It is a sunny day, and you are on a hike with your friends. Suddenly, out of the blue, the sky is overcast, and it starts pelting heavy rain. You are stranded and wet with nowhere to go. That is what a panic attack can feel like. Though it isn't the same, panic attacks are also sudden, often unprovoked, and overwhelming.
Diagnostic and Statistical Manual of Mental Health Disorders (DSM) defines panic attack as "an abrupt surge of intense fear or discomfort" reaching a peak within minutes. They are also often accompanied by physical symptoms like an increased heart rate and chest pain. Usually, an attack lasts for about 5-20 minutes, but they can sometimes last for up to an hour.
When someone has recurrent panic attacks accompanied by an intense fear of further attacks for a period of one month, then they are likely to have a panic disorder. Most people experience panic attacks once or twice in their lives, but recurring attacks usually need more attention to resolve.
Like a thunderstorm, panic attacks start slowly, peak over a few minutes, and then subside. They can be very fatiguing. They may have a trigger that sets them off, like an upcoming deadline or an abusive spouse, but they can also be unprovoked. Panic attacks usually have a similar set of symptoms in each person. Some common symptoms include:
• Increased heart rate
• Profuse Sweating
• Tremors or shaking
• Breathlessness
• Nausea and vomiting
• Chest pain
• Lightheadedness
• A feeling of intense dread
Panic attacks are sudden and the primary goal is to stop the ongoing attack. Panic disorder is also accompanied by a fear of future attacks and needs long-term treatment.
Also called four-square breathing, this technique is used to return your breathing to a normal rhythm after a very high-stress experience. It was initially taught to US Navy Seals as a method to stay calm in demanding situations. It is a highly effective four-step method. Step one is to exhale slowly for four seconds. Step two is to inhale deeply for four seconds, place your hand on your abdomen and ensure it expands. Step three is to hold it for four seconds, and then exhale again. Panic attacks are caused by the hyperstimulation of your sympathetic system. Slow, intentional breathing activates the opposing parasympathetic system and provides a sense of immediate calm.
External stimuli can be overwhelming, especially during a panic attack. If you are in a crowded space, closing your eyes can reduce external stimuli and help you focus on your breathing.
Grounding exercises are physical and mental hacks that bring you into the present moment and calm your anxiety. There are several things you can do that can quickly ground you. One exercise is the 'rule of threes' – Name three things in your surroundings, three sounds, and three body parts. Another is to recite something that calms you, a poem, a song, or a speech. A third common way is to listen to calming music. You can also try describing a routine process, like washing clothes in detail.
Picture yourself on a serene beach, with warm, white sand and gentle waves lapping across the shores. Breathe deeply with the pace of the waves. Visualizing a ‘happy place’ during a panic attack brings peace and can release tension. Many also endorse visualizing a stop sign as a cue to prevent unwanted thoughts.
When we are extremely stressed, our muscles become exceptionally tense. Consciously relaxing different muscle groups can also help reduce the intensity of mental stress. You can start either from the bottom or the top. Close your eyes, sit in a comfortable space, and start by clenching your jaws. Now slowly release the tension in your jaw and pay attention to how you feel. You may feel a release of tension, continue the same with your shoulders, hands, abdomen, and legs. Slowly, you may feel that the exercise helps you feel lighter and calmer.
Professor Paul Salkovskis from the University of Bath recommends having a person you can go to who has a calming effect on you. It could be a parent, a spouse, or a sibling, but knowing who to call or go to in that situation can be very reassuring. Additionally, they can help you with grounding or visualization as well.
Some medications can be prescribed to stop or control ongoing panic attacks, but they should be used very mindfully. It is advisable to use non-pharmacological methods as they are easily reproducible and are less likely to have side effects. If you feel the need for medication, you should consult your physician.
Different forms of psychotherapy can be employed to help you overcome panic disorder. Your psychologist/mental health practitioner/physician can help you devise methods to prevent panic attacks and techniques to cope with ongoing panic attacks. With practice, you can work on minimizing the frequency of attacks. The most common type of psychotherapy used for panic disorder is Cognitive Behavioral Therapy or CBT. Exposure therapy focuses more on confronting your triggers.
There are several groups of medications to treat panic disorder. Some types include selective serotonin receptor inhibitors or beta blockers. They may take a few weeks to become effective and may have side effects. They need to be taken under the supervision of a physician to ensure safety and efficacy. Different people respond to combinations of psychotherapy and medication, and it can take some time to find your fix.
A hallmark feature of panic disorder is fear of future attacks. Living with that constant fear can be challenging and sometimes even debilitating. Having the support of people who face similar trials and tribulations, and who are in different places in their journeys can help you come to terms with your illness and can also help you stay motivated. There are many online and in-person support groups in every city. Meeting like-minded people with a shared goal can mitigate feelings of loneliness and offer tremendous support. While they do not replace therapy, they are an excellent adjunct that can yield good results.
At Bloom Clinical Care Counselling and Therapy Services, we have a team of Psychotherapists and Social Workers who are experienced and qualified to help you with panic attacks. Our therapists can help with a wide range of mental health issues, such as anxiety, depression, grief, couples therapy, child therapy, anger management, workplace stress, and stress management, to name a few.
We currently have two locations, in Scarborough and Mississauga, to serve our clients and families across the Greater Toronto Area. All therapists on our team also provide virtual therapy across Ontario via phone and secure video calls. Our collective goal as a team is to help you flourish in life, guide you to your important milestone, and provide unwavering support.
Our Scarborough Therapists are located at Third floor, 1200 Markham Rd suite 306 c, Scarborough, ON M1H 3C3 for in-person and virtual psychotherapy appointments.
Our Mississauga Therapist are located at 3024 Hurontario St #206, Mississauga, ON L5B 4M4 for in-person and virtual psychotherapy appointments. Similar to our Scarborough Psychotherapy clinic, the new Mississauga location also supports individuals, families, couples, and children seeking help with anxiety, panic attacks, depression, grief, couples therapy, relationship counselling, stress management, and child and youth counselling.
Appointments are offered in-person at Scarborough & Mississauga. Virtually appointments are available across Ontario.
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