Panic Attacks DR ELAINE RYAN

Contents What is a Panic Attack? Page 1 Beginnings of Panic Disorder Page 4 Panic Disorder Page 6 Living with Panic Disorder Page 7 Understanding the Cause Page 14 Self help checklist Page 16 Early warning signs Page 18 Breathe Page 19 How to take control Page 23 Grounding Yourself Page 25 Coping Statements Page 27 What not to do Page 30 ii

CHAPTER 2 What is a Panic Attack? One minute you are going about your business and the next, you might break into a sweat, your heart is pounding out of your chest, it s getting hard to breathe. You might feel like someone has placed a cushion over your mouth and nose, where it feels like you are getting smothered or suffocated, even though there is nothing over your face. You are terrified and convinced that you are not breathing, there s not enough air getting into your lungs. You check your pulse, and it may be rapid, or you might not be able to feel it at all. 1

You are shaking, sweating and feeling complete and utter terror as you may be having the thought (maybe for the first time in your life) that you are actually dying. You may have had different symptoms, but if you have had a panic attack, you will be able to relate to what I have just said. You could very well end up in hospital and get a series of tests, to be told It s okay, there s nothing wrong with you. You just had a panic attack. If you are very accepting of this information, or if it gives you some sort of relief or explanation regarding what has just happened to you, you may never experience an attack again, or as severe. More than likely though, it is very hard for your brain to understand, that what you have just experienced, is just a panic attack. 2

Panic Attacks take a serious toll on your body. You may well feel physically and emotionally exhausted afterwards, and, at the same time, feel, hyper due to the rush of adrenalin in your body. With this in mind, it is extremely difficult to just relax and accept that there is nothing seriously wrong. More than likely, it is playing on your mind, "what has just happened to me?. If this was your first attack, there would have been a slow build up of anxiety in your body to cause the anxiety attack in the first place. This will not miraculously disappear just because you have been informed that there is nothing physically wrong with you. The high levels of anxiety will still be there. 3

SECTION 1 Beginning of Panic Disorder Panic Attacks may be a symptom of Panic Disorder By the time you have had a few attacks, you may understandably be afraid that you might have another. When you are not actually experiencing an attack, your mind is full of fear about the possibility of having another. You might try to cope at this point, by avoiding the things that you believe may be the cause of your attacks. Pretty soon, your life may be consumed with either, experiencing an attack, or the fear of having one. You might be limited in what you can, and cannot do, and where you can, and cannot go. 4

You may not even get a break from this in the safety of your own bed, as many people experience attacks in their sleep. Now, when you go to bed at night, your heart is pounding and you are terrified of sleeping, as waking up in a panic is complete terror. You jump out of bed immediately, experiencing all the symptoms already mentioned, only now it is the middle of the night when everyone else is sleeping. Panic Attacks, if left untreated, can start to dominate every aspect of your life, and turn into Panic Disorder 5

CHAPTER 3 Panic Disorder Panic Disorder is an anxiety disorder. If you have been told that you have Panic Disorder, it is because you are having repeated anxiety attacks and when not having an attack, you live in fear of the next one. You will also notice that you may be doing things differently since your first attack. For example, in order to cope, you might start to avoid things. You might carry water with you everywhere, in case your mouth or throat becomes dry (as having a dry mouth is a symptom of panic.) 7

You might need people to come with you when you go out, in case something happens to you. 8

SECTION 1 Living with Panic Disorder Living with Panic Disorder Panic Disorder can easily consume your life. Your physical health may become affected, as not only are you physically and emotionally exhausted, but you cannot rely on being able to sleep, as your sleep may well be affected. It can be difficult to perform to the best of your ability in work or school, as you have to contend with all the physical symptoms you are now regularly facing on a day to day basis. You may also feel like you are losing control and going crazy, and that other people can see it happening to you. Over time, you may not go out as much as normal, or find it difficult to be alone. This can start to affect your mood. 9

If you have been coping, by avoiding situations that are uncomfortable for you, you may be at risk of developing Panic Disorder with Agoraphobia. Living with panic attacks can result in getting caught up in a life of fear; - fear of what happens during an attack, - fear of the next one, - constantly researching your symptoms, - looking for a cure. This endless cycle, can take over, and it can be extremely difficult to actually start to do the things you need to do, to finally get rid of panic. Living with panic attacks means feeling terror, that most people cannot imagine. 10

