Anxiety is a normal phenomenon; it’s something we all experience. Anxiety is “just our body’s way of letting us know it is uncomfortable,” wrote Dr. Robert Myers, an adolescent psychologist and professor at the University of California, Irvine, in a blog post. Most of us feel a little anxious from time to time, but when we break out in a cold sweat, our heart starts pounding, and we feel like we can’t breathe, it can seem like something is really wrong. This, my friends, is a panic attack. And it’s no fun.
What does a panic attack feel like?
It manifests differently for different people, but I have yet to hear anyone compare it to a warm bath. Physically, a panic attack can include:
In a Student Health 101 survey of high schoolers, 7 of 16 respondents described having a panic attack where they felt like they couldn’t breathe. Three respondents mentioned heart-related sensations or chest pains. And two gave eloquent, eerily similar descriptions:
- It felt “like everything was falling all at once, and [I] couldn’t do anything about it.”
—Sophomore, Anthem, Arizona
- It feels “like everything around you is crumbling, and you can’t find your way out.”
—Junior, Brooklyn, New York
Ugh. Let’s take a quick kitten break.
…OK, I feel better. Here’s what happens in your body during a panic attack: When sensing danger (real or imagined), your body responds by releasing adrenaline, activating a “fight-or-flight” response, and altering your breathing pattern. These physiological responses lead to the sort of symptoms listed above.
Anxiety is rough, but it won’t kill you
Luckily, you’re not actually in physical danger during a panic attack. You might feel like you’re about to pass out, but it’s very unlikely to happen. As Dr. Alice Boyes, author of The Anxiety Toolkit, explains, “fainting isn’t likely because the panic response involves increases in muscle tone, heart rate, and blood pressure,” which is “just the opposite of the physical effects that occur when someone faints.” There are health conditions that can override that increase in blood pressure and cause you to faint even during a panic attack, but those conditions are very rare. Similarly, you might feel short of breath, but that does not actually mean you’re getting insufficient air. Your body and brain are basically messing with you—don’t fall for it. These sensations may feel like signals of real danger, but they’re almost certainly not, and buying into them can just feed the panic.
(Dr. Boyes does note that “occasionally a real heart condition can cause people to experience panic-like sensations, so it’s a good idea to rule this out medically” by checking in with a healthcare provider.)
Anxiety is normal, sometimes even healthy
Anxiety is a totally normal phenomenon. It can even be useful when it motivates us to avoid dangerous situations. Problems arise when anxiety becomes so intense and persistent that it interferes with our daily functioning. Now we’re in the realm of “anxiety disorders,” but these too are super common—about 30 percent of teens have experienced them at some point in their lives.
The good news is that we have some understanding of how mild anxiety escalates into a panic attack. Psychologists have also identified strategies to manage panic attacks.
The culprit: Avoidance
What feeds anxiety is our habit of avoiding the things that make us anxious and the uncomfortable thoughts, feelings, and situations associated with them, according to psychologists Georg Eifert and John Forsyth in their book The Mindfulness & Acceptance Workbook for Anxiety. Avoiding a situation because it’s uncomfortable “is the common thread that binds all anxiety problems together,” they write.
How avoidance feeds our anxiety
Avoiding every situation that makes us feel anxious is likely to make us feel more anxious each time we’re confronted with it, which is how mild anxiety can spiral into panic. For example, if a public speaking assignment makes you incredibly anxious, your instinct may be to avoid it. Not going through with the speech might relieve your anxiety in the moment, but the next time you’re asked to speak in front of people, your anxiety may feel even stronger. Facing our fears—in incremental ways that we can manage—can help mitigate our anxiety when we see that the situation wasn’t so bad after all. Therapists use a similar tactic—called exposure therapy—to help treat anxiety and panic disorders.
This is useful information. By targeting our habit of avoidance, we can deprive anxiety of its fuel source.
Three ways to calm down right now
Dr. Boyes says the key is breathing slowly, which “helps slow your heart rate and naturally calms all of the body systems involved in your body’s fight/flight/freeze response.” Similarly, research shows deep, slow breathing stimulates the parasympathetic nervous system, which helps us calm down. A 2016 study in Singapore found that kids who took deep breaths before a math test were less anxious and performed better on the tests than those who didn’t.
Dr. Boyes advises focusing on your out-breath and not worrying about your in-breath. “Your in-breath will naturally lengthen when your out-breath is longer,” she says. “Try to make your breath out slow, steady, and gentle,” and “breathe out until the last drop of breath is released.”
Here’s a simple technique from mindfulness-based therapies: When anxious thoughts arise, mentally label them “thinking,” and when uncomfortable sensations in your body arise, mentally label them “feeling.” I find this technique helpful when I need to get up and present in front of people, which still makes me anxious even though I do it all the time. I close my eyes and start labeling. The pounding of my heart and the butterflies in my stomach become simply “feeling.” Thoughts like “I’m going to mess up” or “people are going to laugh” or “sweet merciful Beyoncé, why am I doing this?” become simply “thinking.”
