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Anxiety & Panic attacks
Psychotherapist Dr Aaron Balick drops in to answer your questions on anxiety and panic attacks. Find out what causes a panic attack, how to manage them, how to get your friends to help you and more.
Aaron is a psychotherapist, which means he's a specialist at understanding people and helping them solve their problems. He's worked in schools, colleges and universities and he's also the "resident psychotherapist" on BBC Radio 1's call-in advice Surgery with Aled and Dr. Radha. He's recently written a book called Keep your Cool: how to deal with life's worries and stress.
Becky: I cry often, and when I cry loads I struggle to breathe. This can stop and then come back again. Is this a panic attack?
Aaron: Hi Becky. Usually, panic attacks are full of fear and worry. What you're experiencing sounds a little different, but also similar because the emotions become so strong that you struggle to breathe.
When we get really upset (through panic, worry, or crying) we can get so caught up that we start breathing really fast - this is called "hyperventilating".
So, one of the first steps is to slow your breathing down. You can do this by closing your mouth and breathing through your nose (because it's hard to breathe too much out of your nose). Or, you can try counting slowly for each breath until you slow down.
One thing people don't know is that when you start to worry or panic and you breathe really fast, you're actually working yourself up more, rather than slowing yourself down, which is what will help you. The trick is always to slow yourself down, and it's really helpful to start with your breathing.
Becky: What actually causes a panic attack?
Aaron: Panic attacks come from a combination of your feelings, your thoughts, and your physical sensations and they often have what's called a "trigger".
The trigger is the thing that starts you feeling panicked, like maybe feeling like you're far from home, feeling closed in (like in a lift or in a car in traffic) or even seeing something scary like a spider (gross!).
When the trigger happens you can become scared and start feeling things in your body (your heart races, your head tingles, you start to feel like you can't breathe). Then you start to think that something even MORE awful is going to happen, so all this stuff starts to double up. Basically you freak out.
Becky: Oh I see. I get like that when I'm stuck in a tight closed in space.
Aaron: The interesting thing about panic attacks is we do a lot of it to ourselves! It's like we get scared, and then scare ourselves even more with our thoughts. Then we feel even more scared, which makes our bodies stress out more, etc. It's called a vicious cycle.
The trick is to break that cycle so we don't freak ourselves out more than we need to (and most of the time, we REALLY don't need to).
Katie: I sometimes feel panicked when I'm in situations where I don't know what to expect. Or, if something doesn't go the way I'd planned. I feel worried and get pains in my chest sometimes, and start to breathe strangely. I'm confused as to what it means?
Aaron: Hi Katie. What you're talking about is actually really common.
Katie: That makes me feel bit better. I felt pretty alone in it for a while.
Aaron: When we're in situations where we don't know what may happen, we can often fill in the blanks with our own thoughts. Usually, if we start to feel the way you describe, we fill in those blanks with horror stories. Instead of thinking "oh, this might not go how I expect, I wonder what will happen", we think "OMG OMG! It's going to be awful! It's going to be CATASTROPHIC! It's going to RUIN EVERYTHING!" - no wonder that makes us anxious!
It's super important to become aware of your thinking, for example how true is it that this would actually happen? Then it's about talking ourselves DOWN instead of talking ourselves UP. Then you'll find the pains in your chest will go, and you'll start to breathe normally again.
Katie: Okay, thank you!! Feel heaps better now. I guess I just wanted to know I wasn't alone in it, and get some advice to help. I wasn't sure what was wrong with me.
Aaron: That's alright Katie, a huge chunk of the population feels this way sometimes. It's great if you can learn to replace your thinking (sometimes called "awfulising" or "catastrophising") and replace it with something a bit brighter.
Katie: I'm still learning to change my ways of thinking. It's an ongoing task of mine!
Aaron: The good news is that panic attacks won't harm you, and you can learn to control them so they affect you less and less, until they don't affect you at all. Sometimes you can do it on your own, but sometimes you can use a bit of help, like from a counsellor for example, they can help you learn to think differently about stuff like this.
Helena: I've been told when I get panic attacks it's because I have 'dissociated'. What exactly does this mean?
Aaron: Hi Helena. 'Dissociated' is an experience some people have when it feels like they're not in their body anymore, and that can be really unsettling. It can feel like you're just in your head, or very far away, and then that can make you quite scared.
We sometimes dissociate when we are having feelings that we feel like we cannot manage. If you find it happening, sometimes it can really help, like I said before, to start to breathe slowly and feel your breath going in and out of your nose. If you're dissociating a lot, it's best to sort that out with your counsellor or therapist.
