Attack e-book

YES!
You CAN Cope with Anxiety
and Panic Attacks!

By Laura Dickson, LCSW

What is a panic attack and what happens to body and mind when they occur?

A panic attack is an extreme form of anxiety. It is a genuine, physical, emotional or behavioral reaction to a perceived threat.

The feeling of anxiety is exacerbated by the natural release of adrenaline, the body’s automatic way to prepare us for “fight or flight”.

Physiological symptoms vary from sweating and trembling, shortness of breath or a choking sensation, dizziness or feeling faint, shaking or tingling in your hands and/or feet.

Emotional reactions can be those of apprehension, uneasiness, and, at its most extreme, feeling detached from your body or fearful of dying or the feeling that you’re “going crazy”.

If you’ve been diagnosed with panic attacks or extreme anxiety, you know only too well how terrifying they can be. Before you read further, please be assured nobody dies from a panic attack.
Nobody.

• You may feel like you’ll choke to death, but you will not die.
• You may feel like you’re having a heart attack, but you will not die.
• You may feel like you’ll lose complete control of yourself physically or mentally. You will not die.

Please remember:

• You CAN manage anxiety and panic attacks
• You CAN have fewer and fewer of them
• You may even eliminate panic attacks and extreme anxiety altogether.

How can you diminish or even eliminate anxiety or panic attacks?

With the guidance of this article, coupled with the advice of your therapist, you CAN take control.

Here are a few easy-to-adapt methods that can lead to immediate or at least very quick results:

BE PATIENT. Take the time necessary to let the panic pass. Usually, your adrenaline rises during such an event. Adrenaline is nature’s way of telling us that danger is near (a lion! an oncoming car!) Adrenaline enables us to take action to fight the encroaching real danger. For the danger you feel from panic attacks, the actions you should take are:

• to breathe
• remind yourself you are okay
• allow the feelings to wash over you and OUT

BREATHE! The moment you feel a panic attack coming on, check your breath. Breathe deeper and slower. Repeat as often as needed. Use one or all of the following breathing techniques. Taking rapid shallow breaths or holding your breath reduces oxygen and hampers your body’s ability to relax, so breathing deeply is critical to reducing panic attacks and anxiety.

REMIND YOURSELF that this is just a panic attack and you will not die. You are OK!!! Talking to yourself is actually a great thing to do when you find yourself with an impending panic attack. What you say to yourself is important, too: remind yourself that you are safe, you are strong, your are able to move beyond this situation, and you will do just that.

ACCEPT ALL YOUR EMOTIONS. It’s okay to feel anger, sadness, grief, loss, just as it is okay to feel happiness, joy, and the fullness of a life rich with purpose and companions. All feelings are valid. By accepting all the emotions you feel, you can take the relevant steps necessary to deal with your panic attack or extreme anxiety.

DO NOT FIGHT IT. Allow the rush of adrenaline to ease. Be patient as it does take a little time to dissipate. Once released, you will the feeling of anxiety will be greatly diminished. Do not step away from panic. Do not run. Do not hide. Accept that your body is having this experience and do not fight the sensations.

GO WITH THE FLOW. Some people experience a first wave, then a second wave of anxiety during a panic attack. If standing still and accepting the experience or telling yourself that you are okay does not help, go with the flow and have confidence that your body will move through it. Really. Your body is wise beyond your fears of what is happening.

What can you do to get you on the path of fewer panic attacks?
There are a variety of actions you can take right now to insure that you will have fewer and fewer panic attacks in the future.

They really work, so please give them a try.

Today.

REVIEW YOUR LIFESTYLE AND STRESS LEVEL.
A long-view method of reducing panic attacks is to get serious about including regular exercise every day from a brisk walk around the block to a stimulating class of aerobics or a game of your favorite sport from tennis to basketball or swimming. Dance to your favorite CD or go out dancing with a partner. Greet the morning with stretches or yoga. Whatever you choose to do for exercise, do it every day for at least 20 minutes. To fend off boredom, create a mixture of activities, such as stretches one day and dancing the next and playing a sport the next.

Stimulants, smoking, and eating sweets all create physical sensations that can be similar to panic attacks. Decreasing or eliminating these triggers can greatly reduce anxiety and panic attacks.

