panic The main problem with panic disorder is that when those adrenaline feelings kick in, they feel like we are really in danger. It really feels like we could be dying, right now! A panic attack is terrifying! But in fact, these physical feelings of adrenaline are NORMAL and in a true emergency will help us survive. It is the body's alarm system being activated for FLIGHT OR FIGHT. So it feels dangerous, even when it s not:

3 1 st Step: Calming Your Body PAUSE: Turn your mind away from your fear. FOCUS ON: Changing your body chemistry: T. I. P. (via Marsha Linehan) TEMPERATURE CHANGE : Dunk your face in ice-cold water. The ice-dunk simulates the `dive reflex. This is what happens if we are in freezing cold water and our bodies need to conserve energy in order to survive. In such a situation, the body slows or shuts down any functions that aren t absolutely vital for survival. Our anxiety/emotions are not vital, so they will calm down. Fill your sink, or a big mixing bowl with cold water. Hold your breath and dunk your face and head. Stay there as long as you can hold your breath. Come up, take a breath, and dunk again. Repeat as many times as you need to until you feel calmer. Note: Some people prefer warmth: warm blanket, hot water, shower/bath. INTENSE EXERCISE: Do jumping jacks, jog in place, or run up & down stairs. Do this until you wear yourself out. Doing so, will cause your body to take a deep breath. Endorphins will be released and you will relax. Note: people with heart conditions might walk swiftly. PACED BREATHING (or Progressive Relaxation) Slow, deep, mindful breathing with a LENGTHENED EXHALE: Count as you inhale: Then, count as you exhale, twice as long: Your numbers will increase as you take more breaths. Breathe in & out through your nostrils (with mouth closed). Or Breath in & out with your pursed lips, like using a straw. Do this for breaths. Progressive Relaxation involves tensing & letting go of muscles one by one starting with our face, neck, shoulders, arms, hands, chest. And moving down to belly, hips, genitals, thighs, calves, toes. Why does slow deep breathing help? When we breathe in, our sympathetic nervous system is activated. Making the heart beat faster. The body enters a state of hyper-arousal and becomes ready to fight or flee. This is why when running it is automatic and intuitive to breath in long, deep breaths and out short, sharp breaths to keep the body revved up. When we breathe out, the parasympathetic nervous system is activated. This system slows the heart rate and other bodily functions down again, the body enters a state of rest and digest one of comparative calm. During Paced Breathing exercises we make our exhalation longer than our inhalation. In this way, the parasympathetic nervous system gets activated. As a result, arousal decreases and a state of relative calm and control can be regained.

4 2 nd Step: Changing How You Think: Use Self-Talk During a panic attack, when adrenaline is released into the brain, our thoughts become very BLACK & WHITE. Our thinking becomes very negative and dire, and we believe our feelings/thoughts. This, and our activated body reactions perpetuate the panic. When we work to calm our body, our focus shifts away from our fearful thoughts. Thoughts & feelings are just thoughts & feelings, and they will pass. Write down the thoughts you have/believe while you are having a panic attack? If we could just notice the thoughts and feelings, and not react to them, if we could breathe deeply and focus on our breathing. this would slow/stop the flow of adrenaline within a few minutes. Say this out-loud to yourself or to the people you are with: Ø This is just anxiety, and it will pass. Ø I am scared, but I can do it anyway. Ø I can tolerate my anxiety. Write down the words that will help calm you during a panic attack? More Self-Talk Ideas: Ø GET ANGRY! Anxiety is bullying you, robbing you of your happiness & confidence. Tell it you won t let it take control any more. Make a decision to TAKE IT ON! Ø DO THE OPPOSITE: Instead of fleeing, FACE IT. Ø USE COMPASSION: Treat the anxiety like it s a frightened child or scared animal. Tell it you won t leave, that you ll be there to care for it. Remember the times you were strong & competent. GO SLOW.

5 Put It All Together: Your TIP & SELF-TALK Plan Write your goal here: Take a breath, and imagine yourself achieving your goal. Imagine how you will feel when you are successful.

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