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Panic Attacks

Panic attacks are sudden and intense feelings of terror, fear or apprehension without the presence of actual danger. The symptoms of a panic attack usually happen suddenly, peak within 10 minutes and then subside. However, some attacks may last longer or may occur in succession, making it difficult to determine when one attack ends and another begins.

But, there are some steps you can take that may stop a panic attack from escalating out-of-control and reduce your overall anxiety.

Practice deep breathing:

Most people are not really conscious about the way they are breathing, but when people are anxious they tend to take rapid, shallow breaths that come directly from the chest. This type of breathing is called thoracic or chest breathing. Chest breathing causes an upset in the oxygen and carbon dioxide levels in the body, resulting in increased heart rate, dizziness, muscle tension and other physical sensations.

In contrast, during abdominal or diaphragmatic breathing, you take even, deep breaths. This is the way newborn babies naturally breathe. You are also probably using this pattern of breathing when you are in a relaxed stage of sleep.

How Can I Tell the Difference Between Chest and Abdominal Breathing?

The easiest way to determine your breathing pattern is to put one hand on your upper abdomen near the waist and the other on the middle of your chest. As you breathe, notice which hand raises the most. If you are breathing properly, your abdomen should expand and contract with each breath. It is especially important to be aware of these differences during stressful and anxious times when you are more likely to breathe from your chest.

Simple Abdominal Breathing Exercise for Relaxation:

The next time you’re feeling anxious try this simple relaxation technique:

  1. Inhale slowly and deeply through your nose. Keep your shoulders relaxed. Your abdomen should expand, and your chest should rise very little.

  2. Exhale slowly through your mouth. As you blow air out, purse your lips slightly, but keep your jaw relaxed. You may hear a soft “whooshing” sound as you exhale.

  3. Repeat this breathing exercise for several minutes.

You can perform this exercise as often as needed. It can be done standing up, sitting down or lying down.

If you find this exercise difficult or believe it is making you anxious or panicky, stop for now. Sometimes people with panic disorder initially feel increased anxiety or panic while doing this exercise. This may be due to anxiety caused by focusing on your breathing, or you may be unable to do the exercise correctly without some practice. If that happens to you, stop for now. Try it again in a day or so and build up time gradually.

Learn progressive muscle relaxation:

Progressive muscle relaxation (PMR) is a stress and anxiety management technique. If you have panic disorder, agoraphobia or another type of anxiety disorder, you may experience frequent muscle tension. In fact, chronic muscle tension may be so automatic that it seems normal, and you may have forgotten what it feels like when your muscles are completely relaxed. By employing the progressive muscle relaxation technique, you will be able to quickly rediscover the distinctions between relaxation and tension of various muscle groups.

Try this simple exercise: Make a tight fist while simultaneously flexing your hand upward at the wrist. Focus on the sensations you feel while these muscles are tensed. Hold this position for about 10 seconds and release. Let your hand and arm go limp. Focus on how your relaxed muscles feel. Repeat this a couple of times. Focus on the different feelings and physical sensations between tensing and relaxing your fist.

How Does PMR Ease Anxiety?

Anxiety triggers certain physical changes and sensations, including:

  • Increased blood flow to the muscles

  • Muscle tightening

  • Rapid or shallow breathing

  • Increased heart rate

  • Slowed digestive functioning

By using PMR, you can counter these physical changes and sensations to achieve a “relaxation response.” A relaxation response comes from using relaxation techniques to calm your body. During PMR, your breathing slows and your heart rate and blood pressure decrease. When muscles are relaxed, they don’t require as much oxygen as when they are tense. This allows redirection of blood flow from the tense muscles to other areas of the body, which reduces many of the unpleasant physical effects of anxiety.

How to Do Progressive Muscle Relaxation:

Basically, a PMR exercise involves systematically constricting and relaxing various muscle groups from your feet upward or your head downward. You focus on tensing and relaxing muscle groups in the feet, legs, buttocks, stomach, back, hands, arms, chest, shoulders, neck and face.

To be most effective, you should be sitting or lying down in a comfortable position. Your eyes may be opened or closed, but most people find closing their eyes helps maintain focus during the exercise. Loosen any restrictive clothing, make sure your surroundings are quiet and follow these basic steps:

  1. Do some deep breathing before you begin. Inhale slowly and deeply through your nose and exhale through your mouth. Repeat this several times.

  2. Begin tensing and relaxing muscle groups. Bend your feet upward from the ankle toward your face, flexing as much as you can. Hold this position for about 5 to 10 seconds. Quickly release the tension and remain still for about 20 to 30 seconds.

  3. Gradually work your way upward by tensing and relaxing each set of muscle groups. Hold each tensed position for about 5 to 10 seconds. Allow 20 to 30 seconds of relaxation before moving on to the next muscle group.

  4. Focus on how you feel while you are tensing your muscles and while you are relaxed.

  5. After you’ve completed all of the muscle groups, continue deep breathing and focus on how you feel in this relaxed state. Notice the difference between how you feel now and how you felt at the start of the exercise.

Practice Is a Must:

All relaxation techniques are essentially skills, and skills get better with practice. By practicing progressive muscle relaxation regularly, you should be able to achieve a greater depth of relaxation in a shortened amount of time. Once mastered, you should be able to relax tense muscles on cue in many stressful situations.

Special Considerations:

  • If you experience feelings of emotional distress while using progressive muscle relaxation, stop and talk to your doctor.

  • If your muscles are sore or if you have an injury to any body part that you want to target with PMR, talk to your doctor before using this technique.

  • If you experience any intense muscle pain while performing this exercise, stop immediately and call your doctor.

Use a panic diary:

If you have panic disorder or agoraphobia, a panic diary may help you to identify your panic attack triggers and your responses to anxiety-provoking situations. It is usually best to record in your panic diary as you are experiencing (or shortly thereafter) anticipatory anxiety or a panic attack.

  1. What are your physical symptoms? Write down how you feel physically. Physical symptoms may include shortness of breath, heart palpitations, trembling or other physical sensations associated with panic or fear responses.

  2. What are you thinking? Include your thoughts before, during and after the panic attack. For example:

    • Something must be terribly wrong with me.”

    • What if I pass out?”

    • Something must be wrong with my heart.”

  3. What emotions are you experiencing? Fear, anger, sadness, inadequacy, confusion, shame and many others, are emotions that are often associated with the panic attack experience.

  4. ...and what behaviours are associated with your panic attack? Here you should include what you were doing just prior to the onset of the attack, and your behaviours during or shortly after the attack. For example, avoidance of a situation, performing certain rituals or calling a support person may be behaviors associated with a panic attack.

  5. How did you cope with the panic attack? Were you able to use any techniques to reduce your panic symptoms? For example, did you use any of the following:

    • positive self-talk

    • thought stopping

    • deep breathing

    • PMR

  6. How effectively were you able to get through the panic attack? Evaluate what techniques worked and what didn’t. Include the symptoms that you were able to control and those that you were not.

Your panic diary will help you identify what triggers your panic symptoms and how you act and feel as you experience panic and anxiety. You can then work on ways to reduce your triggers and discover what techniques work best to control your symptoms. You can also share your findings with your therapist or doctor, who can help you develop better coping techniques to deal with your panic responses.

Develop your coping techniques:

If you have panic disorder, agoraphobia or another anxiety disorder, anxiety-provoking situations may occur on a daily basis. Enhancing and refining your coping techniques can help you deal with them.

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