How to manage panic attacks when they happen, per psychologists

Hyperventilating, chest pains, sweating and a racing heart are just some of the terrifying symptoms of a panic attack.

One in ten Americans will suffer one this year alone, according to the Cleveland Clinic, and around one in 50 will suffer multiple.

Many sufferers say it feels like they are about to die, have a heart attack or ‘go insane’, while others say it feels like they’ve lost control of their body. 

But DailyMail.com has spoken to three psychologists about how you can prevent attacks naturally – without medication – and how best to deal with them if they present:

THE 4:6 METHOD

While being fed hackneyed guidance such as ‘take deep breaths’ can sound trite to someone experiencing a panic attack or panic disorder, it actually works, according to Dr Ian Stanley, a psychologist from the University of Colorado.

He recommends exhaling for a few seconds longer than inhaling. When one starts to arise, try breathing in for a count of four and out for six.

Inhalation is linked to the sympathetic nervous system that activates the ‘fight or flight’ response. It’s the gas pedal, in a way.

Meanwhile, exhaling is linked to the parasympathetic nervous system, which is what influences our body’s ability to calm down. 

Extending the exhale automatically puts more emphasis on the side of the nervous system that provides rest and relaxation.

‘It just kind of trains the body to slow down and then provide some physiological feedback, that the threat isn’t as imminent as a panic attack makes someone think it is,’ Dr Stanley said.

RAINBOW TECHNIQUE  

Dr Carolyn Rubenstein, a Boca Raton, Florida-based psychologist, recommends honing your senses on something external to serve as a distraction from the physical and emotional panic.

‘What I try to really recommend people do because it’s kind of creative is thinking about the rainbow. 

‘And think about looking for three red things [in the room or your surroundings], three orange things, and three yellow, green, and blue. 

‘And you can even expand that and look for gold and silver and white and black and just really kind of engage it. It works even if you’re driving or if you’re on a plane.

‘It’s really useful in terms of de-escalating because it will keep you engaged and it takes a little bit of time. 

‘And it really does force you to expand your perspective and to get you out of your body for a few minutes so that you can calm down.’

Other helpful distractions could include listening to feel-good music, dunking one’s face or hands in ice water, or getting some fresh air.  

ID YOUR PANIC ATTACK  

For many people, simply identifying the oncoming panic can be soothing. 

Telling oneself very calmly and matter-of-factly that the body’s response to some foreign stimulus is a miscalculation is enough to disarm the panic, in many cases.

Dr Rubenstein said: ‘You are labeling it, you’re looking at it, rather than reacting from it. You are coming from a place of control, rather than symptoms controlling you.

‘It’s a mental trick that we use, it kind of brings in logic, and not so much just the emotions being in control. 

‘Labeling it is really important to get back that control and it puts you back in the driver’s seat for a moment, which can be incredibly helpful when you feel a complete lack of control.’

Panic attacks are not themselves fatal, but experiencing one can feel like enduring a heart attack or even dying. 

Symptoms are wide-ranging and depend on the individual, but some of them include chest pains, dizziness, nausea, shaking, sweating, rapid heartbeat and hyperventilating, and a profound fear of losing control.

They typically come on fast and can last anywhere from five to 20 minutes. 

The period after a panic attack in which the body and mind are recovering can feel like a nasty hangover.

PUFF OUT YOUR CHEST 

Dr Karen Lynn Cassiday, Managing Director of the Anxiety Treatment Center of Greater Chicago told DailyMail.com that people prone to panic attacks should maintain good posture and sit up straight.   

Altered breathing caused by bad posture induces and exacerbates the level of anxiety. 

She said: ‘What people do, and animals too, when they’re in chronic stress, they get into this fear posture and you make it hard to breathe naturally with your body and suddenly you exhale too much carbon dioxide.’ 

Standing or sitting in a confident posture with your chest puffed and shoulder broad has a psychological boost, improving confidence, mood and energy levels and reducing stress, anxiety and depression. 

SLOW DOWN YOUR BREATH

While the 4:6 method helps press the brake pedal on panic, Dr Cassiday also cautions against breathing too deeply when in the midst of a panic attack. 

Many people in the throes of a panic attack will be able to remember the oft-given advice to breathe profoundly or deeply to steady their heart rate. But when hyperventilating, that’s easier said than done and in fact exacerbates the problem.

That’s because hyperventilation happens when people breathe so quickly and deeply that they expel an unusually high amount of carbon dioxide, which in turn causes heady symptoms such as dizziness that characterize a panic attack. Those symptoms simulate the feeling of suffocating, which sets off a vicious cycle of breathless panic.

Dr Cassiday said: ‘The worst thing you can do is take a big breath because that only serves to lower carbon dioxide levels even lower. Breathe slowly and gently through your nose so it’s as quiet as possible and you can barely hear it in the back of your throat.’

TRY THERAPY

Anxiety is a common malady and psychologists and licensed social workers are trained to coach people through it. 

There are plenty of treatment options for panic attacks and panic disorders. Cognitive behavioral therapy often called talk therapy or psychotherapy is the first line of treatment for panic disorder and panic attacks. 

CBT equips the patient to better modify their thought processes and actions to confront and disarm intrusive thoughts that lead to panic attacks.

Therapy can not only help someone better understand what to do when a panic attack strikes, but also how to modify their behavior and patterns of thought that might prompt a panic attack in the future. 

Dr Karen Lynn Cassiday said that a panic attack is ‘Like the time when you were a kid and somebody’s older brother held your head underwater in the swimming pool and you didn’t think you’d ever get to the surface.’

‘Having four or more of those symptoms is really overwhelming, that’s why a lot of people might think, I’m having a stroke, I’m going insane, I’m dying, something is terribly wrong with my body. And in fact, they’re correct, it’s just none of those things I’ve just mentioned.’

Many people who deal with panic attacks face a constant fear of being caught off guard by one while carrying out normal life functions, such as food shopping or driving.

Some people will never experience a panic attack. Many people will experience one or two in their lives. But an unlucky 4.7 percent of Americans have panic disorder, chronic anxiety including frequent panic attacks.