According to the National Institute of Mental Health, almost 5% of the United States population will be diagnosed with a panic disorder at some point in their lives (nimh.nih.gov). This may seem like a low number, but it doesn't take into account that an estimated 22.7% of people will experience at least one panic attack at some point in their lives (Kessler et al). This means that almost � of people in the US alone will have to deal with panic as a part of their lives.
Having worked with a number of clients who struggle with either panic disorders or periodic panic attacks, I've found that it helps to have some quick and easy skills to draw on in the event of a panic episode. Struggling with panic can be difficult even during non-stressful times, as panic attacks can come on suddenly and without an obvious trigger. Even when things are good, there can be the fear in the back of a person's mind of a looming panic attack, and I've found that having effective and simple strategies to manage these events can help to ease this fear. Before discussing strategies, I find that it's always best to first discuss the origins of panic, the reasons that we react in this way, and the physiological aspects of anxiety and panic.
Understanding Your Body's Fight or Flight Response
The common misunderstanding about anxiety and panic is that they are purely psychological in nature. When you feel anxious or have a panic attack, the physical sensations you may experience are due to actual physical things happening in your body. The body's fight-or-flight response is crucial to understand in order to also understand anxiety and panic.
Human beings developed the fight-or-flight response through evolution as a way to instantly prepare our bodies for life-threatening situations. In the time before civilization, this included attacks from predators, attacks from other humans/tribes, and even natural disasters. When we're faced with a life-threatening situation, the sympathetic nervous system triggers certain physical responses that prepare us to either fight for our lives or run away. For example, heart rate and respiration grow rapid, muscles tense, adrenaline is released, and non-essential functions like digestion slow down or halt in order to preserve the energy we need to survive. After the threat has been neutralized, the parasympathetic nervous system kicks in to help our bodies return to normal. Heart rate begins to slow down, respiration returns to baseline, the flow of adrenaline stops, and normal bodily functions resume.
What Happens to Your Body During a Panic Attack
In modern times, we don't really have the same threats to contend with. Most of us are not in life-threatening danger most of the time. We don't have to worry about predators or competing tribes or even the elements like we used to; the problem so to speak is that we still have the same, "hardware," that we did tens and hundreds of thousands of years ago. Our natural response to danger doesn't get utilized like it used to, but it is still there. Sometimes, and for reasons we won't get into in this particular article, the fight-or-flight response can, "malfunction," in a way where it starts to activate when there is no actual danger. This is what we call a panic attack.
The good news is these physical reactions won't hurt you. When you experience a panic attack, it's usually accompanied by a feeling of impending doom and a belief that you are in severe danger or are dying. It's easy to misinterpret your racing heart, shortness of breath, and other physical symptoms as a heart attack, stroke, or some other medical event. It's important to remember that these responses are actually designed to help you, not hurt you. Panic attacks are not life-threatening, they're your body's attempt to preserve its life at a time when it's not necessary.
Panic Attack Strategy 1: "It's Going to Be Okay"
The first strategy for managing panic attacks is reminding yourself that you're going to be okay. What often happens when the first signs of a panic attack appear is that a person will start to panic about their panic. The fear of something horrible happening makes a panic attack progress faster and more intensely. When you start to feel anxious or start to feel the symptoms of a panic attack coming on, remind yourself that you're safe, that it'll be over soon, and that you're going to be okay. Though this strategy alone won't likely stop a panic attack completely, it will help you to have the wherewithal to apply some of the strategies that will.
Panic Attack Strategy 2: Reduce Overall Anxiety
The key to managing a panic attack and even reducing overall anxiety is to teach your body to activate the parasympathetic nervous system rather than the sympathetic nervous system. This can be accomplished with skills that you develop over time like mindfulness meditation, deep breathing, and progressive muscle relaxation. As great as those skills are, they take time and practice to master, and this article is about simple and practical strategies that anyone can use in a time of panic.
Panic Attack Strategy 3: Vagus Nerve Stimulation
Activating the parasympathetic nervous system quickly and easily is done through vagus nerve stimulation. There are 12 pairs of nerves that connect the brain to the rest of the body called the cranial nerves. The vagus nerve is the 10th cranial nerve. What makes the vagus nerve so special is its connection to the parasympathetic nervous system. Stimulating the vagus nerve can activate the biological responses that help to de-escalate and stop a panic attack (i.e. reducing heart rate and respiration, stopping the flow of adrenaline, etc). There are some surprisingly easy ways to stimulate the vagus nerve, including breathing deeply, singing, laughing, and gargling liquid (the vagus nerve is involved in the muscles necessary to complete these actions). There's one method, though, that I think works best and is the most practical in a time of panic.
Panic Attack Strategy 4: Engage Your Diving Reflex
The first step in this method involves finding a bathroom. I know this sounds strange, but the bathroom is the perfect place for you to plan to go when you're starting to feel anxious or panicked. No matter where you are, there's almost always a bathroom fairly close by, and you don't have to worry about explaining yourself to people when you excuse yourself to the bathroom (this reduces the common fear people have around others noticing that they are panicking). Once you're in the bathroom, take a few deep breaths and start running the cold water in the sink. You can do this one of two ways, either fill the sink with cold water and plunge your face into it for a few seconds (this is the most effective method), or simply splash the water on your face a few times while holding your breath. Why does this work? It activates the diving reflex.
The diving reflex, which occurs when the vagus nerve is stimulated during immersion in cold water, is a set of physiological survival responses that would keep us alive in the event of being submerged under water. These responses are the exact opposite of the ones activated in normal survival situations (i.e. fight-or-flight). For your body to have the best chance of survival in a situation where it was submerged in cold water, your heart has to pump blood through the body slower to preserve oxygen, your breathing has to slow significantly, and you need to be clear headed and calm. Basically, the body reacts with the opposite of panic. By using this strategy, you're combating an undesirable survival instinct by activating a more desirable one.
Though having a panic attack isn't life-threatening, it can feel like an emergency when it's happening. Just like in other situations that feel like an emergency, it's important to have a simple emergency response plan for when a panic attack occurs to help you get through it as easily as possible.
Remember, remind yourself that you're going to be okay, find a bathroom, take some deep breaths, and activate the diving reflex. You should start to feel better within a minute or two, and if you don't, try activating the diving reflex again. If you use this strategy consistently at the first signs of anxiety or panic, it can also help to re-train your body which will hopefully lead to an overall reduction in the frequency and intensity of panic episodes.
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Sources:
https://www.nimh.nih.gov/health/statistics/panic-disorder.shtml
Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006). The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of general psychiatry, 63(4), 415—424. doi:10.1001/archpsyc.63.4.415