It also really helps (and I know it sounds weird) to feel your feet on the ground. You can just stomp your feet once or twice to feel the hard ground and that can remind you that you're just standing there on the ground like everyone else.
Jo: Great tip about stomping your feet on the ground, I like that.
Aaron: Jo, whenever we panic it's like we dissociate a little, so it's just a way of reminding ourselves that "here we are, just this person standing on the street like everyone else and nothing crazy is happening!"
Emma: I would definitely echo what Aaron said. Having your feet on the ground helps because it reminds you that you're "there". Also touching a wall can help to remind yourself of your surroundings or wrapping yourself in something soft like a duvet or blanket to feel something similar and sooth yourself.
Helena: Okay I understand that, thank you for your advice about the stomping! Is that called a grounding technique Emma?
Emma: It is indeed. Hard to do when you're already on edge or whatever you want to call it, but *if* you remember, it can help.
Aaron: Great advice Emma. It can also help to say something to yourself gently that situates you, for example something like "Here I am right now, and there's a tree over there, and the sun is out, and there's a house on the corner". It can bring you out of your head and back to real life.
Chris: Is the subconscious really that powerful? I mean, does talking to yourself and positive thinking work? I've read a few self-help books that explain that if you think of a positive scenario and talk to yourself about it over and over again, it might actually work for you.
Aaron: That's a great question Chris, and it's a bit tricky to answer! Negative thinking ("awfulising" and "catastrophising") really does get in the way of you feeling good about yourself, and can really push you into feeling anxious and stressed.
Of course it's better to feel positive about stuff, but if you're just saying positive things, and don't believe them, it's probably not going to help too much. The real trick is to learn to BELIEVE stuff about yourself that is positive, and try to keep those thoughts with you.
For example, things you're good at or things you like about yourself. When good things happen or when you do good things, hold on to those things and believe in them.
Sometimes we have a "negative script" about our life and when good things happen that don't fit the script, we ignore them. What really works is when you actually change that script to include good things about yourself.
It also helps if, when bad things happen, we don't use them to confirm bad things about ourselves. It's natural that some things don't go our own way; that just happens. Just try not to use those times to think "see, it's true, I really do suck!"
"The good news is that panic attacks won't harm you, and you can learn to control them so they affect you less and less, until they don't affect you at all."
Instead, it should be, "oh, that didn't work out how I'd have liked it, but it can be different next time".
Emma: Often when I have a panic attack it leads to a flashback, but by that point I've already lost control and find it very hard to regulate my breathing. This can go on for hours and it's scary for me, but worse for my friends if they witness it. Is there anything which I can do, to sort of cut short the spiral?
Aaron: Hi Emma, it sounds to me like sometimes this can be a bit of a struggle for you. If you're having flashbacks, it probably means that there is some emotional stuff hanging around for you that you might need some help in getting resolved. I would really recommend that you seek some help about this and describe what's happening to a GP to start with.
If you're worried about friends then it might be a good idea to let a few close ones know what is going on. If you have a sense of what would be helpful when you experience this, then let your friends know so they won't feel lost if it happens.
You might suggest that they take you to a quieter place or maybe talk to you about stuff to distract you from feeling upset.
Emma: My GP knows but panic attacks have always been dismissed because of other stuff. Or they've been like "hey let's faff about with your meds again!"
Aaron: Emma, it's true that meds can sometimes have something to do with it, especially when meds or dosages are changed, or if the kind of med you're on just isn't right. However, you're absolutely right, the panic is still about SOMETHING and that SOMETHING needs to be looked into. You might have to be more assertive with a doctor and say that you feel this isn't being dealt with well enough, and that you might benefit from a talking therapy (if you're not already in one) or something like that.
Emma: Thanks Aaron, I'm already open with friends, but I think giving them some tips on how to deal with me in those moments, when I'm past rational speech/actions is something to consider doing :)
Aaron: It's good to hear you're open with them. It helps when people that we are comfortable with know.
Olivia: Definitely Emma, I've asked my boyfriend to do something similar with me.
Olivia: My boyfriend also has panic attacks and when I'm with him its fine, I can calm him down. The problem is that I never know what to do or say if I'm not with him and he has one. Any ideas?
Aaron: Olivia, that's great you're able to help him when you're with him. Are you asking how to support him on the phone, or how to help him deal with them himself?
Olivia: I guess what can I generally do when I'm not there? When I am, I get him to focus on my voice and stuff but that doesn't work if we're texting or something.
