(Mental) Health, Wellness, Fitness

Anxiety and Panic Attacks – A comprehensive guide, treatment options and immediate self-help resources

It is a beautiful day, mild, the sun is shining, birds are singing, kid’s laughter is to be heard from the nearby playground, butterflies flutter by…
I am enjoying the warm rays of the sun on my face, slowly walking through the park, the kids already running towards the playground, shrieking in excitement, waving hellos to the other kids. I sit down on a bench, coffee in hand, and start rummaging around in my bag. I know, I still had a book in there and this is the perfect opportunity to continue reading it. The kids will be busy for quite a while, any effort to pry them loose from their imaginary adventures will prove to be futile – I am well prepared to spend at least an hour on this park bench…
Another glance at the kids to make sure they are safe and in eye sight, I flip through the pages, trying to find the page where I left off last night. The kids are laughing, running, in their own world. I start reading…

A moment later, the letters on the page start to blur, I can’t make them out anymore. Like a dark fog, a surreal, irrational fear starts to close in, my heart starts beating faster and my breath is short, a heaviness around my chest, closing in, I can’t breathe, I can’t breathe… I am getting dizzy, I can’t really see well anymore, the world seems to be spinning so fast, the sunlight is blinding, every noise alarming. I feel like running, but I can’t move, or breathe, or think. I can’t breathe…
I am so afraid.
But why am I so afraid?
There’s nothing to be afraid of…
I can’t breathe…
I can’t move…
The heaviness on my chest.
My palms sweaty, the book almost gliding through my fingers, I am trembling…
I can’t breathe…
What am I so afraid of…?

I am taking gasps of air, then remind myself to try to breathe calmly. I squeeze my fists, clench them hard, then release, I CAN move.
I CAN breathe…
Slowly, calmly…
I am so goddamn afraid and I don’t know why!
BREATHE!

The fog seems to retreat as I force my breathing to become more regular, still clenching and unclenching my fists.
The bird’s singing and the kid’s laughter breaks through the fog.
BREATHE!
I can breathe…
I can breathe…
I am still alive…
It is over.
There was nothing to be afraid of…

It was just a panic attack. Another one. The third one this week and it is only Tuesday. But I survived it like so many before. Some are harder to get through than others, some last longer, some go by quickly. They are all unexpected, but well feared, without a warning sign, like a bad storm that hits you and then retreats and leaves you with the aftermath.

By now, I learned how to deal with them, how to get through them, how to survive them. I still fear them, though, like so many of us, who suffer from anxiety and/or panic attacks.

According to the findings of a survey, 14,2 % of respondents aged 18 to 65 (which equates to 6,91 million of the 18-to 65-Year-old German resident population) suffered under a clinically relevant anxiety disorder in the last year or under. ¹

WHAT IS ANXIETY AND WHAT ARE PANIC ATTACKS?

Panic attacks are recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and are categorized as unexpected or expected.
They usually involve various physical symptoms which can differ from individual to individual and from situation to situation, no panic attack is alike.
Anyone can experience a panic attack, if they happen more often, it may be a sign for panic disorder.

The DSM-5 defines anxiety as a feature of a number of common psychiatric disorders. The symptoms usually consist of worry, distress, and fear. Anxiety tends to be related to the anticipation of a stressful situation, experience, or event. It may come very gradually or in waves.

SYMPTOMS OF ANXIETY

There are various symptoms of anxiety, they may all come together, but may also appear singularly.

  • restlessness, inability to be still and relax 
  • you may fatigue more easily and feel very exhausted
  • difficulties with concentration, forgetfulness, blank mind
  • irritability, lower temper
  • muscle tension 
  • difficulties easing your mind, constant, uncontrollable worry
  • sleep problems, difficulty falling or staying asleep, nightmares, waking up unrested

People with generalized anxiety disorder oftentimes feel constant worry and fear over a prolonged period of time, whereas panic attacks are an unexpected, short termed event. ²

SYMPTOMS OF A PANIC ATTACK

Panic attacks usually come unexpected and out of the blue. There may be an underlying trigger that will induce a panic attack, but that is not always the case.
A panic attack will only last for a short time and then fade away, it includes 4 or more of the following symptoms:

