When left untreated, anxiety can become unmanageable.
Anxiety disorder is the most common mental illness in the U.S. About 18% of the population experiences anxiety, according to the Anxiety and Depression Association of American, including perhaps its most troubling manifestation: an anxiety or panic attack.
Suffering a panic attack can be excruciating. “On the scale of 0 to 10, it’s a 10,” says Debra Kissen, CEO of Light on Anxiety Cognitive Behavioral Therapy Treatment Centers in Illinois. “It feels like your whole brain and body are in freeze mode because you are in immediate danger — your pants aren’t on fire, but you have all the feelings and sensations of immediate danger. It feels like dying, going crazy, utterly out of control, but those feelings don’t match up with the moment.”
Friends and relatives can help someone going through a panic attack. It starts with knowing the signs of anxiety.
Symptoms of generalized anxiety
Everyone with anxiety experiences different symptoms, but they can be broken into three categories, according to Johns Hopkins Medicine.
— Edginess or restlessness.
— Feeling short of breath.
— Getting easily fatigued.
— Believing the worst will happen.
— Constant worrying.
— All-or-nothing thinking.
— Overgeneralizing (making overall assumptions based on a single event).
— Avoidance of feared situations or events.
— Seeking reassurance.
— Irritability and frustration in feared situations.
— Compulsive actions (like washing hands over and over).
According to the Cleveland Clinic, people often use the term anxiety attack and panic attack interchangeably, but there is technically no such thing as an anxiety attack (medically speaking). An intense, anxious reaction to a situation or trigger is labeled a panic attack.
Still, many of these symptoms of generalized anxiety may also appear during a panic attack, so it’s important to be able to recognize them.
Symptoms of a panic attack
Knowing the symptoms helps, but also be aware that many of the symptoms of a panic attack are internalized and may not be obvious to an observer. “It’s not always so easy to spot a panic attack when it’s occurring,” says Simon A. Rego, chief of psychology at Montefiore Medical Center and associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine. “The patient thinks it’s very obvious, but the fact is it happens all the time in the general population and most people have never seen it.”
Observable symptoms, Rego says, may include:
— Flushed or sweaty skin.
— Trembling or shakiness.
— Distraction or preoccupation.
— Restlessness or appearing “jittery.”
— Tense irritability or acting “snappy.”
“They may tell you they are feeling really scared, not feeling well, are short of breath, their heart is racing, or they have stomach distress,” Rego says. “Or if they have experienced it before, they might know what is happening and tell you.”
Rule out a medical cause.
Panic attack symptoms often mimic serious medical conditions like a cardiac event. “So, a bit of a line to walk is, if you are not sure they are medically OK, get a medical evaluation,” Rego says. “Rule 1 in psychiatry is always rule out medical causes first.”
This is particularly important if the person has never experienced something like this before. “If they already know (it’s a panic attack), don’t encourage medical attention. Label it as a panic attack, so they know what it is — uncomfortable but not unfamiliar,” Rego explains.
Validate their discomfort.
If you know they are medically OK, validate their discomfort. “Don’t tell them, ‘Don’t worry about it, it’s just a panic attack,'” Rego says. “It feels very scary and uncomfortable.”
Instead, ask them what you can do to help. “You don’t want to perpetuate the panic. Once you validate that it’s a panic attack, now it’s like a riding the mechanical bull,” he says. “You have a rise and a fall. It lasts about 10 to 15 minutes; ask them, ‘Can you hang on to the bull for the ride?'”
Remind them there is no real danger.
A panic attack is driven by the sympathetic nervous system, the fight-or-flight response to a perceived danger. “Remind them that the symptoms feel scary, but that doesn’t mean they are dangerous,” Rego says.
That’s difficult when their brain is telling them they are in harm’s way. “It’s the hardest thing in the world to do,” Kissen says. “They have this rush of adrenaline, all this fuel in their body. They have to let it move through, then they can move on.”
Help them calm themselves.
Again, don’t tell someone in a panic attack to calm down. If they could, they would. “Help them regulate their physiology through your emotions,” Kissen says. “Talk slowly and calmly. Encourage them to take tiny, gentle sips of air, not gulps.”
The object, Kissen says, is to help them learn that their panic is not related to any actual danger and that it will pass.
Suggest they do the opposite.
“If they know it’s a panic attack, you want them to do the opposite of what their brain is telling them to do,” Kissen says.
For example, if the person says they can’t think straight, Kissen suggests giving them something to read, in order to prove that they can indeed concentrate. Or if they are in a public place and tell you they feel the need to leave immediately, she says to encourage them to embrace the feeling and “ride the bull” for a few more minutes.
“If you are an outsider, I would say, ‘What is (this feeling) telling you to do, and how do we play with it? What if we tolerate this and move through it together? I think you can tolerate this,'” she says. “You kind of want to call its bluff. Every time they give in, that is teaching the brain that it’s real. The goal is to teach their own brain that a panic attack is a false alarm.”
Help them through the aftershocks.
After a panic attack passes, the parasympathetic system — “the yang to the sympathetic yin,” Rego says — starts to kick in. That can cause the person to feel anxious after an attack; “not acute, intense symptoms, more like aftershocks,” he says.
Validate these feelings as well. “Relax with them, do a bit of relaxation and breathing exercises. In the acute phase, these are not helpful,” Rego says, but after an acute panic attack, they can help further ease the person’s agitation.
Suggest seeing a mental health professional.
If panic attacks are a recurring problem for the person and are interfering with their life, reconnect after their acute anxiety symptoms have subsided and suggest they seek help from a mental health professional.
“The good news is that anxiety is highly treatable, through cognitive behavioral therapy and/or medication,” Rego says. “Short-term treatments can help them become panic-free relatively quickly.”
Kissen agrees: “It’s one of most treatable and quickest to treat conditions. When you learn how to move through it, you can see rapid progress.”
What not to do.
Those in the know say that some common, reflexive thoughts on how to be helpful actually aren’t helpful at all:
— Take a deep breath. “That’s the worst idea, because in a panic attack they are over-breathing to start with,” Kissen says. “They don’t need all this air. They are not running from anything.”
— Calm down. That “buys into someone else’s panic,” which is the wrong approach, Kissen says. “A panic attack is not dangerous, it’s just super uncomfortable. Have the confidence for them that they don’t have.”
— Just distract yourself. “This reinforces putting their mind on something else because they can’t handle this. It’s like running away. You want to have a looser reaction to the moment,” Kissen says.
Here’s how to help someone through a panic attack.
— Rule out a medical issue.
— Validate their discomfort.
— Remind them there is no real danger.
— Help them calm themselves.
— Suggest they do the opposite.
— Help them through the “aftershocks.”
— Suggest they see a mental health professional.
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Update 05/11/21: This story was previously published and has been updated with new information.