Panic Attacks! What they are and what to do.

What's the deal with Panic Attacks?

Panic attacks suck. They are one of the most overwhelming emotional experiences within our emotional rolodex. As someone who has had a number of panic attacks over the years, I can attest that they are some of the most uncomfortable moments in my life- worse even than hearing about a coworker's cat, awkwardly avoiding commenting as a friend tells you how good Nickelback is, or speaking in front of a large group of people. Overall, about one in  four people will experience at least one panic attack in the course of their lives and I would argue those stats are a little low as many don't actually realize that what they are experiencing is a panic attack.

Those experiencing panic attacks may believe they are “going crazy”, “dying”, or having a heart attack. In fact, men frequently present to the hospital complaining of symptoms of heart problems that are later diagnosed as panic symptoms. Panic attack's include feelings of dread, anger, anxiety or sadness. People often notice a rapid heart rate, shallow rapid breathing, tearfulness, dizziness, nausea, chest pain, muscle tension and a variety of other uncomfortable physical symptoms while they are happening. Panic attack’s are called an “attack”  due to the rapidly escalating nature of symptoms. Panic attacks often have a rapid and intense onset-reaching their peak within a few minutes.

Panic attacks happen because of an over-activation of the central nervous system. They are a good sign that we have maxed out our coping resources. They can happen related to any event that is perceived to be threatening- including relationships, social embarrassment, financial stress or fearing you may have to hear about a coworkers cat. They can also happen related to phobias- like dogs, needles, heights or airplanes.

There is a small group of people who don’t have panic attacks related to any fear and rather the panic symptoms are linked to internal changes such as heart rate or breathing. This group is especially at risk for a diagnosis of Panic Disorder. Panic Disorder is not about having panic attacks- rather it is a disruption in your life related to the fear of having panic attacks. One way this fear of panic attacks can impact your life is called “agoraphobia.” Agoraphobia refers to a fear that help might not be available to you, or that there will not be an opportunity for safety. For some this happens in enclosed spaces and for others it happens in public- more open- spaces. Agoraphobia can lead to people dramatically restricting their experience of the world and in some cases not wanting to leave the house at all.

Though disorders related to panic attacks are fairly rare- the experience of a Panic attack is common and about 25% of people will experience at least one panic attack in their lifetime. For many, panic is something that happens more frequently than that. It is something that comes through my doors frequently as a mental health professional who works with children and youth. Many youth refer to these symptoms of panic as “shutting down” or “getting stuck” in moments of intense arousal.

Here are some essentials for parents and caregiving professionals to know about how to help a child who is experiencing a panic attack.

So- what can we do to help someone that is having a panic attack?

1) Breathing

Breathing retraining is essential as breathing deeply and mindfully can slow the onset, decrease intensity and shorten the duration of a panic experience. Practice healthy breathing (deeply in through the nose, holding the air deep in the belly and slowly exhaling through the mouth) when calm in order to make this an available tool when distressed. Do not save healthy breathing techniques for moments of distress or they will likely not be beneficial. For more on how to teach a child to breath in a healthy way read this: How to teach a child to breathe and why we should all do it!

2) Reduce Stimulation

When someone is having a panic attack their system is overwhelmed and we need to help them minimize and reduce arousal. Helping someone with an overwhelmed system feel safe is different than helping them feel safe when calm. We create safety for an overwhelmed person by showing them we are available but not adding to their hyper-stimulation.

Keep your verbal interactions simple and brief. Slow your movements and lower your body position where possible with small children.  Limit stimulating features in the environment such as turning of televisions or music, moving others to another room, or dimming lights. Use the child's name, make eye contact and tell them you are there for them and want to help them get through it- and then be present and available.

3) Allow time for the nervous system to spike and calm

Intense arousal, like that seen during a panic attack, is not just a shift in how the brain works; it is a shift in the whole physiology of the body. Things physically change and will take time to reset. No matter what we say or do- someone having a panic attack is going to continue to experience the discomfort of that attack until these physical changes revert to a more typical level.

During a panic attack- the blood stream floods with hormones like cortisol and adrenaline and these take time to break down and reabsorb. Breathing shallows, the heart speeds up and blood flow shifts towards the extremities. All of these take time to readjust. Be patient and prepare to sit with your child in their feelings rather than frantically try to change them. Don’t rush calming or it will intensify the felt anxiety and discomfort.

4) Communicate clearly that the discomfort that they are feeling will pass

Panic attacks suck but they are typically very brief. If you are with a child having a panic attack, sit with them calmly, communicate that you are there for them and remind them that everything is okay. Tell them the gross way they are feeling will pass. Acknowledge what you see happening in their body and briefly note that it will not last long. For example, “your heart is beating really fast- that is okay- it is part of the panic attack. I’m here. It will feel better soon.” Let them know that even though it feels really uncomfortable that it cannot hurt them.

5) Teach your child about panic attacks

If you are providing care for a child that experiences panic attacks, teach them about what is happening. The most uncomfortable part of a panic attack is often the confusion and lack of understanding about what is happening. A child who thinks they are going crazy, dying, or just out of control is going to calm a lot slower than a child that is able to recognize that it is a panic attack, it is normal, and it will pass.