  • racing heart
  • heart palpitations
  • sweating
  • trembling or shaking
  • perceived shortness of breath
  • feeling of being choked
  • chest pain or pressure
  • nausea
  • abdominal pain
  • upset stomach
  • dizziness, lightheadedness, feeling faint
  • chills or heat sensations
  • Parasthesia, i.e. a feeling of numbness or tingling sensation
  • Derealization, i.e. a feeling of unreality, not knowing what is real and not
  • Depersonalization, i.e. being detached from oneself, feeling like you are not yourself and in control of yourself and your body
  • fear of losing control or “going crazy”
  • fear of death or feelings of threat in absence of imminent danger ³

POSSIBLE TREATMENT OPTIONS 

There are many options and angles when it comes to how to treat anxiety disorders, here a list of possible treatment and therapy options that are available and recognized in this field.
Since it would go too far to explore all these options in depth in this article, please check the following resources for more information on these options: https://adaa.org/finding-help/treatment/therapy# and  https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145338

CBT, Cognitive Behavioral Therapy
ACT, Acceptance and Commitment Therapy
IPT, Interpersonal Therapy
EMDR, Eye Movement Desensitization and Reprocessing
DBT, Dialectical Behavioral Therapy
Exposure Therapy
Stress Management Techniques
Self-Help and Support Groups
Antidepressants
Anti-Anxiety Medication
Beta-Blockers

Please note that therapy as well as medication that will work, differ from individual to individual and should be talked about with a health care professional. Do not self-medicate.

 


WAYS TO HELP YOU GET THROUGH A PANIC ATTACK 

If your panic attacks are induced by a trigger, it would seem wise to avoid that trigger altogether. That is not always possible and since avoiding triggers can lead to worsening of the problems, or can mess with your social life and ability to live a normal life, it is wise to seek treatment if that is the case.

Breathing Exercises / Controlled Breathing

Since a choking sensation, a perception of not being able to breathe or uncontrolled breathing are not only very common, but also very scary symptoms, learning how to deal with this is extremely helpful.
When you have a feeling you might hyperventilate, try breathing into a bag.
Try taking controlled breaths, in through your nose and out through the mouth, slowly counting: In, 1, 2, 3, breathing out, 3, 2, 1. Repeat this, until you have your breathing calm and under control.
There are various breathing exercises and techniques that you can employ, some may work better for you than others.

Progressive Muscle Relaxation

This can be a very effective method to not only reduce stress, but also to immediately help in a panic attack. This will especially help with feelings of depersonalization and feelings of not being in control or losing control, since it will help you regain control over your body and show you that you indeed are in control as well as yourself. It can also help with tingling sensations, shaking and such.
There is a full guide to progressive muscle relaxation, but that might be hard to follow in the immediate wake of a panic attack. I recommend a “softer version” of this method, clenching and unclenching your fists, then rolling your shoulders, then tightening the abdominal muscles, relaxing them again and so forth throughout all parts of the body.
This exercise will help you focus and regain control over your body.

Have an “Anchor Person”

Have someone you can call that knows about your panic attacks that will be able to listen to you and therefore calm you. I like to call it an “Anchor Person”, since they are like an anchor in a stormy sea in situations like these. There is no need of these people to necessarily be professionals, even though it would be ideal if this was the case, but this is more about a feeling of safety, a reassurance they are not alone. This person does not need to advice them, but merely listening and being there is incredible help in a panic attack. Knowing that your emotions and fear are being taken seriously and listened to can make a huge difference.
If you do not have a person of trust, there are help hotlines like The Suicide Prevention Lifeline 1-800-273-8255 or Panic Disorder Information Hotline: 1-800-64-PANIC (72642) or National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI (6264).

Distraction

It can help to try to distract yourself from the symptoms of the panic attack. Reading, coloring or solving puzzles can help focus your mind and distract it from the feeling of fear.