CUT OUT STIMULANTS. Review your consumption of alcohol, caffeinated beverages and foods such as colas, coffee, tea, chocolate or yerba mate. Caffeine and alcohol tolerance varies widely, so determine if you’re sensitive, allergic, or intolerant and adjust your diet accordingly.

STOP SMOKING. Stop!

REDUCE SWEETS. Read labels of every package of food you bring into the house. “savory” foods contain corn syrup, fructose, high fructose corn syrup, sugar, honey, agave, and glucose. Some foods contain all of these! Go the extra mile and prepare foods at home with fresh ingredients.

The above actions are usually enough to make significant changes in mind and body that will lead to fewer panic attacks and anxiety. If you believe that they are not decreasing, this is the point where you could explore with your therapist the possible sources of these panic experiences.

What are the possible emotional triggers that create and maintain anxiety and panic attacks?

Dramatic or traumatic life changes are frequently a trigger to anxiety and panic attacks. Divorce, death of a loved one, job loss or unexpected change, financial loss or similar elements of a high stress life style are ways that can make us vulnerable to anxiety. Professional counsel is a direct and very effective way to work out your feelings and help you onto the path toward feeling more empowered about your life.

Personality traits like lack of assertiveness, negative self talk, feeling a lack of meaning or purpose in life or an unwillingness or inability to express feeling can build up within us until they explode into anxiety or panic attacks. Even a lifetime of extreme shyness or lack of purpose can be greatly improved with expert therapy. It is a vital step in self-awareness and empowerment.

Other triggers can be witnessing a traumatic event or even seeing something or someone that reminds you of unhappy experiences. Even extreme stress or fatigue can lead to episodes of anxiety.

When you learn to understand your triggers for panic attacks, through self-awareness or the therapeutic process, you can take the necessary steps to reframe these triggers and reduce their assumed threat.

You can help yourself identify these triggers by keeping a little notebook and jotting them down as you remember them. Ask yourself:

• Why did this upset me?
• How can I think of this incident in another way?
• What action or actions can I take to avoid them in the future?

Okay, you’ve identified your triggers. You’ve reduced stimulants in your diet and increased your exercise. You’re going along feeling fine and there’s a little rumble going on. Not a full-scale panic attack but something’s definitely brewing; what to do?

Here are some easy exercises to do anywhere you are:

BREATHE!
The simplest and incredibly effective 4-4-8 technique should be used whenever you feel a panic attack coming on and any time you need to relax. Here’s how to use this technique:

Place your right index finger on your right nostril to keep it closed. Breathe in with your left nostril for the count of 4. Hold the breath for the count of 4. Slowly exhale for the count of 8. Next, using your left index finger, hold your left nostril closed. Breathe in with your right nostril for the count of 4. Hold the breath for the count of 4. Slowly exhale for the count of 8. Concentrate on the counts and try to exhale as slowly as you can for those 8 counts. Doing two or three sets should be immediately helpful in relaxing both your body and your slowing down the anxiety you feel under a panic attack.

An alternative way to use this is to breathe in on one side of your nose and exhale with the other such as breathe into the right nostril, hold the breath then exhale via the left nostril. Switch and then inhale with the left nostril, hold the breath, then exhale with the right nostril. Use the same 4-4-8 counts.

CALM YOURSELF WITH QUIET ACTION.

• Sing a soothing or smile-inducing song.
• Eat some fruit or crackers or chew a piece of gum and chew consciously.
• Count stuff: cars on the road, people in line, the money in your wallet.
• Check or update your calendar.

CLENCH AND RELEASE
This is a technique is used by tightening the muscles and holding for 10-15 seconds, then relaxing them for a little longer, 15-20 seconds. It will replace the feelings of terror and replace them with feelings of relaxation. Do this from the top of your forehead to your toes. This is a wonderful way to relax the body enough to get a restful sleep or nap after an attack.

FOCUS ON A HEALTHFUL ACTION:

• Read.
• Solve a puzzle.
• Do something repetitive with your hands: Knit, sew, paint or draw, etc.
• Play cards or a board game off or online.
• Use a calculator.
• Play a musical instrument.

