Introduction

Panic attacks are extremely frightening. They may appear to come out of the blue, strike at random and make people feel powerless, out of control and as if they are about to die or go mad.

A panic attack occurs when your body experiences a rush of intense psychological (mental) and physical symptoms. It is rush of adrenalin and an exaggeration to your normal bodily reactions to stress.

You may feel an overwhelming sense of fear, apprehension and anxiety. As well as these feelings, you may also experience physical symptoms such as:

• butterflies
• shortness of breath
• tight band across chest area
• dry mouth
• nausea
• sweating or hot flushes
• trembling
• choking
• irregularity in your heart beat (palpitations)
• a feeling of wanting to visit the toilet more often

Approximately 1 person in 10 experiences occasional panic attacks.

How do panic attacks happen?

Many people suffer from panic attacks after experiencing a shocking, frightening or traumatic event in their lives. For some, this attack may happen only once. However when these attacks have no apparent trigger, are recurring or happening on a regular basis, this can be attributed to a panic disorder.

Panic disorder

In the UK, around 1 person in every 100 has a panic disorder. Panic attacks can occur on a regular basis, often without warning and sometimes for no specific or obvious reason. With this condition, people feel stress, anxiety and panic on a regular basis.

There are certain underlying conditions that can cause this level of anxiety:

Phobias: are an extreme or irrational fear of an animal, object, place or situation.

Generalized anxiety disorder (GAD): is a long-term condition that causes excessive anxiety and worry relating to a variety of situations.

Post-traumatic stress disorder (PTSD): is a condition that has psychological and physical symptoms and is caused by very frightening or distressing events.

Sufferers of panic disorder often feel fine one minute and yet the next, may feel totally out of control and in the grips of a panic attack. Panic attacks produce very real physical symptoms from a rapid increase in heartbeat to a churning stomach sensation. These physical symptoms are naturally unpleasant and the accompanying psychological thoughts of terror can make a panic attack a very scary experience. For this reason, sufferers start to dread the next attack, and quickly enter into a cycle of living 'in fear of fear'.

How to help someone who is having a panic attack

The important thing is to keep calm yourself. Stay with the person and reassure them that they are going to be okay and that what they are feeling will soon pass. Panic attacks do not last long. Encourage the person to practice relaxation techniques (as discussed later in this booklet) and to concentrate on breathing slowly and more deeply. Once the person is calmer, then work out with the person what particular stresses they are under at that time that may be making it worse. Try to encourage the sufferer to remain in the situation where they feel anxious rather than allowing them to flee.

Panic attacks can be very frightening and intense, but they are not dangerous. A panic attack will not cause you any physical harm and it is unlikely that you will be admitted to hospital if you have had a panic attack.

Diagnosis and treatments

People who suffer a panic attack tend to seek help very quickly as they may feel their symptoms are attributed to something else; such as a heart attack or a stroke. Health professionals are usually quick to identify when someone is having a panic attack and can help the person.

For people with a panic disorder, the treatments available are anti- depressants or cognitive behavioral therapy or both. Anti-depressants can be particularly effective when taken to run alongside therapy. However, care should be taken to reduce use of this medication gradually and at the right time in someone's progress. Coming off this medication too soon can lead to side effects and a possible relapse in the persons progress in their therapy.

Legal responsibilities

If you have panic disorder, it may affect your ability to drive. It is your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability.

Managing anxiety

Now that we have looked at what a panic attack is and how they might develop, it is important to look at coping methods for managing high levels of anxiety that a sufferer of panic attacks may face. The aim is to learn to control your anxiety, NOT to get rid of it. The following are some of the main ways to help reduce levels of anxiety:

Relaxation

Practicing relaxation techniques can also be a beneficial tool for anxiety and those who suffer from panic attacks. Relaxation training can effectively reduce physical tension in the body that has built up by the anxiety itself. Not only can relaxation training help lower the heart rate,blood pressure and slow down the rate of breathing; but can help a person considerably with their mental well being.

There are many ways that people can practice relaxation techniques. These include meditation, visualization, Tai Chi and Yoga, to name but a few. Despite these variations, most will focus on each muscle group in the body in turn and alternating between tensing and relaxing. When this is carried out, the person's overall muscle tension will be very much reduced. This reduced muscle tension will in turn help you let go of any anxiety that you have been holding in. Also, if you can train yourself to get into a state of deep relaxation before a situation that may cause you anxiety or a panic attack, it will help you later on. The effects of such deep relaxation can last several hours and sometimes days.

A relaxation exercise for you to try:

Set aside 20-30 minutes of your time where you will not be disturbed. Try not to do when you feel sleepy. Either lie on a bed or in a comfy chair and get as comfortable as possible. You may wish to put on a relaxing music and / or burn some essential oils to create a relaxing ambience.

Firstly, close your eyes (once you have practiced these exercises - with practice, you will know these off by heart). If your lying down, have your arms by your side and your legs uncrossed slightly apart. If in a sitting position, hold your hands and arms comfortable in your lap or resting on the arms of the chair, with your legs uncrossed in a comfortable position.

Concentrate on your toes. Scrunch your toes up as tightly as you can and hold for a count of 3 seconds. Then let go and relax and uncurl your toes. Repeat this until tension has gone.

Now concentrate on your feet. Push the soles of your feet downwards. Feel the tension and hold for a count of 3, then relax. Repeat this again.

Tense the muscles in your thighs. Hold for a count of 3, then let go and relax and repeat.

Tense the muscles in your bottom. Hold for 3, then relax and repeat.