Panic / Anxiety Journal

Writing down when you are feeling anxious or when and under which circumstances panic attacks happen, can help identify potential patterns and triggers. It can also be very calming to write down the feelings you experience and also be helpful to read through these experiences after the panic attack or anxiety has ceased to realize that these occurrences are in fact, not life threatening, only terrifying.

Workouts / Physical Activity

Sport is proven to not only improve overall health, but also to generally reduce stress. It is also a good distraction method during panic attacks. The physical activity will help you control your body and breathing and feel one with yourself and help with depersonalization as well as with tremors. Physical activity helps to reduce the signs of depression and anxiety symptoms and aids with stress management. 4

Meditation

A study recently found that meditation can have a long-term positive effect when it comes to anxiety, even when not actively meditating. 5
Different meditation techniques even proved to have different effects.
You may want to pick up the practice and reap its benefits as well. Be warned, meditation is not learned quickly, but needs practice and patience. Once mastered, it can help with the reduction of stress, anxiety and even be a wonderful mindfulness practice to help you get through a panic attack.

Aromatherapy

Proper scientific research on the actual effects and/or benefits of aromatherapy are still rare. According to a study, “rose water noticeably reduces the anxiety of (…) patients. Therefore, inhalation of rose water can improve the patient’s emotional and spiritual condition (…).” 6

Many people swear on the positive effects of various essential oils. Here some of which are supposed to have calming properties: Lavender, Roman Chamomile, Ylang-ylang, Vetiver, Damask Rose, Frankincense, Bergamot Orange.
Aromatherapy stores and essential oil dealers even oftentimes offer special calming blends or anti-anxiety blends.

Music

There have been several studies7 to show that music can reduce anxiety levels of patients, sometimes significantly. Music, especially the right kind, can have calming effects and reduce stress levels.
A marketing study by Dr. David Lewis-Hodgson for Mindlab International8 has also recently created quite a stir, claiming to have found the most relaxing song ever. Indeed, in their trial, the song “Weightless” by Marconi Union has shown to reduce stress and anxiety by 65% and also a 35 percent reduction in their usual physiological resting rates. You can listen to the song for free HERE, there is also a extra long, 10 hour version available.

CBD 

Medical Cannabis is getting more and more attention, also when it comes to helping with mental illnesses. CBD is a compound of cannabis that does not produce a high, but can be of great help with relieving anxiety, all that with little to no side effects.
A small 2010 study9 found that cannabidiol could reduce symptoms of social anxiety in people with social anxiety disorder (SAD). Brain scans of participants revealed changes in blood flow to the regions of the brain linked to feelings of anxiety.
In this study, cannabidiol not only made participants feel better but also changed the way their brains responded to anxiety.
CBD can be bought online or at pharmacies, it is not regulated since it is not psychoactive, and it can be safely taken regularly for prevention purposes and better overall wellbeing.

Apps

In our modern times and age, the digital world can also play a role in our emotional wellbeing and help to deal with anxiety and panic attacks.
There is a braod spectrum of apps, most of them free, that aim at helping people who suffer from anxiety and/or panic attacks, either by distracting, monitoring, offering relaxation techniques and guidance through an attack or even all of the above.
I have not personally tried all of these apps, here is just a selection of readily available free apps for download: Stop Panic & Anxiety Self-Help, The Worry Box Android app, Fast Calm app, Happify, Anxiety Reliever, Headspace, Breathe2Relax and many, many more.

 


STUDIES, REFERENCES & SOURCES 

1 – Robert Koch Institute, Federal Health monitoring, issue 21
Anxiety – Authors: Hans-Ulrich snow and Frank Jacobi – Publisher: Robert Koch Institute

2 – NIMH, National Institute of Mental Health, https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml 

3 – ADAA, Anxiety And Depression Association of America, Stefan Hoffmann, PhD, Aleena Hay, PhD, Abigail Barthal, BA

4 –  Jewett, R., Sabiston, C.M., Brunet, J., O’Loughlin, E., Scarapicchia, T., O’Loughlin, J. (2014) Sport participation in early adulthood, Journal of Adolescent Health, 55, 640-644

