HOW TO: A Practical Guide for Contending With Panic Attacks

I've had enough panic attacks to fuel a dozen Woody Allen movies. Here are my tips on how to deal.
Publish date:
April 25, 2012
mental health, sara benincasa, anxiety management, panic attacks

Ahhhhh, peace!

Urgh, panic attacks. Even writing the term makes me feel a little odd, like I ought to make sure my bottle of Klonopin is nearby (it's never very far away, though I don't use it often).

I'm loaded up on copious amounts of Prozac and Abilify, but I still occasionally get what I think of as breakthrough panic attacks -- the gnarly scare-fests that manage to break on through my chemical wall of toughness in order to freak the living daylights out of me. And I had one recently.

In retrospect, all the ingredients were there: I was hungry (low blood sugar sometimes sets me off), I hadn't had enough sleep the previous evening, I'd been fretting about an issue with a friend, and it was ladytime. Moon cycle goddess worship week, if you will.

I've also been having a pretty hard time adjusting to the life of a stay-at-home freelancer -- turns out it's real lonely and gives you plenty of time to consider your personal shortcomings .

I know these are all pretty light problems, but the other day they combined to kick me into an old-school panic attack. It occurred, as so many of my panic attacks have, in the bathroom, albeit in a friend's bathroom rather than my own.

The primary difference is that it's entirely acceptable to lay down and sob with your cheek against the cool tile of your own bathroom floor, while it's maybe not the polite thing to do in your friend's water closet.

Now, for those folks who don't know what a panic attack is (maybe you've never had one, or maybe you have and you've mistaken it for something else) I'll grab a definition here from one of the most helpful books I've ever read, "Full Catastrophe Living" by Dr. Jon Kabat-Zinn, Ph.D:

These are episodes in which a person experiences a discrete period of intense fear and discomfort for no apparent reason. Often people who suffer from panic attacks have no idea why they get them or when one will happen. The first time it happens, you can think you are a having a heart attack since it is frequently accompanied by acute physical symptoms including chest pains, dizziness, shortness of breath, and profuse sweating. There may be feelings of unreality and you may also think that you are dying or that you are going crazy or that you may lose control of yourself.

Your body goes into what's known as the fight or flight response: Your heart beats extra fast, you get schvitzy, the muscles in your legs tense so that you can spring into action, and blood flow is diverted from your digestive system to your heart and lungs so that you're extra revved up to fight or flee.

I've written before that a panic attack feels like the moment before you throw up, but without ever getting the gross relief of actually puking. To put it another way, a panic attack feels like the exact inverse of an orgasm.

Women are more likely than men to be diagnosed with anxiety disorders, including panic disorder. Whether that's due to underreporting by men is up for debate. It may simply be an accurate representation of the situation, and there are probably many contributing factors to the higher incidence of panic attacks among women.

That said, it's clearly an issue of concern for many women, and I've got a few tips that will help folks of any gender deal with panic attacks.


This seems obvious, but it's easy to forget when you've been seized by sudden, inexplicable, heart-pounding, stomach-churning fear. It's time for you to reassert control over the situation. Your panicky brain is no match for the power that resides right under (or inside, actually) your nose.

If you breathe slowly and mindfully during a panic attack, your heart can't help but slow down, too. Here's some additional info from "Spontaneous Happiness" by the awesome Dr. Andrew Weil, M.D.:

Breath links body and mind, consciousness and unconsciousness. Working with the breath is one of the main components of yoga for three reasons. First, it gives access to the involuntary nervous system and makes it possible to influence cardiovascular, digestive, and other functions ordinarily beyond conscious control. Second, it is a way to calm the restless mind, facilitating one-pointed attention and meditation. Third, it promotes spiritual development and well-being…

Dr. Weil also describes a variation on a breathing technique I first read about in Sassy magazine! Basically, it involves counting beats while you breathe. He calls it the "4-7-8" breath, but there are many versions.

In his recipe, you put the tip of your tongue against the fleshy area above and behind your front teeth. Then you breathe out as much air as you can. After that, you close your mouth and inhale through the nose for 4, hold for 7, and exhale through the mouth for 8. He suggests only doing it a few times, but I find that a really gnarly panic attack often calls for several rounds of this type of breathing. If you stop and the panic starts up again, you can always begin the breathing cycle again.

Talk to yourself

Generally regarded as a sign of craziness rather than a solution to it, talking to yourself can be incredibly helpful during a panic attack. I think of it this way: a panic attack is your undisciplined, uneducated, untrained wild mind taking over in a bad way. With no disrespect intended toward our furry and feathered sistren (not that they can read blogs or whatever), you might even call it your animal mind. Your human mind (or highest self, or however you want to put it) always has the power to control the unruly animal mind. You've just got to exercise that power.

Here are a few things to consider saying to yourself, silently or aloud, when you're in the midst of a panic attack:

I love you.

I am here to take care of you.

This too shall pass.

Just keep breathing.

I wouldn't advise going all tough love on yourself and saying, "Quit feeling bad!" or something, because that's only going to make you feel worse. This is a chance to nurture yourself a little bit.

Summon comforting images

Sometimes when I fear I'm losing my marbles, I actually picture myself in a serene, safe setting like a gorgeous meadow or, you know, my comfy bed. My brain has already taken me on an involuntary journey to a crappy spot; I'm just turning the plane around and heading for a better destination. The meadow is no more or less real than the fearful, panicky images inside my head and the irrational thoughts that circle round and round my scared brain. Why not turn a negative fantasy into a positive one?

Of course you can also rely on prescription medication if your doctor OKs it -- I use it sometimes, and I find it to be quite helpful. It's nothing to be ashamed of. But I figured I'd just share these non-drug techniques with you because, well, they're easiest and free. If you've got other techniques that help, by all means, share in the comments.