I’ve always been a nervous person, easily worried. So, if my chest constricted with fear, if a task I dreaded left me shaking and breathless, if I had to hug myself through a few minutes of absolute terror during my day, I assumed these were par for course for my personality. It was years before I learned of the term “panic attack”, many more years still before I understood how to manage them and ask for help.
The past few years have seen a surge of information online seeking to normalise the conversation on mental health issues. This is helpful for a lot of us who may find it difficult to understand how our body and mind respond to various kinds of stress. But as words like ‘panic’ and ‘anxiety’ become common parlance, it can be difficult to trawl through the internet to understand exactly what they mean.
HuffPost India spoke to experts to understand what a panic attack is, how to recognise one, how to get through it and when to seek professional help.
So, what exactly is a panic attack?
The experience of a panic attack differs from individual to individual, says Paras Sharma, counselling psychologist and head at the Alternative Story by Cuberoute.
“Our body has an emergency survival response called as the ‘Fight-Flight-Freeze’ response. Whenever our brain perceives something as dangerous to our safety and well-being, a part of our brain called the ‘limbic system’ (which is our ancient mammalian brain) activates this response,” he says.
As the body goes into overdrive to protect itself from the perceived threat or fear, which are often mostly psychological, the energy then manifests as symptoms, says Sadaf Vidha, a Mumbai-based psychotherapist.
How do you recognise the onset of an attack?
The first time, a panic attack can be extremely difficult to recognise as it feels palpably physical, Sharma says. “Often, people go to the emergency room believing they are having a heart attack. If physical causes such as cardiac, neurological or respiratory issues are ruled out by a medical professional, it is most likely that the experience is a psychosomatic one. This is how most people realise that what they experienced is a panic attack,” he says.
But the attacks can be predictable. “Usually the triggers are same or similar, for the same person. For example, for someone who has been harassed on public transport, there’s more likelihood of it occurring in the same setting,” says Vidha.
Symptoms of a panic attack
A panic attack is a group of symptoms occurring together. The symptoms usually reach their peak intensity and subside within ten minutes, says Vidha. Officially, at least four of the following symptoms need to occur for it to qualify as a panic attack, she says.
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesia (numbness or tingling sensations)
- Derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
- Fear of losing control or “going crazy”
- Fear of dying
9 Ways To Get Through A Panic Attack
1. The 5-4-3-2-1 grounding technique
Grounding exercises help you reorient the mind and get out of the ‘fear’ mode it is in, says Vidha.
“These usually involve using the five senses, like 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, 1 thing you can taste,” she says.
This could mean looking at calming images, listening to soothing sounds, touching things that are comforting such as plush or squishy balls, or sipping warm teas. These helps take the edge off the panic and get through a panic attack faster, says Sharma.
2. Transition objects
The purpose of transition objects, such as a body hugging cloth or blanket, is to give you a sense of safety and love, Vidha says. “Any object that gives you comfort can be held. Voice messages from loved ones could be heard on a loop,” she says.
3. Sensory Grounding Box
The above two steps could be put into what Sharma describes as a ‘Sensory Grounding Box’. “This contains soothing visuals, textures, candies/foods, perfumes/oils etc. which helps one deal with a panic episode immediately,” he says.
4. Breathing exercises
“Simple breathing exercises, such as paced breathing wherein one breathes slowly and deeply from the abdomen, and not the chest, to the rhythm of a ticking clock or a metronome, are extremely useful for people with anxiety and panic,” says Sharma.
Sharma also recommends guided meditation. “Many clients keep meditation apps downloaded on their phone or have self-affirmations (reassuring self-talk) which they use when they are feeling panicked.”
6. Repetitive movement
For some people, a repetitive movement like rocking the body or tapping the seat next to them can help release the energy they’re feeling, Vidha says.
7. Restore energy
Panic attacks can be draining, so it helps to keep some fruit, water and a medical energy drink at hand to help restore energy, Vidha recommends.
8. Avoid too much sugar, caffeine
Sugary, caffeinated foods like coffee or colas or energy drinks can induce or prolong feelings of restlessness or edginess, says Sharma.
Vidha recommends eating foods with low glycemic load which release glucose into your bloodstream slowly.
9. Avoid any alcoholic or psychoactive substances
People who experience panic attacks should avoid any alcoholic or psychoactive substances, says Sharma. “Alcohol may help one feel relaxed, but over time, worsens depressive feelings. Similarly, marijuana improves mood in the short term but worsens anxiety, and a mixture of alcohol and psychoactive substances can be dangerous,” he says.
How do you help someone having a panic attack?
A panic attack can take place anywhere. In the middle of a work day, during class, even at home. It helps if the people next to the person can reassure them as they go through the attack.
“The job of the person is to remind them that they are okay and that they are not alone, says Sharma.
“Some people appreciate a hug or a pat or a back rub, they can be asked and be provided that. Give them a space to sit, perhaps a drink of water when the attack had passed,” Vidha says. “See if you can remove the fear inducing element from the environment or do something about it to help with the trigger itself.”
“Reminding them to be calm and to breathe deeply can help, but don’t force someone to do something that isn’t helping them feel better. Remember that the person experiencing the panic attack is feeling the sensations of it, not you!” Sharma cautions.
When should you seek professional help?
It is okay to deal with a one-off panic attack on your own, says Vidha. “But, for regular debilitating ones, you should seek help.”
Anxiety before events such as a big deadline at work or an exam can be normal, says Sharma. If you experience heightened levels of anxiety that persist for several days (usually two weeks or more), if there is no known physical, social or professional trigger for these feelings, he advises seeing a professional.
If you or someone you know needs help, mail email@example.com or dial 022-25521111 (Monday-Saturday, 8am to 10pm) to reach iCall, a psychosocial helpline set up by the Tata Institute of Social Sciences (TISS).