5 – Massachusetts General Hospital. “Meditation appears to produce enduring changes in emotional processing in the brain.” ScienceDaily. ScienceDaily, 12 November 2012

6 – The Effect of Aromatherapy on Anxiety in Patients, by Farzaneh Barati (Department of Nursing, Neyshabur University of Medical Sciences, Neyshabur, IR Iran), Ahmad Nasiri (Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, IR Iran), Negarin Akbari (School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, IR Iran) and Gholamreza Sharifzadeh (Faculty of Medicine, Birjand University of Medical Sciences, Birjand, IR Iran) – PMCID: PMC5111093

7 – Music therapy: an intervention to reduce anxiety in the myocardial infarction patient. White JM Clinical Nurse Specialist CNS [01 Jan 1992, 6(2):58-63] – (PMID:1617576)

8 –   Dr. David Lewis-Hodgson for Mindlab International, Marketing Research

9 – Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report by José Alexandre S Crippa, Guilherme Nogueira Derenusson, Thiago Borduqui Ferrari, Lauro Wichert-Ana, Fábio LS Duran, Rocio Martin-Santos, Marcus Vinícius Simões, Sagnik Bhattacharyya, Paolo Fusar-Poli, Zerrin Atakan, Alaor Santos Filho, Maria Cecília Freitas-Ferrari, Philip K McGuire, Antonio Waldo Zuardi, Geraldo F Busatto, Jaime Eduardo Cecílio Hallak, BAP British Association for Psychopharmacology


Please note, that above mentioned techniques only aim at helping you get through anxiety or a panic attack, they are only helpful tips. None of these replace the help of a professional, therapy or prescribed medication. If you are suffering from anxiety or panic attacks or suspect that you might be affected, please contact a health care professional and describe your symptoms to them.

Are you suffering from anxiety or panic attacks?
Do you have helpful tips?
How do you deal with them, what helps you the most?
I would love to hear your opinions and experiences.
Sharing of this article for information purposes is highly appreciated.

7 Comments

  • Shalely Hamburg

    Das ist ein super informativer und ausführlicher Artikel. Fast alles was du aufführst, hat mir auch meine Therapeutin geraten. Ich habe angefangen Sport zu machen, habe einen Kursus mit PMR besucht (was super geholfen hat) und habe gelernt, wie ich mich in einer Panikattacke verhalten kann. Atemübungen und Ablenkung sind für mich ganz wichtig um nicht immer tiefer in die Panik abzurutschen. Am schlimmsten war für mich bei jeder Attacke das Gefühl von Kontrollverlust und nicht mehr klar denken zu können. Du hast das sehr schön beschrieben, mit dem Nebel der sich um einen legt. Echt eklig.
    Die Panikattacken habe ich inzwischen recht gut unter Kontrolle – toi toi toi. Aber die generalisierte Angststörung…. die Symptome sind geblieben. Ständige Anspannung, überhaupt nicht belastbar, Streß und Aufregung tun mir gar nicht gut. Daher kann ich auch immer noch nicht arbeiten. Aber gut, langsam…. ganz langsam gehts voran.

  • Maus1980

    Hallo, dieser Beitrag ist sehr emotional und bedrückend. Irgendwie tat es mir gut das Alles zu lesen, leide leider selbst seit grob 10 Jahren an einer generalisierten Angststörung.

  • Sarah

    Ich kenne Panikattacken sehr gut und habe mich durch deinen Artikel gestöbert. Ein riesen Lob an dich, du hast es genau so eingefasst wie es ist!
    Ich kenne viele Therapiemöglichkeiten, aber du hast mir Neues zum ausprobieren gegeben 🙂

    Danke vielmals für den Beitrag!

    • Alicja

      Lieben Dank und dir vor allem Alles Gute – es freut mich, wenn mein Beitrag etwas helfen oder neue Anregungen geben kann. Ich wünsche Dir für die Zukunft nur das Beste.

    • Alicja

      You might very well be allright, if you get professional help. When talking about curing mental health problems, it is difficult. Oftentimes, they don’t necessarily disappear and then are just gone. They waver, you learn to live with the issues and you develop mechanisms to cope with difficult situations.

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