When you have an anxiety disorder, your mind can incorrectly sense danger and engage your fight-or-flight response, putting you in a state of panic and fear. This event is typically referred to as a panic attack, but can also be termed an “anxiety attack.” These terms are contested, but for the sake of simplicity I’ll use “anxiety attack” in this article as panic attacks are often one-time-only events, while anxiety attacks can be associated with a chronic anxiety disorder.
Anxiety attacks are different for everyone. They can be brought on by genuine reasons, or for no reason at all. You can see them coming, or they can come out of nowhere. Your mind tells you that you need to panic, and all of the sudden you can feel part of a never-ending cycle of escalating cataclysms that, as your brain vehemently tells you, will result in something awful happening to you and your loved ones.
A certain level of anxiety is good, as it keeps you alert in potentially dangerous situations—like when you’re walking alone in a sketchy neighbourhood. Past a certain low-grade, temporary level, anxiety can escalate quite quickly with no external cause—and this is when you’re most susceptible to an attack. Whatever the cause, anxiety attacks can be traumatic and make it difficult to do even simple tasks, let alone carry on with your day. Here are some steps I’ve found help me in coping with and coming down from an attack.
Recognize the Signs
While everyone has different warning signs, you may eventually learn your “tells” for when you’ve past the helpful level of anxiety and are about to experience an attack. Symptoms differ among people but there are some common threads; mental symptoms often include ruminating (overthinking/racing thoughts), feelings of dread or despair, trouble concentrating, emotional shut-down and even fear of imminent death. Physical symptoms can include pounding heart, trouble breathing, temperature changes, dizziness, chest pain, nausea and numbness or tingling. Some of these signs are more common than others; for example, my warning signs are quite common: immobilizing fear, difficulty breathing, chills, feeling desperate to get help and overwhelming, panicky rumination. Recognizing the signs of an attack can help you move to a private and comfortable place, where you’ll be able to get through the attack without having to worry about explaining it to other people.
Say It… Out Loud
Okay okay, I’m sorry for quoting Twilight, but it genuinely does help to verbalize what’s going on! Whether it be to a friend, family member or even just yourself, and even if you feel silly, try saying things like “I recognize an anxiety attack coming on and I know I can get through it.” You can even address the anxiety itself, as if it’s a person, if that makes it easier to dissociate it from you. It’s easy to self-blame when you’re anxious, so dissociating your anxiety from yourself might also help with avoiding unfair self-deprecation.
Be Forgiving of Yourself
Recognize that you might have self-deprecating thoughts during an anxiety attack. It’s easy to blame yourself for whatever is causing you distress, and oftentimes anxious people tend to hold themselves accountable for things that are simply out of our control. The act of having an anxiety attack can even become an extra thing to blame yourself for, escalating the self-criticism spurned by something that was not your fault. Even if the thing you’re panicking about was partially caused by or related to you, it is almost never as big of a deal as your mind tells you it is during the moment. You will be able to work through it, but not when you’re panicking about it, and definitely not when you can’t focus on anything but blaming yourself.
Try to be gentle with yourself, and remember that you wouldn’t believe these self-deprecating thoughts if a stranger walked up in the street and said them to you. Just because you’re thinking them during a weak moment does not mean they are true. The thoughts that tell you that you aren’t good enough, are more of a burden than a blessing, or have done something worthy of punishment are not the voices of reason. They are your panicky mind trying to come up with a reason for the physical and emotional symptoms of your attack, and they’re wrong.
Visualize It
Don’t force yourself to get over the attack, as much as you know you want to. Try to imagine the anxiety attack like waves crashing onto a beach—you know they’re coming, and each time your anxiety grows and peaks, a wave breaks onto the shore. The waves might get bigger or smaller as time goes on; any of this is normal. Imagine yourself sitting on the beach, facing the waves and accepting that they are going to wash over you, knowing they will be over soon. Recognizing and accepting that your anxiety is going to peak is incredibly powerful, and might make your attack that much easier to get through knowing you still have some agency over the process.
Breathe
It’s easier than you’d think to forget to breathe when you’re having an anxiety attack, because your neurons are firing so fast, and you’re so focused on your racing thoughts, that you often aren’t aware of what your body is doing. Despite the freneticism of your mind, try to sit still and take even breaths—not too shallow or deep, so that you don’t end up gasping for air. If you feel like you can’t breathe evenly, as is common during an attack, focus on your individual breaths and just try to make sure you’re getting enough air. Breathe in through your nose and out through your mouth, and once you feel in control again, try inhale-exhale patterns that use counting to bring consciousness to your breath. I like to use the 4-7-8 method, which consists of inhaling for 4 seconds, holding for 7 seconds, and gently exhaling for 8 seconds. Breathing evenly not only gives your mind something else to focus on, but also triggers the relaxation response in your Parasympathetic Nervous System—slowing your heart, lowering your blood pressure, and relaxing your muscles.
Grounding
One of the things that helps me the most during an anxiety attack is grounding myself, which helps slow my ruminating over the same panicky thoughts. Try thinking about the feeling of your feet on the floor, or your body resting on your chair or bed, focusing on the contact points between your body and the ground or furniture. Think of these points as anchoring you to the Earth, steadying you while you go through the anxiety attack. If this works, you can take it a step further by trying the 3 senses technique—naming 5 things you can see, hear, and touch in the room. In being aware of what’s around you, you may find your mind less centered on ruminating thoughts and more grounded in reality, and this may even bring you out of your anxiety attack.
Anticipate and Accept
After the peak of an anxiety attack, which can last anywhere from a few seconds to 10 minutes, it takes at least 30 minutes to fully come down from an attack. That means that within this time, it is extremely easy for anything to trigger another anxiety attack, resetting the recovery time. While your mind seems to have gotten over the attack, your body is still on high alert—so make sure to keep an eye out for the signs of another attack coming on. Furthermore, try your best to accept the fact that having another anxiety attack doesn’t mean you did anything wrong in handling the first!
Move On (Slowly!)
Once the anxiety attack is over, you might experience another, or you might not. Often the aftermath of an attack results in a state of emotional detachment or numbness, but sometimes you’ll go back to feeling just fine. Remember that whatever you feel is okay. Don’t rush yourself into feeling better or returning to the day right away, but feel out what your body and mind would be comfortable with doing—sometimes starting with a small task to get you back into the day is a welcome change of pace from the anxiety attack. If you find you can’t focus or have no will to get anything done, this is okay too! Personally, I like to sit somewhere comfortable and just be present with my thoughts for some time afterwards, so as to bring myself back to the day and move on.
First-time anxiety attack experiencers often end up in the emergency room thinking they’ve had a heart attack or are dying—and you survived it! It might not have been easy, but you got through it and now know you can do it again if you have to. No matter what, remember that having anxiety attacks doesn’t make you an incapable person; sometimes they’re just part of life. All you can do is learn how to cope with them to make the experience as bearable as possible.