How to Control Anxiety Attacks
Written by listed counsellor/psychotherapist: Graham W Price, Chartered Psychologist, CBT specialist, BPS, BABCP Accredited
28th October, 2010
There is much written about anxiety attacks (proper name: panic attacks). Some is helpful, some not, the latter because it’s either commercially motivated or just innocently misguided. I recently read an article that seemed well-meaning enough, but was certainly misguided. The article recommended distraction and avoidance, meaning distraction during the attack and avoidance of situations that trigger attacks. Both recommendations would be likely to reduce panic in the immediate sense and both would make it worse in future.
Independent advisory bodies such as the National Institute of Clinical Excellence (NICE) in the UK, universally recommend Cognitive Behavioural Therapy (CBT) as the treatment of choice for panic and other anxieties. In recent years CBT has been enhanced by combining traditional CBT treatments with more modern acceptance-based approaches. The latter are especially useful for dealing with anxiety.
The prime treatment for any anxiety problem is acceptance, that is acceptance of the anxiety symptoms and acceptance of the trigger. Acceptance is the opposite of resistance. Anxiety is always caused by resistance of the symptoms of anxiety and/or resistance of (meaning fear of and avoidance of) whatever is triggering the anxiety.
Panic involves resisting the symptoms of anxiety. An anxious thought initiates the panic cycle. The anxious thought often involves anticipation of panic. Any fearful thought automatically generates a release of the hormone adrenalin, a process known as the fight-flight response that developed during our evolution to increase our chances of survival when under physical threat.
Physiological responses to adrenalin include an increased heart rate, intended to get more blood to the muscles to enable us to fight or flee, increased breathing, again to get more oxygen to the muscles, perspiration to cool us down, effects on the digestive system such as a dry mouth or bowel movements (digestion being an unnecessary function when the body is preparing to fight or flee) and tingling on the skin due to blood being diverted to the muscles and changes in carbon dioxide levels. Some people experience all these symptoms, others just some of them.
With panic the person experiencing these symptoms then becomes fearful of the symptoms themselves. Often this is because they already know the symptoms may lead to panic. Fear of the symptoms simply results in more adrenalin being released. And so a vicious cycle of adrenalin and increasingly fearful thoughts is initiated, leading to panic.
These days, the body’s automatic adrenalin response to a fearful thought is usually unhelpful, since most fearful thoughts are no longer related to physical threats. So the fight-flight response is now largely an unwanted annoyance.
The important thing to know is that anxiety, and the adrenalin that drives it, are completely harmless. This understanding can enable us to be willing to experience the anxiety and eventually to accept it.
In the case of panic, acceptance immediately diminishes the anxiety, since it interrupts the fear-adrenalin cycle. But more importantly it enables us to stop avoiding, or escaping from, situations that generate panic. And this is ultimately the key to resolving the problem.
Most people naturally try to diminish or avoid panic, either through attempts at distraction or through avoiding, or escaping from, situations that trigger panic. Unfortunately all these actions reinforce the conscious or unconscious beliefs that are driving the anxiety in the first place. And they prevent us from finding out that panic is harmless.
In the case of panic, we have a belief that panic is dangerous. Each time we try to diminish panic through distraction, avoidance or escape, we reinforce that belief.
To resolve the problem, we need to understand that panic is not harmful or dangerous, then cease any attempts to diminish or avoid it, go through the experience of panic and watch the feelings rise, peak and come down again, as they always do. Once we realise that panic will do us no harm, we can become more accepting of it, so increasing our willingness to fully experience it. So the fear-adrenalin cycle is broken and gradually the problem is resolved.
So the cure for panic is simply this. Stop using distraction, avoidance or escape as a means of controlling panic. Next time you panic, stay with it and watch the feelings rise, peak and then subside as they always do. Understand they will do you no harm. Keep doing this until the problem is resolved. To speed up the process, positively seek out situations where you’ve previously panicked.
And so join the thousands of others who used to suffer from panic attacks and now no longer fear them, so they no longer arise.
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