You never feel okay. During an attack, every part of your body is doing something, making you feel things that were beyond your own imagination before. It is practically impossible to explain to someone what life is like for you now, and have them really understand, and get what it feels like. I fully understand what life is like for you. I understand that it might be difficult to read this page, that you might constantly Google your symptoms to check that you are okay. I understand what it feels like for your body to completely change in the blink of an eye. To constantly check to make sure that you are okay, that you are not dying, that your heart is still beating. I get, that you 11

might check your pulse on your neck or your wrist, to check it is beating, and not feel reassured, as it is beating so fast you cannot count it. I understand what it feels like to be okay one minute, and feel like you are smothering the next, actually gasping for air. I get, that your breathing no longer feels right, that you are aware of it all the time. I also understand, that you do not have to live like this. There are things that you can do, to take control. In order for you to take control, you need to understand the role of fear and panic attacks. Fear comes from you not fully understanding what is happening. You cannot fix anything, unless you first understand what the problem is. 12

Understanding what is happening to you and why, takes away the fear. Without fear; your panic attacks will stop Panic attacks need fear to survive Afraid of your thoughts Your thoughts can reach scary places when you start to have panic attacks. 13

Any sensation in your body can spark thought processes that you would rather not have. You might feel your heart beating and start to think that you are about to have a heart attack. You might be feeling okay and become aware of the fact that you are okay. Your thoughts can then be taken up with Was I feeling okay yesterday?" and then, "What happened to make me anxious? Your thoughts are scanning for possible things that could go wrong. Fear then quickly turns into panic. In this example, it is your thoughts that stimulated your anxiety. Your thoughts are not neutral, which means they can make you feel something in your body. 14

When you remember a really great funny time, you might feel a little happier just recalling the memory. When you remember a particularly bad argument with someone, you can start to feel angry when you go over it again in your head. It follows then, that when you were feeling okay, your thoughts "was I okay yesterday?" stimulated your anxiety and you go from feeling okay to feeling panicky. Afraid of the sensations in your body 15

This is one of the most uncomfortable fears. You become terrified of what is happening in your body. Scared when it is actually happening and, living in fear of it happening again. Afraid of having another attack Even when you feel okay, you live in fear of the next one. Checking your body to see how you are doing. All this does, is make you more alert to the normal sensations we all have in our body. Afraid of meditation and breathing techniques Most of the time you want to distract yourself from what you are feeling in your body. Any technique that involves you paying attention to your body can be alarming in the beginning, as it brings all your attention to what you are feeling. On one hand, meditation does focus your attention on what is going on in your body right now, which you may not like. On the 16

other hand, it helps you to accept what you are feeling and over time, takes away the fear. Panic Attacks find it hard to exist without fear. Afraid to go to bed If you have panic attacks in your sleep, you probably wait until you are exhausted before going to bed. When you lie down you may feel your heart pounding and hear it beating in your ear, against the pillow. All your thought processes are then focused on your heart. Being exhausted, your body is probably relying on adrenaline to keep you going, causing more anxiety. You get out of bed and the cycle begins again. 17

Afraid to go out You might feel safer at home and be terrified to go outside, worried that you might have a panic attack. Even thinking about going out can cause you to feel fear. Once you feel fear, you will start to feel anxiety in your body. This anxiety will then trick you into believing that you should stay at home. The anxiety that you now feel, it not because of being outside, it has been created by your brain responding to what you are thinking about. Afraid to stay at home alone 18

Being at home alone can be too much for some people. You are left alone with your thought processes and may not have anything to distract you from what is going on in your body and mind. You might not be able to kick back and watch TV or do what you need to do around the house, as your mind is racing. There will be nothing in your home that is actually causing the anxiety. The anxiety, will be caused by a habitual response you have developed - fear of thought processes, - fear of what may happen, - fear that there is no one there to help you if you need it. 19

It is your thoughts that will be keeping this going maintaining the fear. 20

CHAPTER 4 Understanding the root cause This involves a detailed understanding of what causes anxiety. What you think, feel and do, shapes your brain. This simply means, what you habitually think, what you habitually feel, and how habitually you react, lays down a learning process in your brain. 21

For example. If you have to go shopping and you previously had a panic attack in the shop, you understandably might avoid the shop. If I asked you to come shopping with me, you might think "I can't, I will have a panic attack." Even though you may think that you are protecting yourself from having a panic attack, by avoiding a "trigger," you are in fact, teaching your brain something that will not help you in the long run. If you keep thinking "I can't, I will panic." You are helping your brain learn, Shop = panic The thought of the shop, may remind you of your previous attack, and you can start to feel nervous in your body. You will want to avoid it at all costs. 22

