Expert tips: How to deal with persistent panic attacks

Fionnula MacLiam is a cognitive-behavioural psychotherapist and a registered psychologist with the Psychological Society of Ireland. She is a lecturer on Trinity College Dublin’s postgraduate courses in CBT. Here she gives some advice about panic attacks.

– Panic attacks and anxiety attacks are different. If you have a panic attack you feel that you are in imminent danger. There is a feeling of threat, that something dreadful is going to happen in the next few minutes. With an anxiety attack the threat is not imminent. It could be something further off, or even a long time away like, “how am I going to manage when I retire in two years time?”

– During a panic attack people will experience enormous fear. Sometimes, they will specify that they think they are having a brain haemorrhage or a heart attack, but there is always an intense feeling of impending doom.

– What happens during an attack is that your body misinterprets a situation as dangerous. And because it perceives a threat of imminent danger it displays the physiological responses of fight or flight. These physical symptoms support the belief that something dreadful is about to happen and that you are in danger. Your heart is beating fast. Your breathing is fast. You are sweating. You are trembling. You might have a feeling that you are suffocating or choking. You might be having pain because your intercostal muscles around your ribs are tightening up. You might be feeling dizzy and lightheaded.

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– Some people can experience daily panic attacks. They happen generally in public, which is what leads to agoraphobia. Someone will not want to go out in case they get a panic attack. They stay at home because they feel safe. However, people can have them sitting at home, which then makes it seem very dangerous to be sitting on the sofa watching TV.

– Because it is an emergency response by the body a panic attack cannot actually last very long. Therefore, if you stay wherever you are it will die down within about 20 minutes. This is because it is enormously draining on your energy, as all your systems are going like the clappers. If you actually were in a real emergency situation this is what would help you to get out of the situation fast.

– What people usually do during an attack is to leave the situation they are in. Or they will find techniques such as breathing, focusing, bringing a bottle of water to glug, or other forms of distraction to bring the fear down. However, these aren’t actually helpful. They will get rid of that particular panic attack, but will not stop it happening again. People always want a quick fix, which is why they avoid situations, or do something that gets rid of their panic straight away. However, this just keeps the vicious cycle of panic, avoid, panic, avoid, going.

– The solution is to sit with the anxiety, to stay, to ride it out. However, that’s much easier said than done. People are firmly convinced that, for example, they are going to have a heart attack. So it is difficult to persuade people to stay in a situation. And that’s completely understandable, because as far as they’re concerned, what I’m suggesting is that they risk their lives. However, always remember that leaving a situation, breathing a particular way, or whatever you normally do to reduce your symptoms, wouldn’t make any difference if you were actually having a heart attack.

– Stopping panic attacks comes down to: education; examining thinking and beliefs and gradually challenging them; and then dropping what we call safety behaviours. In therapy we explain that what you’re feeling is a normal physiological response to an emergency, even though there is no actual danger. And the thing that is really frightening, the thing that keeps it going, is the thought that pops into your head: “I’m having a heart attack”. It’s all down to the misinterpretation of the symptoms. For example, I nearly had a panic attack myself once. I was walking down Abbey Street when I suddenly started feeling really weird and my heart was thumping. And I thought to myself, “I’m having a panic attack”. And my next thought was, “how interesting. I’ve treated people with panic disorder, now I can watch this and see how it goes.” And because I wasn’t thinking of it in terms of impending doom, it went away again.

– When people begin to understand that they are misinterpreting their symptoms we ask them to take a dispassionate approach to what’s going on, to observe themselves during an attack, and to gather information about their physiological and physical symptoms. After that, it’s a matter of taking a leap of faith to try and sit with the panic, often first within therapy, and then in real life. In therapy we would try to mimic some of the symptoms of panic, depending on what’s the most relevant for the person, such as the heart racing or dizziness. We might find ourselves doing jumping jacks to make ourselves breathless, or panting, or spinning around in an office chair to make ourselves dizzy.

– You have to recognise the panic attack for what it is, and learn to sit with it. And the more you do that the less panicky you get. For example, the first few times you go to a cafe, and you think you’re going to have an attack, you will get very anxious. However, sit it out and 20 minutes later you will feel much better. After doing this a few times you will stop having the anticipatory anxiety – the worry about having an attack – and reducing this anxiety means you are even less likely to slip into a panic.

– If you know someone is having a panic attack talk to them calmly. First aid for anyone who panics will mimic their own safety behaviours: distract them with questions; get them to describe every minute of their day, or a TV programme they watched. They’ll probably feel better out of the gaze of the public. If a family member or friend has repeated panic attacks, educate yourself on panic disorder.

– Cognitive behavioural therapy is available, usually with clinical nurse specialists, through the HSE Mental Health Services. If you find self-help measures aren't working for you, or when panic attacks interfere with your normal life, your GP can make a referral. Waiting lists vary around the country. Lists of properly trained and accredited therapists can also be found through the Irish Association for Behavioural and Cognitive Therapies and CBT Ireland.

Read: I hope my terrifying panic attacks never return