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Having a panic attack? Have a history of panic attacks?

Racing heart? Nausea? Sweating? Shortness of breath? All of these signs point to a panic attack. Panic attacks can feel scary, but thankfully, they do not last forever and they cannot kill you. Symptoms of a panic attack typically occur abruptly and peak in about 10 minutes.

So, what exactly is a "panic attack?"

"Panic attacks" or "anxiety attacks" are the body's fight or flight response gone awry. We all have a built-in alarm system that responds to dangerous situations. In many cases, this alarm system works well; however, some individuals' responses are disproportionate with the stress that is occurring or may be keyed up with no stress at all. For many college students, panic attacks are often qued by midterm examinations, final examinations, speeches, etc. In these situations, a little bit of anxiety is a good thing; however, the problem arises when the anxiety becomes overwhelming and unbearable.

So, how do I know if I'm having a "panic attack?"

You may be having a panic attack if you have experienced four or more of the following symptoms listed below. Remember, these symptoms typically occur abruptly and peak in about 10 minutes.

  • Racing heart
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feeling of choking
  • Chest pain
  • Nausea or abdominal distress
  • Feeling dizzy, lightheaded, or faint
  • Fearing of losing control or going crazy
  • Feelings of unreality or being detached from oneself
  • Fear of dying
  • Numbness or tingly feeling
  • Chills or hot flashes

It is important to note that panic attacks are sometimes accompanied by avoidance of certain places or situations. These are often situations that would be difficult to escape from or in which help might not be readily available, such as shopping malls, driving a vehicle, public transportation, restaurants, etc. It is not uncommon for individuals to begin to avoid the places where they have had panic attacks; however, over time, individuals may begin to decrease their activities and negatively impact their quality of life. It is important for you to decrease this avoidance. You can do so by creating an "exposure hierarchy" of your feared places/situations.

Please see Behavioral Health Consultants: Overcoming Panic Attacks for more information on how to create an "exposure hierarchy."

What do I do when I am having a "panic attack?"

1. Acknowledge that you are having a panic attack.

Since panic attacks can produce both psychological and physiological symptoms, it is important for you to recognize the reality of the situation. You may be unaware at first that you are experiencing a panic attack. Tingling scalp, tightness in the chest and an overwhelming feeilng of dread are common initial symptoms. Identifying that you are having a panic attack is key for beginning to actively calm yourself.

2. Practice deep breathing.

During the middle of a panic attack, chances are that you are beginning to hyperventilate. When we hyperventilate, certain blood vessels in our bodies become narrow and the brain receives less oxygen. This often leads to dizziness, confusion, and lightheadness that often occur during panic attacks. Other parts of the body may experience less oxygen, as well, which can lead to numbness or tingling in the hands, legs, and feet. At that time, your heart is likely to pump faster. Although, these sensations are uncomfortable, it is important to note that they are not life-threatening. You can overcome these sensations by practicing the following steps:

  • Inhale. With your shoulders relaxed, inhale slowly and deeply as your can while you count to six.
  • Hold. Hold the air in your lungs as you slowly count to four.
  • Exhale. Slowly breath the air out of your lungs as your count to six.
  • Repeat. Do this inhale-exhale exercise several times until you become calm

3. Use cognitive distractions & positive coping statements.

During the middle of a panic attack, chances are you are focused on the potential severity of the situation. With that being said, you need to distract your mind from you fear through different cognitive distractions. For example, you can count backwards from 100 by 2's, list the presidents in order, or recite lyrics to your favorite song.

By using positive coping statements, you are able to change the pattern of anxious thoughts by replacing them with more calming and supportive statements. This can help alleviate anxiety symptoms and divert the panic attack. Below are some common positive coping statements when experiencing a panic attack:

  • "This is not an emergency."
  • "I don't like feeling this way, but I can accept the reality at this moment."
  • "I can feel like this and still be okay."
  • "Even though this is uncomfortable, I cannot die from a panic attack."
  • "This has happened to me before, and I was okay. I will be okay this time, as well."
  • "A little anxiety is a good thing. I can still deal with this situation."
  • "I am strong enough to deal with these uncomfortable sensations."

You can also use guided imagery as a way to distract yourself from the panic. With guided imagery, you can think of a place in which you feel at peace and relaxed, such as your home, on the beach, in the shower, etc. As you begin to think of this place, begin to add details to the scene, in terms of sight, smell, touch, and taste--focus your entire mind on imagining this scene. Feel free to practice guided imagery with your eyes open or closed. When you feel as though there is a reduction in your anxiety, you may end the exercise.

For many different guided imagery and deep breathing exercises, please go to

4. Practice progressive muscle relaxation (PMR)

PMR is the process of slowly tensing and relaxing each muscle group of your body. PMR identifies two goals, 1. it forces you to concentrate on something other than your fear or anxiety, and 2. it relaxes your muscles.

  • Begin by tensing the muscles in your face and then work your way down your body until you have relaxed all of the major muscle groups in your body.
  • Major muscle groups: jaw, mouth, arms, hands, stomach, buttocks, thighs, calves, and feet
  • Tense each muscle group for ten seconds, and then release the pressure by slowly releasing the tension.

For a tutorial of PMR, please click on the following webpage, Progressive Muscle Relaxation Meditation

5. Get moving.

Sitting and ruminating over your anxiety will actually worsen your current state of mind and make it more difficult to manage your anxiety symptoms. Distract your mind by performing a task, such as cooking, cleaning, drawing, knitting, exercising, calling a friend, visiting a friend, shopping, etc.--anything that will keep you busy and happy.

Exercising is a great way to manage your anxiety. Actively engaging in exercise releases endorphins in your body that are responsible for improving your mood. It is recommended that adults ages 19-64 years should do at least 150 minutes (2 hours and 30 minutes) of moderately intense cardio activity each week. Also, muscle-strengthening activities that include all the major muscle groups (i.e. legs, hips, back, abdomen, chest, shoulders, and arms) are recommended two or more days per week. So, go for a walk, practice yoga, run a few laps, lift weights, or play a sport, whatever helps you to release the tension in your body is helpful when reducing anxiety.

6. Watch your diet.

Yes, your diet can have a lot to do with your anxiety symptoms. Unstable blood sugar levels and caffeine are primary sources that can contribute to the onset of a panic attack. Therefore, you should maintain a healthy and balanced diet that includes fruits, vegetables, whole grains, and lots of water. With that being said, try to avoid sugary foods and drinks, caffeine, alcohol, and smoking because they all contribute to . Also, try to avoid caffeine, alcohol, and smoking because they all exacerbate symptoms of a panic attack.

7. Seek professional help.

If you have severe panic attacks over an extended period of time and have tried all of the aformentioned techniques, it may be time for you to seek professional help. Even though the symptoms may seem uncomfortable and appear life-threatening, they are not. Typically, panic attacks do not constitute a crisis, even though they may feel like it at the time.

If you would like more information on how to manage your anxiety and possibly speak to a counselor regarding your anxiety symptoms, SIUE Counseling Services staff is willing to help you. Please feel free to call our office, 618-650-2842, to schedule an intake appointment with one of our counselors. If we find that you have severe anxiety and we are unable to provide appropriate treatment, we will refer you to a community mental health provider that is equipped to treat your condition.


Behavioral Health Consultants: Overcoming Panic Attacks

Guide to Effective Anxiety & Stress Management

St. Louis Behavioral Medicine Institute
Center for OCD & Anxiety-Related Disorders
1129 Macklind Ave., St. Louis, MO, 63110

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