We tend to buy into our thoughts, whether or not they’re accurate or helpful. At the same time, we flinch away from the uncomfortable physical sensations that arise with anxiety.
Using this labeling technique helps with both. When we label thoughts “thinking,” we don’t buy into their stories. When we label body sensations “feeling,” we can simply observe them without getting overwhelmed by them or fleeing from them.
Therapist John Tsilimparis, MFT, recommends using “grounding techniques” that give you something else to focus on during a panic attack. In a post for ExpertBeacon, he suggests you “run your fingers along the teeth of your house keys, or hold an ice-cube in your hand for as long as you can, then switch to your other hand.” The point is to get your brain to focus on a physical sensation. Tsilimparis calls this approach “healthy diversion”; you’re deliberately distracting yourself to lessen the impact of the anxiety.
The Counseling Center at James Madison University, Virginia suggests some additional grounding techniques:
- Press your feet down and feel the solid ground underneath you.
- Stretch and massage your muscles.
- Slowly cross your legs or arms and notice the control you have over your body.
How to manage anxiety in the long run
There are ways to reduce your anxiety overall and prevent future attacks. These techniques have been proven by research to help.
Cognitive behavioral therapy
Cognitive behavioral therapy, or CBT, has been rigorously studied and shown to be an effective treatment for anxiety. This form of therapy helps you develop a healthier relationship to the thoughts and behaviors associated with anxiety. One important element of CBT is “exposure therapy,” in which you confront anxiety-producing situations in incremental steps. Over time, you react with less avoidance, and your anxiety fades. “The basic idea is that people learn through experience that they can cope with situations and physical sensations they associate with panic,” says Dr. Boyes.
Many therapists are trained in this technique. Talk to your parent or school counselor about finding a therapist who can help you, or search for one online using this tool.
A large body of scientific research has shown that you can also manage your anxiety through mindfulness, a mental practice derived from meditation. Simply put, mindfulness is about resting our minds in the present moment, rather than getting caught up in memories of the past, thoughts of the future, or other mental stories.
Meditation is a core element of mindfulness practice. You can find excellent guided audio meditations from UCLA; most last between 5 and 15 minutes. If you’d like something more bite-sized, here is a simple, 30-second meditation practice to help you get out of the anxiety-fueling trap of avoidance.
A few simple lifestyle changes can majorly affect your anxiety level and susceptibility to panic. Try these tips from the Anxiety and Depression Association of America:
- Exercise regularly
- Eat well
- Get enough sleep
- Limit caffeine and alcohol
- Give yourself unstructured time to relax
These changes are easier said than done, I know. Still, if you take them slowly, they are worth the effort. It’s tough to build multiple habits at once, so consider working on one change at a time. For example, you might start by committing to take the stairs instead of the elevator whenever possible, or by gradually reducing your soda intake. After a few weeks, if you feel like the new habit is solid, you can take on another positive lifestyle change.
How to be an anxiety ally
I’ll assume that between the last paragraph and this one, you’ve done several weeks of CBT, learned mindfulness directly from the Dalai Lama, and trained for a triathlon. Good work!
Just kidding, of course. Even if you haven’t tried the techniques in this article yet, you at least understand anxiety better than the average person. This puts you in a great position to offer help and understanding to others.
When someone around you is having a panic attack, “the key is to stay calm yourself,” says Dr. Mary Alvord, psychologist and co-author of the Resilience Builder Program for Children and Adolescents. She suggests that you “guide the person to take slow breaths through the diaphragm” and remind them “that these are normal bodily reactions to panic and will dissipate shortly.”
Be prepared to help
When possible, “it’s better if you’ve practiced and agreed on a game plan in advance,” says Dr. Boyes. “You might practice slow breathing together when the person is not feeling anxious and then act as their breathing coach when they’re having a panic attack.”
The Depression and Bipolar Support Alliance asked more than 3,000 people about anxiety and mood disorders, specifically what actions by friends and family they found helpful or unhelpful. According to the findings, here’s what helps someone who is experiencing anxiety and what doesn’t:
Remember, you deserve allies too. Don’t be shy about letting your loved ones know how they can help and support you.
You got this.
The classic modern mindfulness book: Full-Catastrophe Living by Dr. Jon Kabat-Zinn
An excellent book on Acceptance and Commitment Therapy, a mindfulness-based therapy: The Happiness Trap by Dr. Russ Harris
Alice Boyes, PhD, author of The Anxiety Toolkit, blogger for Psychology Today, former clinical psychologist, Las Vegas, Nevada.
Mary K. Alvord, PhD, psychologist, director of Alvord, Baker & Associates, Rockville, Maryland.
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