As you breathe in deeply, hold your tummy tightly in for a count of 3. Then take a deep breath out and release your tummy. Repeat this.

Lift your shoulders up to your ears and hold for a count of 3, then relax. Repeat this. Scrunch your face up tightly and hold for a count of 3, then relax and repeat. Scrunch your eyes up tightly Hold for 3, relax and repeat.

Now altogether, tense all your muscles in your body as before but all at the same time....your toes, feet, thighs, bottom, tummy, shoulders, face and eyes. Again, hold for a count of 3, then let go. Repeat this, then relax.

At the end of this exercise lie for 5 minutes to relax with your eyes closed, perhaps getting into a more comfortable position. It might help to visualize a place that you may find relaxing - such as a beach, a summer meadow, a peaceful lake side. Mentally walk to your special place. Take in the sights,sounds,smells,tastes and feelings. When you feel ready, slowly walk away mentally and count slowly back from 10 until you are aware that you are back in the room. Gently stretch and get up slowly.

Breathing

Correct breathing is so important when controlling anxiety and helping avoid suffering a panic attack. When people are anxious, they tend to breath too quickly or hyperventilate. Many people find that by correcting their breathing, their feelings of anxiety are vastly reduced.

A breathing exercise to try:

Practice the following exercise. Aim to practice this, so that when you feel anxious, you can take some time out to do.

Breath in slowly for a count of 3 seconds. As you breath in, push your tummy out. Hold for a count of 3 seconds. Breath out through your mouth for a count of 5 seconds As you breath out, pull your tummy in.

Distraction

Using distraction techniques can be a very useful tool when a person feels anxious and may feel a panic attack may arise. The idea is that in place of your anxious thoughts, you distract yourself by thinking of something else.

We have all heard of the advice for public speakers who are feeling nervous before a presentation to imagine your audience in their underwear. This works on the same principal. Instead of concentrating on your negative feelings and your anxiety, to think of your surroundings in a more positive and light-hearted way. For example, for someone who feels panicky about large crowds, instead of the person concentrating on their anxious feelings and feelings of wanting to get away from the situation, for them to take the time to look around them. Concentrate on those around them and the details of their surroundings. What are the people around you wearing? Who are they with? Imagine that they all have silly purple hair or are wearing Pat Butcher type earrings..even the men! You can distract yourself with anything you can think of really, so long as it totally absorbs your thoughts. Other ideas could be:

• Running through your times tables
• Counting or saying the alphabet backwards
• Singing a song that you know very well in your head
• Running through a list... of your favorite bands, characters in your favourite TV program or anything else you can think of.

Depending on the particular surroundings you are in, it can also be suggested that reading aloud, from a newspaper or a book, can help distract yourself from anxiety.

Linked to this, you can use some thought stopping techniques when an anxious or unpleasant thought enters your head. It is about learning to produce an automatic response to an unwanted thought. You can shout "STOP" loudly in your head as you think of the anxious or un-wanted thought. You can even visualize the word STOP if it helps or a flashing red sign. At this point, you can use some of the distraction techniques as suggested before.

Self-talk

It is helpful to write down all the thoughts that reoccur every time you feel anxious. For example; feeling frightened and panicky, thinking you might die, thinking that you might have a heart attack / be sick / faint / have a brain tumour, etc...Next to all of these thoughts you have written, write alongside them all a positive response. For example, if your negative thought is "I can't cope, I'm going to have a heart attack", your written response to that would be along the lines of "I have coped before and I will continue to cope even better" and "I know I won't have a heart attack because it is only the adrenaline that is making my hear beat faster. I am not going to die". Practice these responses and this will help you to control and rationalize your anxious thoughts.

Other things that may help

In addition to the direct things you can try to help alleviate feelings of anxiety as discussed in the previous sections, it is important to keep your mind and body as fit and healthy as you possibly can. This will all have a significant impact on your levels of anxiety and help keep a positive focus on yourself. If you look good and look after yourself, then you will feel good and more positive inside.

Try and keep to a a sensible and well balanced diet. Try and reduce sugary snack foods . You want a steady release of sugar so stick to balanced nutritional meals and healthy snack options. Carbohydrate foods such as bread, rice, cereals and pasta are very good at releasing sugar more gradually.

Cutting down, or stopping altogether, caffeine, alcohol and cigarettes can have dramatic effects on your anxiety levels.

Physical exercise keeps us both physically and mentally healthy and well. Physical exercise uses up the excess adrenaline that sufferers of anxiety have in their bodies. Swimming, walking, cycling and Yoga are all good forms of exercise; even for those who are not so sporty.

There are various herbal or other natural remedies that can also help feelings of anxiety. St. John's Wort, Kava, Valerian, Homeopathic remedies and Bach Rescue remedy. You can get more advice on these from many health food shops and some GPs will have information and guidance on this. Some people also find the vitamin B6 useful in helping control their anxiety. Aromatherapy is also useful with alleviating feelings of anxiety. Try lavender and geranium oils in particular.

As well as cognitive behavioral therapy that was mentioned earlier, some find hypnotherapy extremely useful with dealing with coping with panic attacks and anxiety. You can contact Anxiety UK for locations and details of therapies in your area that can help. Details are at the end of this booklet.

Getting support from people around you is so important. If there is a nearby self-help or support group to you, this may help you, if only to know that you are not alone and there are others around you that are going through exactly the same or similar feelings to what you are going through and experiencing. Your GP may have information on support groups local to you, or you can search online.

Further help & support available

Panic attacks and panic disorder are extremely common, so do not be afraid to get help from you GP or other professionals. GPs can also discount other medical conditions such a thyroid disorder.

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