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HOW TO CALM A PANIC ATTACK:

THE FIVE STEPS OF AWARE
Here's a five step process you can use to guide your responses during a panic attack. I have borrowed this (with some modifications of my own) from Anxiety Disorders and Phobias: A Cognitive Perspective, an excellent text by Beck, Greenberg, and Emery

As you read this, think about how it compares to what you usually do during a panic attack.

The five steps are:

Acknowledge & Accept

Wait & Watch

Actions (to make myself more comfortable)

Let's take a look at what each step entails.

ACKNOWLEDGE & ACCEPT
Here I'm going to acknowledge the present reality, that I am afraid. I won't try to ignore it, or pretend it's not there. I won't struggle to distract myself, or command myself to "stop thinking about it!", because that probably won't work. Note that I am acknowledging that I am afraid, not that I am in danger. The thought that I am in danger during a panic attack is just another symptom of fear, not a realistic appraisal of reality.

And I'm going to accept the fact that I am afraid at this moment. I'm not going to fight the feeling; or ask God to take it away; or blame myself, or others. I'm going to accept, as best I can, that I am afraid in the same way I would accept a headache. I wouldn't like having a headache, but I wouldn't bang my head against the wall to try and get rid of it, because that would make it worse.

You might wonder, how can I accept a panic attack?

What makes it acceptable? The fact that, while it feels awful and fills me with dread, it is not dangerous. It will not kill me or make me crazy. Someone pointing a gun at me, that's not acceptable. I might get hurt or killed. If someone points a gun at me, I have to do whatever I can to change that: run, hide, fight, yell, bribe, or beg, because the consequence of being shot is so terrible that I have to do whatever I can to avoid it.

What's the consequence of a panic attack?

I'll be afraid and, if I'm having a panic attack, I'm already there!

I'm already experiencing the worst that will happen, I just need to ride it out. That's what makes the panic attack acceptable.

Why would I accept the panic attack? Just because the more I resist the attack, the worse it gets. And the more I accept it, the sooner it leaves. This is a very important aspect of panic attacks, one that's central to your recovery. I've already described this in the article entitled "The Panic Trick", so be sure to read that if you haven't already.

That's Acknowledge & Accept. How does it compare to what you usually do during a panic attack?

WAIT & WATCH
What I mean by wait and watch is this: don't just do something, stand there. It's similar to the suggestion "count to ten before you get mad".

One of the hallmarks of a panic attack is that it temporarily robs you of your ability to think, remember, and concentrate. This step will buy you a little time to regain those abilities before you take any action. When you react before you have a chance to think straight, what are you likely to do? If you're like most people, you'd probably flee, or struggle, or do something that makes it worse. This is what people mean when they say things like "I know I'm doing it to myself".

So, even though you have a powerful urge to leave, postpone that decision for a little bit. Don't tell yourself you CAN'T leave - keep that option open so you don't feel trapped - but put off the decision about whether or not to leave. Stay in the situation.

With respect to watch: use the occasion to observe how the panic works, and how you respond to it. I ask my clients to complete a panic diary whenever they have a panic attack. It's designed to help them notice important aspects of a panic attack, so we can discuss it later and figure out how they can respond more effectively the next time.

My clients often report that just filling out a diary helps them to calm down. How does this work? It's not that they're distracted, because the diary questions are all about panic. I think it works because, when they're completing a diary, they're in the role of an observer, rather than a victim. It helps them get a little distance from their emotions. If they're in a situation where writing is impractical, perhaps while driving a car, they can use a tape recorder to record their observations, or pull over for a few minutes to write.

How does "wait & watch" compare to what you usually do?

ACTIONS (to make myself more comfortable)
Now, having gone through the first two steps, is a good time to make yourself more comfortable while waiting for the panic to pass. Those first two steps are very important. If you jump right into action without going through the first two steps, you'll probably overreact and make it worse, so discipline yourself to stay with this program.

Remember, it is not your job to bring the panic attack to an end; that will happen no matter what you do.

Your job is to make yourself as comfortable as possible, while waiting for the attack to end.

So at this point, you can use any additional coping techniques you favor. The self help literature is full of suggestions, and you will find a listing of such books at our Resource Directory. Here are a few techniques that my clients have found particularly useful.

Regardless of what else you do, do diaphragmatic breathing. If you don't know how, check out our video & instructions. If you do know how, check out our video & instructions anyway. Many people think they know how to do diaphragmatic breathing, but don't do it correctly, so they don't get good results. A good diaphragmatic breathing technique is a very powerful tool!

Second, talk to yourself (silently) about what is happening, and what you need to do. One way my clients find very helpful is to ask themselves this question: is this Discomfort or Danger?. Some of the other responses my clients like include the following:

Fine, let's have an attack! It's a good chance to practice my coping techniques.
They respond to all their "what if...?" fears by saying "So what? I'll get afraid, then calm down again."
"It's okay to be afraid."

People don't panic in the present.

People panic when they imagine something bad happening to them in the future or in the past. This is why your panic attacks are almost always accompanied by some "what if...?" thought. The reason you have to say "what if...?" is because what you fear is not actually happening! You have to imagine losing control, going crazy, dying, etc. That's why people think "what if...?". In this context, "what if " means "let's pretend something bad!"

To counter this, get involved in your immediate environment.

Get back into the activity you were engaged in prior to the attack, and become involved with the people and objects around you. If you're in a store, resume shopping, reading labels, comparing prices, asking questions, etc. It will be a big help to you to bring your focus and energy back to the present environment. By this I mean, work with what is around you.

Learn to identify, and relax, the parts of your body that get most tense during a panic attack. This typically involves first tensing, and then relaxing, the muscles of your jaw, neck, shoulders, back and legs. Do not allow yourself to stand rigid, muscles tensed, and holding your breath. That just makes you feel worse! Instead, work with your muscles and posture to regain a sense of control over your body. If you feel like you "can't move a muscle", start with just one finger!

And if you're in a situation where it would be appropriate to get some cardiovascular exercise, either by running, walking, climbing stairs, dancing, or whatever, go ahead and do this. It will help you burn off some of that adrenalin. (This will be safe and very beneficial for the great majority of people but, as always, ask your personal physician if this is OK for you to do).

REPEAT
This step is here because you might start feeling better, then feel another wave of panic. Your first reaction might be to think "Oh No it didn't work!". The Repeat step is here to remind you that it's OK if that happens, just take it from the top again. It's not unusual or dangerous. You may go through several cycles, and you just need to repeat the AWARE steps again, as often as you need.

END
This is here to remind you that your panic attack will end; that all panic attacks end; that they end regardless of how you respond; that it's not your job to make the attack end; and that your only job is to make yourself as comfortable as possible while waiting for the attack to end.

So the next time you panic and hear yourself thinking "Will this ever end?", you'll be ready to answer, "YES!"

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This page was last modified on 6-10-2004.