How to Manage a Panic Attack

Three concrete strategies to calm your mind and stop anxiety

Panic attacks are not uncommon: Six million adults in the United States have a diagnosed panic disorder, and millions more struggle with panic attacks every day. And they can be very scary. Your heart may beat out of control, and your mind may race. The world can feel like it's spinning out of focus. Sometimes the physical sensations can be so strong that you may worry you are having a heart attack or dying.

These symptoms can be similar to an undiagnosed thyroid problem or cardiac disease, so I always recommend that my clients first have a checkup to rule out other conditions. But for many people, panic attacks are either a symptom of a panic disorder or are rooted in general anxiety. In either case, consulting with a mental health professional who specializes in panic or anxiety can bring the greatest relief from your symptoms.

But when you are having a panic attack, trying these techniques can make it feel less scary and painful:

Roll with the waves. Panic attacks often come in waves of tingling sensations, dizziness, shortness of breath, and racing thoughts. Many people try to make these feelings stop by telling themselves to just snap out of it. This may just cause you to end up feeling overwhelmed and helpless if the panic attack continues to run its course instead. Although it's counterintuitive, taking the time to observe your anxious sensations and ride out the experience can often be a very helpful way to reduce the intensity and scariness of a panic attack.

Try this: When you begin to feel panic sensations, instead of trying to shut them out, visualize each feeling as a wave which you are riding until it comes to rest on the shore. Anticipate the wave passing and becoming less and less intense as it crests. Remind yourself that just because you might feel like you'll drown beneath the wave, it doesn't mean you can't swim. You might also remind yourself that the panic sensations are just passing waves on the constant, powerful ocean that is you.

Anchor yourself. Panic attacks can make you feel surreal and out of control. One way to counter that out of body feeling is to reconnect with your body and anchor yourself in the tangible world.

Try this: Practice full-body breathing every day. Breathe in deeply through your nose and imagine your whole body filling up with air like a balloon. Next, make your mouth small like you are exhaling through a straw. Slowly exhale through your mouth until you feel like all the air has completely emptied from your body. Repeat this about 10 times and notice any changes in your heart rate or body tension. Once you are comfortable with this kind of breathing, use it during a panic attack to slow your heart rate and calm down.

Other ways of anchoring yourself during an attack include rubbing your hands or bare feet on a surface such as a chair, couch, or rug. The sensation helps bring your focus out of your mind and into the physical world. Similarly, put an ice cube in a paper towel and squeeze it as hard as you can in one hand for a minute until you can feel the coldness and discomfort. Switch hands and repeat until you have the same sensations in your other hand. 

All these practices draw your awareness to your body in the here and now and away from the surreal feelings of panic.

Engage your whole brain. When you have a panic attack, it's because the emotional part of your brain (responsible for fight-or flight-responses) has hijacked the controls. Stress hormones flood your brain and put your body into survival mode. Although this mechanism helped our ancient ancestors survive, nowadays it often misfires, sending us into flight for little reason. The good news is that so many other parts of our brain have evolved since our days in the cave, including our thinking, logical brain. Engaging your thinking brain to reign in your emotional brain is one of the most effective therapies for anxiety and panic.

Try this: When you feel a panic attack coming on, use your thinking brain to talk yourself through it. Verbal reasoning helps you label and understand the sensations as a passing, although painful, bug in your system rather than a sign that you are going crazy or dying. You might say to yourself, "Here's that annoying panic feeling again. This is going to suck a little, but I'm glad it will be over soon."

Another way to engage your thinking brain during panic or anxiety is to do tasks that require motor or cognitive skills. Wash some dishes, sort laundry, do a word search or crossword puzzle, count backwards in a foreign language, etc. All these activities require you to use more complex executive and motor skills that force your thinking brain to take over.

All these tools should lessen the grip that panic has on you and help you return to a calmer state. But if you experience multiple panic attacks in a day, or find that you are constantly worried about having one, it's worth meeting with a mental health professional who specializes in anxiety. You do not have to accept this level of anxiety in your life, and treatment is very effective.