Aaron: OK Olivia, and here's some general advice for everyone, some really simple things that can help to reduce panic attacks. Stuff like avoiding too much caffeine, watching what you eat (so you don't get blood sugar spikes and troughs), and watching alcohol intake (hangovers cause anxieties) and lots of drugs (speed, hallucinogens, etc.) are also a clear "no no".
The NHS has a great audio guide for dealing with panic that you could show him to give him the basics. While it's great that you support him, you also need to think about the idea of him developing a dependence on your support.
He will need to learn that he can survive it on his own too, and that will be REALLY helpful to him if he learns, even just one time, that he can handle it on his own, he'll be less likely to experience it again.
Olivia: I will do, thank you.
Aaron: It might also help for you to discuss how he might deal with it next time, that he learns the basic skills (slow breathing, relaxing his body, feeling the ground, talking himself down) and maybe waiting five or ten minutes before calling you, so he can learn to do it himself. I know that will be hard, but ultimately it will be really good for him.
It would be so great if he could ring you and say "I did it!" one time; it would give him loads of confidence and the knowledge that he's getting a handle on it.
Olivia: That would be awesome!
Anna: Can you actually have panic attacks without knowing what's caused them?
Aaron: Hi Anna, yes you can. They can be particularly scary because you don't know why it's happening. The thing is, there is almost always a reason somewhere, something that triggers off the panic. It can simply be a feeling in your body that scares you (like your heart skips a beat and then you panic), a rogue thought that comes along (something like "watch out, you're far from home!" or "there are loads of people around!") and then you go into the vicious cycle.
Awareness is so important when it comes to panic attacks so we can see those triggers when they are just beginning, then we don't have to wait until a full blown panic to recognise them. Then, if we feel a little scared (like "there are too many people here") you just tell yourself "that's fine, so there are lots of people, but I'm just fine!" and then it doesn't rise up into a panic.
You might think at first you want to get away, but you might be surprised that when you become aware of the trigger, and don't allow yourself to get worked up (by remaining calm and breathing deeply) you may not even need to go away, and then you've beat it! Panic isn't ruling your life anymore.
Jo: There seems to be a lot we can do to bring ourselves down and cope with panic in the moment, can we ever stop panic attacks completely?
Aaron: The good news is that yes, a lot of the time we can make them stop entirely, but the bad news is that there is no magic wand, like you can't say, "from now on, this will never happen again!"
The big trick with panic attacks is to realise that whilst it feels like they happen TO us, we actually participate in making them happen. It's nobody's fault, it's just the way we find ourselves responding.
Jo: I see, that's a really good way of thinking about it.
Aaron: So the key is to start to become aware of how we do it to ourselves, and to not accept the invitation to let it happen anymore. So if we start to panic, we're able to stop and say, "This is just a feeling, it's not going to kill me. It's unpleasant, but it will go away soon. I'll be calm, breathe slowly and deeply, and soon it will go away."
Once we learn that we can control panic and anxiety (and it doesn't just control us) we're well on the way to waving them goodbye forever.
Peter: How do I get over my anxiety of public speaking?
Becky: Ooh good question Peter :)
Aaron: Fear about public speaking is about a few things: we might be imagining that we'll do really badly, we get scared that we'll go blank or freeze, we imagine that people will laugh at us, be unsupportive, or even mean. And, on top of all that we develop a fear that's much bigger than the worst thing that can happen. For example, you might not be brilliant, but it's unlikely the crowd would start throwing rotten tomatoes at you. And even if they did throw rotten tomatoes at you, it's not the worst thing in the world, so why should you be so scared?
So, just imagine that things will PROBABLY be alright, and if they're not, it's really no big deal, it just didn't go your way.
Chris: I had that, it's really difficult. I did a lot of practice at home first, made my sister the audience and spoke in front of her, then with my mum too. I'd practice about twenty times before I went on stage. To overcome the fear, I faced it.
Aaron: It's all about putting your fears in perspective, then the fear turns into excitement (like stage fright) which is just enough stress to make you brilliant, without making it feel like you're going to be swallowed by a pack of lions. Practice can not only help you to speak better, but it also helps you to confront your fear.
A really important final thought is this: The recipe for anxiety is the OVERESTIMATION of FEAR multiplied by the UNDERESTIMATION of your ability to COPE.
Almost always it's not as scary as we'd expect and we can always cope better than we think we will. In short, most of the time we are just fine (and when we're not, it's not the end of the world).