You will find, in the long run, that it is more helpful to you to think, "okay I am a bit anxious but I will give it a go, and go to the shop." You may well feel anxiety, but if you talk yourself through it, and remind yourself "if I steady my breathing, I will calm down my body..." You are starting to break down the learning that you do not want. Shop = panic and are teaching yourself to have a more helpful pattern in your brain. Shop = is okay 23

SECTION 1 Self help checklist Self help checklist What you think Do you worry about getting another panic attack? Do you worry in general? Are your thoughts taken up with how will I cope?, what if I get anxious? I am going crazy? I m having a heart attack. What you feel Anxious. On edge. Irritable. Worried 24

What you do Are there things you do, that act as safety blankets or crutches? These might be, bringing water with you everywhere in case your mouth is dry, Do you do a quick check in places, to get a route out quickly, in case you have an attack? Do you sit nearest the door to get out quickly? Are you avoiding things? If the checklist seems familiar to you, what you are thinking, feeling and doing, is ensuring that your brain stays anxious. 25

The longer you do these things, you stronger the learning pathway becomes in your brain. Eventually you will reach the end of your learning curve, and become skilled at being anxious. When this happens, you now can do all of these unhelpful things automatically. You have an anxious brain. 26

SECTION 2 Early warning signs Early warning signs Even though it may seem like panic attacks come out of the blue, there are usually early warning signs that, with practice, you can learn how to stop a panic attack. Start to monitor your attacks and note what your own early warning signs are. Possible early warning signs include, feeling a tightness in your chest noticing a change in your breathing feeling your heart beat faster When you have developed a list of early warning signs, you are in a better position to stop your anxiety from developing. 27

SECTION 3 Breathe What to do if you spot your own early warning signs of anxiety. Remind yourself you are simply experiencing the effects of anxiety and that it will not harm you. Start a mindfulness exercise such as the following one Start by simply noticing your breath. This may be difficult at first, but this is why it is called a mindfulness practice. It does not have to be perfect each time you try it: you simply practice. 29

If your breathing feels laboured or fast or uncomfortable, just notice it, and try not to engage your thought process, as anxiety related thoughts may increase your anxiety. Start to count each out breath breathe in, breathe out 1 breathe in, breathe out 2 breathe in, breathe out 3 breathe in, breathe out 4 breathe in, breathe out 5 Repeat this until the number 10 and start again with the number 1 through to 10. 30

Focusing on your breathing, with no judgement, and letting your thoughts come and go as they please will eventually calm your body and mind. If you feel other symptoms of anxiety while doing this, just notice them and bring your attention back to your breathing. If your heart is racing, just notice it racing, and bring your attention back to counting your out breaths. At first this may feel difficult, but with practice you will lower your anxiety. This is a good exercise to do on a daily basis, not just when you feel your own early warning signs of anxiety. Developing a daily practice will help you to lower your overall anxiety levels and make it less likely that you will experience a panic attack. 31

Why focus on your breathing when you feel anxiety? When you notice your own early warning signs, regardless of what they are, they are due to the activation of the stress response (your sympathetic nervous system). You can read more on this by clicking here. 32

To calm down, whatever it is that you feel in your body, you need to activate your relaxation response (your parasympathetic nervous system.) Different rates of breathing, result in different emotions and feelings in your body. You breathe too much during a panic attack, resulting in hyperventilation. What happens when you breathe too much? - Your heart rate speeds up. - You take in too much oxygen and your carbon dioxide levels lower. 33

This is known as hypocapnic alkalosis or more simply put, your blood is too alkaline and makes you light headed dizzy feel unreal suffocating or smothering feelings And a host of other symptoms. You can read more about the symptoms of anxiety by clicking here. When feeling unreal, light headed and dizzy, you panic, which of course, makes you feel worse and your symptoms increase. Breathing is something that your brain takes care of, it is normally outside of your control. If you are having a panic attack, you are breathing more than you should be, and you need to take control. 34

Taking control of your own breathing will allow the anxiety to melt away. Controlling your breathing will Calm your heart rate Restore the levels of carbon dioxide, and your uncomfortable symptoms will go away 35

CHAPTER 5 How to take control If it feels like you are gulping in air, or notice that your belly really expands when you breath in, you are taking in too much air. The uncomfortable feeling of panic breathing will naturally make you want to breathe more deeply, but don t. Your over breathing is the problem. Breathe in, through your nose, slowly, do not gulp. Breathe out slowly, through your mouth, as if you were blowing up a ballon. Make sure your exhale is longer than your inhale. 36

