Panic Information booklet RDaSH leading the way with care
It is common to feel panicky from time to time. It could be because you think there is someone following you, you can t remember your words in a play or an important speech, or you lose sight of your child. You may notice that you feel uncomfortable physical sensations. The feelings experienced usually pass fairly quickly. A panic attack, however, is a more intense feeling. There is a sudden unexpected surge of extreme anxiety and fear that makes you want to leave the situation. Who experiences panic attacks? At some point in their lives many people have had a panic attack. Some only one, others have numerous panic attacks over many years. Sometimes panic feels so strong, strange and unexpected, that people think it must be something more serious than a panic attack. However panic attacks are not dangerous, nor are they a sign of serious mental or physical illness - and they are treatable. Some non-serious physical conditions can cause symptoms similar to panic attacks. These symptoms include certain medicines taken together, drinking too much caffeine, thyroid problems, low blood sugar and pregnancy. What are the symptoms of a panic attack? Physically you will experience many symptoms: a rapid heart rate, sweating, a tight and painful chest, breathlessness and dizziness. You may find it hard to swallow. You may feel sick or experience numbness or tingling in fingers, toes or lips. You may feel that your legs have turned to jelly and your hands may shake. Emotional symptoms include feelings of absolute terror, of unreality - as though you re not really there. You may worry that you are going to have a heart attack, that you will collapse, faint, suffocate, choke or be sick. There is a sense of losing control and a fear of looking foolish or going mad. People often say that they want to leave the situation because of the distressing symptoms and thoughts. Many people do leave situations in which they experienced a panic attack, and then they go on to avoid these situations so it does not happen again. The most common situations that are avoided because of a fear it can trigger anxiety and panic are: Crowds Public places (e.g. town centres) Open spaces (e.g. fields) Enclosed spaces (e.g. lifts) Places far away from home. 2 Panic
A panic disorder is used to describe a condition where panic attacks seem to happen unexpectedly, rather than in specific situations. The causes of panic attacks Panic symptoms are nothing more than an extreme form of fear. Fear is our body s natural response to a situation perceived as threatening. It can range from mild anxiety (which can be helpful when there is a goal, like passing an exam) through to full blown panic. Although unpleasant, fear is very useful. It prepares your body for action, so that when you feel fear, your body is preparing to fight or run away from the thing it feels threatened by, or possibly to stay completely still and wait for the threat to pass. This is known as the fight or flight response. When you are frightened, your body feels under threat and this triggers a reaction which is normal and healthy: you breathe more quickly so that you can get lots of oxygen to your muscles; your heart beats faster to pump the blood faster around your body; your digestive system closes down to allow your body to concentrate on the threat. But panic attacks usually occur when there is no obvious physical threat. Your body is reacting as though it is about to be attacked, but it is a false alarm. This alarm system was designed many years ago, and our ancestors were protected by it when they had to cope with danger in order to survive. Nowadays, we have very different threats, mainly related to stress caused by things like financial and work worries, moving house, bereavement, relationship problems and problems from the past which have not been dealt with. Some people become anxious about real or imagined health problems, and sometimes we just don t know why panic attacks happen. These life stresses can raise our anxiety levels to the point where our alarm system is triggered. The cycle of panic Panic attacks affect your body, thoughts and behaviour. All three work together to keep panic going. How a person behaves and thinks before, during and after a panic attack plays a big part to play in whether panic attacks keep happening. Techniques to help you cope with and reduce panic attacks Panic attacks are very treatable. They may start to reduce as soon as you begin to recognise, understand and accept that they are not harmful. www.rdash.nhs.uk 3
You may find some techniques to deal with them more helpful than others. If you have been having panic attacks for a while, it may take some time for the techniques to work, so persevere and don t expect miracles straight away. Practise the techniques regularly when you are not anxious. Behaviour Challenging what you do is probably the most helpful way of overcoming panic. It is worth remembering that the symptoms of a panic attack do reduce naturally if you stay in the situation long enough. Avoidance Avoidance only reduces anxiety in the short term and will only maintain your fears. Therefore gradually tackle your avoidance. If, for example, you are frightened of being alone or visiting a supermarket, try gradually spending a little bit more time on your own, or going to a small shop. You ll find that your feared disaster (such as having a heart attack/ choking/making a fool of yourself) didn t actually happen. Next, do it for a bit longer, more often. You will probably feel