How to talk yourself down from a panic attack

Everyone experiences anxiety from time to time, usually in response to a stressful or overwhelming situation. But sometimes anxiety manifests itself in really inconvenient ways, for example: as a panic attack.

Youth mental health challenges have been on the rise and highlighted in the news throughout the pandemic. In 2021, one year into the global pandemic, the Canadian Mental Health Association (CMHA) - Waterloo Wellington Branch reported experiencing a 40 per cent increase in youth accessing mental health services. But panic attacks can be experienced by people of all age groups, and anyone can reach out for mental health support, with or without the presence of a formal mental health diagnosis.

How do I know?

To start, I’m an Occupational Therapist with frontline experience as a community mental health worker. But more importantly, I was once a young person who struggled with panic attacks. In fact, I still deal with panic attacks…but over time, it has become less of a struggle. I’m excited to share what has helped me on my journey!

However, I don’t have much experience working with youth, so I reached out to my colleague Siva Balaskantha, Clinical Lead on the Early Intervention and Transitional Youth Programs at CMHA-Toronto Branch. He is also an Occupational Therapist and has about 8-years of experience working in youth mental health. He says that “learning information [about panic attacks] can often help dispel some of the myths or fears around panic attacks.” So let’s learn more, together!

Disclaimer: If you or someone you know is in crisis and requires emergency assistance, please contact visit your local emergency department, call 911, or contact a Crisis Response Programs in your area (Link for Toronto Crisis Response services)

WHAT IS A PANIC ATTACK?

“A panic attack involves intense fear and physical symptoms like a fast beating heart, dizziness, sweating, difficulty breathing, a feeling of choking or needing to vomit,” says Balaskantha. Other symptoms of panic attack include: trembling, shaking, chest pain, numbness/tingling, fear of losing control or going crazy, fear of dying, and feelings of unreality or being detached from your body. The Diagnostic and Statistical Manual of Mental Disorders (DSM), an imperfect but widely used mental health diagnostic tool, says you need to experience at least four of those physical symptoms for it to be labeled a panic attack.

Many people interchange the term ‘panic attack’ for ‘anxiety attack,’ but Balaskantha explains that ‘anxiety attack’ is not a technical term at all. “People may use the term anxiety attack to describe anxiety which can come on more gradually and can last much longer than a panic attack. This might include frequently feeling on edge, worrying or not being able to relax for long periods of time”, says Balaskantha.

Although anyone can experience a panic attack, according to Statistics Canada, only 3.7% of Canadians will go on to develop a panic disorder, which in the most simple terms, is when panic attacks become so frequent that they totally disrupt your life and you may become fearful of the panic attack experience itself.

For me, learning about anxiety wasn’t the key to understanding panic attacks (though it certainly helped) – it was learning about fear that really changed my relationship to panic.

Humans have a built-in, instinctual response to danger. Our bodies will go into “fight, flight or freeze'' in response to dangerous stimuli. Think about how you naturally react if you accidentally touch something scalding hot; without thinking, we will pull our hand away from the hot thing.

Experiences of anxiety and panic attacks can be thought of as a fear response that happens even when there is no danger. It’s part of what makes a panic attack so inconvenient.

Learning about the human fear response helped me normalize my panic attack experiences. I learned that my body and brain aren’t trying to kill me, even though that is often exactly how it feels in the moment. My body and brain are actually trying really hard to protect me from harm.

WHAT CAN YOU DO TO MANAGE A PANIC ATTACK?

Balaskantha first reminds us that “Different people find different strategies to be helpful.” In my experience, it can take a bit of trial and error to find what works for you, but there are some common strategies that work for many.

“Because a panic attack often involves quick or fast breathing, people find deep breathing exercises to be helpful, to slow down their breathing.” says Balaskantha. My personal favorite breathing strategy is called box breathing. For me, focusing too closely on breathing sometimes worsened my panic experience, because I would worry I wasn’t breathing correctly. I like box breathing because it gives you a box shape to focus on instead.

Other common strategies Balaskantha mentioned include: “Progressive muscle relaxation techniques, where you tense one muscle at a time and relax them”, as well as the classic technique of calling “someone they trust, or a crisis/distress line, to talk through a panic attack.”

“Some people may find a panic attack to be even more stressful, when in public,” says Balaskantha. “It may be difficult to remember to use particular strategies when you’re experiencing a panic attack, so practicing strategies like breathing exercises regularly is key. Some people also like to have a card in their wallet or maybe a note on their phone, with strategies, which they can pull up to walk them through a panic attack.”

Before accessing any of these techniques, the first thing I do when I feel panic starting to bubble up is to remind myself “I am safe.” Panic can make you feel like you’re about to have a heart attack, could pass out at any moment, or are in immediate danger. Reminding yourself “I am safe” can help ground you in those intense moments.

It has taken a lot of work for me to identify that while I cannot always control my external experience of safety, I can control my inner experience of safety by recognizing that the panic feeling itself is not connected to danger in my environment. It is important to note that the concept of safety when it comes to mental health is nuanced, as everyone experiences safety differently. For example, people directly affected by systemic oppression might find it more difficult to feel safe during mundane moments in life, such as walking to the grocery store.

“Even though it’s very scary, remind yourself that the attack will pass, and will stop,” says Balaskantha.

WHAT CAN YOU DO TO PREVENT PANIC ATTACKS?

When I first started to look into addressing my panic attack experiences, I was very resistant to the advice Balaskantha shares about preventing panic attacks. He says, “Healthy lifestyle habits, like getting in regular exercise, trying to lower your stress, reducing your caffeine intake and trying to cut down or stop the use of drugs and alcohol can be helpful. It’s also important to try and get at least 7 hrs of sleep a night, and also make sure you are eating regularly (to prevent low blood sugar, which can cause panic attacks for some people).”

While new studies show that having an overall healthy lifestyle is a key component of managing panic attacks, it is important that we are also compassionate with ourselves. So many different life things can get in the way of being able to implement new habits and reduce exposure to stress. For example, Statistics Canada’s 2019 Report Portrait of Youth in Canada indicates that access to income, something we don’t always have control over, especially as a young person, plays a huge role in the experience of mental wellbeing. It is important that we don’t beat ourselves up for not being able to implement these preventative strategies, and that we do our best to surround our selves with supportive people, including family, friends, communities, and healthcare providers.

“Some people also seek psychotherapy, like CBT (Cognitive Behavioural therapy) or ACT (Acceptance and Commitment Therapy) to help with panic and anxiety,” says Balaskantha. While a lot of psychotherapy support costs money, there are free self-help resources out there, such as BounceBack Ontario, and WellnessTogether Canada.

“Others may also use medications, or a combination of medications and therapy. It may also be helpful to see your family doctor, to see if there are any health or medical issues that can be connected to your panic attacks,” adds Balaskantha.

As mentioned earlier, both Balaskantha and I are registered Occupational Therapists in Ontario - our profession focuses on people’s ability to engage in “occupations,” which we mean to be any of the activities of life you want and need to do, from brushing your teeth to going to school. We both want you to know that panic attacks are a normal part of the human experience; and yet, if panic attacks are getting in the way of you doing what you want and need to do, help is out there!

“Overall, there are lots of helpful approaches and treatment to support someone who may be struggling with panic attacks,” says Balaskantha. “Please seek support and explore what works for you.”