Each time you breathe out, relax your shoulders, let them drop. Wait for the next breath to come. If you are gulping in air, you probably started to breathe in, before you needed to. Wait Wait for the next breath to come. What to do if you are controlling your breathing and your mind is racing? It is normal to have scary thoughts during a panic attack. In addition to taking your control of your breathing, you need to ground yourself. This will take your attention away from your thoughts. 37

SECTION 1 Grounding technique Focus on something else. I would recommend focusing on something else in your body, as your body is always with you! - Focus on the soles of your feet. - Shift them about a bit. - How do they feel on the ground. - Walk around and pay attention to your heel coming into contact with the ground, followed by the rest of your foot. By doing this, you are taking your attention away from scary thoughts that add to your anxiety, and focusing on something neutral something real. Your feet on the floor. Talk Slowly 39

Talking to yourself slowly, will calm down your racing heartbeat, calm down your bloom pressure and calm down your fear. There is too much adrenaline in your system, speeding everything up, including your thoughts - slow it down. If you are referring to this guide during a panic attack, read it slowly. It takes practice as you will want to skim through it, but slowing everything down on purpose, is you taking control. All of this sound too simple for you? It may sound simple but bear in mind. You experience a panic attack, due to activation of your sympathetic nervous system; your stress response This is controlled by your brain, you did not choose to activate it. 40

Controlling your breathing IS your choice. You are activating your parasympathetic nervous; your relaxation response, which will restore balance in your body. Focus on your feet too simple for you? If you continue to focus on thoughts that are fuelled by panic, you will most certainly spiral more into panic. Focusing on your feet, is you choosing to focus on thoughts that are not adding to your panic. Remind yourself that you are only feeling this because you are hyperventilating and that you will be okay, or by using coping statements. 41

SECTION 2 Coping statements This will pass I have felt this before and it goes away The sensations are because I am over breathing, nothing else. If my thoughts are scary, I know that they are not real. My thinking is irrational when I have a panic attack. Pay no attention to my thoughts I choose to focus on something else. So what? if I am having a panic attack. It will pass You can add some coping statements of your own. 42

Accept your feelings Don t run away from panic, but do not fight it either just accept it. Accept it for what it is your nervous system being over stimulated. Accept your feelings of panic without your own spin on what is happening. By this I mean thoughts such as I am going to die, I can t handle this etc. Accepting your feelings, is just describing them, for example My heart is beating fast as opposed to I am going to have a heart attack My breathing is fast as opposed to I am suffocating 43

Acceptance statements My heart is beating fast I feel pins and needles I am sweating This way, you are simply accepting what is happening, without adding fuel to the fire. Take control of your panic attacks by Controlled breathing Grounding yourself Acceptance 44

CHAPTER 6 What not to do Do not smoke If you are a smoker, you might reach for a cigarette to help you relax. Smoking will stimulate your nervous system, causing your heart to beat faster, and may in fact, make you more anxious than you were. Do not misinterpret your symptoms If you have had panic attacks before, you will know that any of your anxious thoughts relating to what may really be happening do not come true. If your mind is focusing on some other scary reason for your symptoms, this will create more anxiety. 45

Talk yourself through it, know that whatever symptoms you feel, that it as a direct result of your sympathetic nervous system. Do not run away from whatever you are doing. It is a natural reaction to leave wherever you are, when you have a panic attack. If you are in a shop, you will want to leave, to get outside for fresh air. It is not the shop, or the air in the shop that is resulting in the difficulties you have breathing. It is your sympathetic nervous system. If you leave whatever you are doing, you are sending a signal to yourself, that you are not safe where you are. If you can manage to talk yourself through it, and stay where you are, your body and brain will thank you for it. 46

With panic attacks, it is all too easy to avoid places that you believe may cause you to have an attack. It is not the place that is causing your panic. It is your body giving you a stress response in situations where you do not need it. Do not fight it. With practice you can learn to accept that what you are feeling is as a result of anxiety. This acceptance, lessens the fear. Having less fear means that the attack will pass quicker. Learning not to do these things will take away some of the fear. Without fear, there is no panic. 47

CHAPTER 7 Summary Your brain is either helpful, or hurtful to you. Dr Elaine Ryan You have panic attacks because you are getting a stress response when you do not need it. There are things that you are thinking, feeling and doing that keeps this fear active in your brain. You can unlearn this and Retrain Your Brain. 49

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