anxious to begin with, because you have learnt to be anxious in certain situations and you may have been avoiding them for some time. Escape If you stop eating a meal half way through in case you are sick, or leave the supermarket without your shopping, try staying in the situation until your panic starts to go down. This will tell you that, again, the feared outcome did not happen. Safety behaviour This is not true avoidance behaviour, but you do things which you believe reduces the likelihood of having a panic attack. By doing this you never lose the fear of having a panic attack. Try to gradually stop doing the things you do to keep yourself safe. For example, if you think you are going to have a heart attack and usually lie down, stand up instead. If you normally keep still to stop yourself fainting, try moving around. This will put your fears to the test and, as you find that your worst fear never happened, you will gradually become more confident. Your panic attacks should become fewer and weaker. Mental techniques Stop focusing Panic becomes worse when you focus on your symptoms, sometimes trying to find something wrong. This can lead to misinterpreting normal symptoms as a symptom of panic. 4 Panic
Focus on what is going on outside rather than inside by using distraction techniques. Distraction Distract yourself for at least three minutes: try thinking of a pleasant scene or object; study what other people are wearing; count the number of blue cars on the road; sing your favourite song in your head. Thought challenging It can be helpful to question your thoughts so that you no longer believe them. Start to challenge anxious thoughts and worst fears and come up with more realistic and helpful ones. Once you are aware of your thoughts and pictures in your mind, ask yourself: What is the evidence for and against them? How many times have you had these thoughts? Has your worst fear ever happened? 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. Examples include: I am having a heart attack (I have had this feeling many times and I am still here); I will make a fool of myself (I have panicked before and nobody has ever noticed because they are getting on with their own business). Face up to emotional problems: One other way in which your mind may be contributing to panic may be because there are other things bothering you. Panic can arise as a result of difficult feelings or situations you may not have dealt with. It may be helpful to work out if there is anything from your past that you haven t sorted out that is preying on your mind. Talk it through with someone you trust or go to your GP who will be able to refer you to a trained therapist. Physical techniques Being relaxed and breathing calmly is the opposite of panic. Relaxation and controlled breathing are helpful for a number of reasons: they can help you deal with stressful situations better and reduce levels of anxiety; they can stop anxiety early before it gets much worse, stopping the cycle that leads to full blown panic by reducing anxiety symptoms and preventing hyperventilation; they can be used to reduce avoidance and to help you cope with situations you fear. Relaxation People relax in many different ways. As well as finding everyday ways of relaxing, such as swimming, reading or walking, there are special relaxation techniques which can help with specific symptoms of panic. www.rdash.nhs.uk 5
Try to relax your muscles whenever you start to feel anxious, because one of the things that happens when you panic is that your muscles tense up. Relaxation is a skill which has to be learnt and practised. Relaxation classes or yoga can help. Relaxation CDs (your doctor or library may have some) teach you to go through the main muscle groups in your body, tensing and relaxing your muscles. Controlled breathing When someone becomes frightened they start to breathe more quickly, so that oxygen is pumped more quickly round the body. However, breathing too 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. Slow your breathing down, and breathe out from your mouth and in through your nose, filling your lungs with air from the bottom up. Do this calmly and slowly for at least three minutes. This can be hard to do in the middle of a panic attack, as one of the effects of over-breathing is that you feel you need more air, so it is difficult to do something which makes you feel as though you are getting less. Further help and information The techniques outlined should help you to get better by yourself, but sometimes you may need professional help too. If so, start by talking to your GP. Telephone numbers: CRUSE help for bereaved people and those caring for bereaved people, 0808 808 1677 MIND, 0300 123 3393 Text on 86463 National Debt Line help for anyone in debt or concerned they may fall into debt, 0808 8084000 (freephone) Relate help with marital or relationship problems, 0300 100 1234 (local Rate) No Panic national self help organisation for phobias, anxiety and panic, 0844 967 4848. 6 Panic
Websites: www.bemindful.co.uk information about mindfulness www.mentalhealth.org.uk for wellbeing podcasts downloadable to mp3 players or burn on to CD www.mind.org.uk/foodandmood for information about food and its impact on mood www.bbc.co.uk/health/ healthy minds website useful information on all aspects of mental health. www.rdash.nhs.uk 7
This information is correct at the time of publishing Last Reviewed: July 2012 get get approved We are a smokefree organisation. Please provide a smoke free environment approved for your healthcare provider DP2841/04.17