TALK OR WRITE IT OUT.

• With a friend.
• With your therapist.
• With a pen, listing the possible reasons for your feelings.
• With artwork; draw your feelings onto paper.

DO SOMETHING THAT YOU KNOW FEELS GOOD:

• Get a hug. Give a hug.
• Have sex. If nobody is available, masturbate.
• Take a luxurious bath or a hot shower.
• Eat high quality protein with carbs (steak and potatoes, cheese and crackers, hard-boiled eggs and raw carrots.

EXERCISE!!

• Get out and walk around the block.
• Do calisthenics.
• Play a sport (tennis, ping pong, even jacks!)

IF ALL ELSE FAILS, WALK AWAY
Move away from where you are and excuse yourself from any people you are with. This is particularly important if a panic attack occurs while driving or even when you’re a passenger. Pull over or ask the driver to pull over, and begin breathing techniques or get out and stretch or walk. Give yourself some “positive self talk”. Ask your therapist for some examples.

If you’re in a work situation and have an office, close the door to do the breathing techniques or do some stretching exercises. If privacy is not possible, go to the bathroom and sit quietly in a stall and do the breathing techniques or go outside and walk briskly to a place where you can sit down and begin to your breathing exercises.

What are other breathing exercises?

DEEP BREATHING:
Deep breathing works best when you breathe fully and deeply from the abdomen so that you can push up as much air into your lungs. The benefits are inhaling more oxygen, which reduces tension, eliminating shortness of breath, and greatly reducing anxiety.

You can do this sitting or lying down.

SITTING METHOD:
Sit in a straight-back chair and sit more on the back of your thighs than on your derriere. This helps keep your back straight and the breathing more comfortable. Until you are experienced, use your hands to help guide you. Put one hand on your chest, and the other on your abdomen or stomach.

Breathe in through your nose. When done deeply, the hand resting on your stomach should rise yet the hand resting on your chest should not move or if it does, very little.

Exhale through your mouth while expelling as much as you can, contract your abdominal muscles. The hand on your stomach should move as you. Exhale and your other hand will not move much at all.

Continue to do this, taking note if your abdomen is rising. To increase the relaxation feeling, make the time spent exhaling longer than the time used to inhale the breath.

LYING DOWN METHOD:
Lie down on the floor and put a small flat pillow or a paperback book directly onto your stomach. Follow the directions above for breathing, noting that the book or pillow will rise as you INHALE and fall as you EXHALE. Try to do this for at least three minutes, longer as desired. This is also an effective way to relax yourself before going to sleep.

YOGA BREATHING
In principle, yoga breathing begins atthe bottom of the lungs, followed by full abdominal expansion, then full chest expansion outward and upward then inhaling with the collarbone and shoulders drawn upwards toward your head. An expert yoga instructor can help you learn yogic breathing so that you can eventually do this in one elegant and continuous inhalation.
Classes are available everywhere from your local Y to the health center of many hospitals to independently run yoga studios.

Consider learning some basic yoga positions and the accompanying yoga breathing techniques. Hatha Yoga and Iyengar Yoga are two of the most valuable practices.

FINAL WORDS:
Please know that I am here to help you whether it’s learning techniques to deal with anxiety and panic attacks or helping you discover any emotional or physical causes that can lead to these attacks.

Remember, panic attacks and anxiety CAN be reduced or eliminated when you take the relevant steps.

A therapist’s role is a vital, relevant step to help you get there in a comfortable, safe, and effective way.

Call me today. I care.

LAURA DICKSON, LCSW

A graduate of the School of Clinical Social Work from California State University at Long Beach, Laura Dickson, received additional training in clinical hypnosis and EMDR to further her skills and effectiveness as a therapist. A National Board-Certified Clinical Social Worker and Certified EMDR Therapist, she has been a therapist for more than 15 years. She serves clients throughout the San Gabriel Valley including Arcadia, South Pasadena, Monrovia, Temple City, Baldwin Park, Duarte, Altadena, and Sierra Madre. Her office is in Glendale.

To make an appointment with Laura Dickson, LCSW, or to ask a question, please call 818 476 0111 or email her at
ldicksonlcsw@sbcglobal.net