Anxiety & Panic Attacks

Here is some info/tips on dealing with anxiety and panic attacks.

Anxiety Tips

Square Breathing:

v  Breath in for 4 seconds

v  Hold for 4 seconds

v  Breath out for 4 seconds

v  Hold for 4 seconds

https://www.youtube.com/watch?v=HAlTJscAuy8

Progressive Muscle Relaxation:

v  Tense and relax each muscle group starting from head to toes

https://youtu.be/1nZEdqcGVzo

Safe Space:

v  Create a space at home with calming things that you can go to when experiencing anxiety

Drawing Safety:

v  Draw your safe space

v  Hang it where you can see it easily

Grounding:

v  Think of 5 things you can see

v  Think of 4 things you can feel

v  Think of 3 things you can hear

v  Think of 2 things you can smell

v  Think of 1 thing you can taste

v  (You can even create a grounding toolkit with small objects with different textures like stress or sensory balls and things you can taste like small candies, mints, or flavored lip balm)

https://drdinabuttu.com/create-a-coping-toolbox-grounding/

Breath Counting:

v  Focus on your breath and count each one

v  Don’t worry about how deep or shallow, just focus on counting

Calm List:

v  Make a list of calming, soothing things

v  Keep it handy

v  When your anxiety rises go back to the list and visualize each thing

Grounding Through Posture:

v  Hunch/collapse forward

v  Stretch up tall/expand the chest/shoulders back

https://www.youtube.com/watch?v=KK2mLR-7_Lo

Get Physical:

v  Get moving – walk, exercise, do yoga, put on music and dance – give that anxious energy somewhere to go

Anxiety 101

Taken from Overcoming Panic Attacks by David Shanley, PsyD

Panic Self-Assessment:

Physiological Symptoms – Which of the following physiological symptoms do you experience during an anxiety/panic attack?

·         Shallow breathing

·         Tightening of chest

·         Choking sensations

·         Coldness/chills

·         Gastrointestinal issues

·         Rapid heart rate

·         Hot flashes

·         Hyperventilating

·         Lightheadedness/dizziness

·         Nausea

·         Stomach pains

·         Sweating

·         Tingling/numbness

·         Trembling/shaking

·         Tunnel vision

Cognitive symptoms – Which of the following thoughts have you experienced during an anxiety/panic attack?

·         I’m going to die

·         I’m having a heart attack

·         I can’t handle this

·         I’m losing control

·         I’m losing my mind

·         What if I never calm down

·         I feel trapped

·         I can’t tell what feels real

·         I need to get out of my body

Avoidance behaviors – Which of the following places, situations, or things do you avoid because you fear you will have a panic attack?

·         Airplanes

·         Bridges

·         Caffeine

·         Class/school

·         Close friendships

·         Crowed spaces/public events

·         Elevators

·         Grocery stores

·         Gyms

·         Highways

·         Job interviews

·         Meetings

·         Networking events

·         Public speaking

·         Presentations

·         Romantic relationships

·         Social events

·         travel

Safety behaviors – What safety behaviors do you use to avoid/prepare for anxiety/panic attacks?

·         Always carry water with you

·         Always carry a certain medication with you

·         Avoid certain places at certain times of day

·         Avoid going out of the house alone

What do you value?

Defining your values provides you with motivation to go after the life you want and deserve.

·         What kind of life do you want?

·         What kind of relationships do you want?

·         How important is your job/career?

·         What activities do you want to be engaged in?

·         If panic attacks, anxiety, and stressors were no long a problem, what would you do with your life?

·         What qualities do you value in yourself?

·         What kind of person do you want to be in this world?

·         How do you want to be with/toward others?

·         How important are health and well-being to you?

Where/How does your anxiety show up?

·         Where in your body does the panic usually show up? Try to pinpoint specific areas.

·         What sensations do you notice? Numbing? Tingling? Tension? Heat? Chills?

·         Do you sweat? Feel nauseous? Dizzy? Lightheaded?

·         Scan your body from head to toe to see what each area is feeling.

·         Check your pulse

·         Check your respiratory rate

·         Gather all this data in a notebook for reference

*** Do this in normal situations as well – it can show you that the fluctuations might not be as extreme as you think; i.e. I am having a heart attack.

Reflect on your thoughts

·         What are your thoughts when your anxiety rises?

·         Do you experience any thoughts related to your physical safety and well-being?

·         Do you experience any thoughts related to your mental well-being or sense of control?

Rate your fears

·         Rate your fearful thoughts from the last strategy on a scale of 1 -10.  Think about how scary the felt to you in the moment.

·         Identify the thoughts you’ve given the highest scores. Do these thoughts feel scary right now when you’re thinking about them, or only during a panic attack?

** Now that you have rated and reflected on your fears, you have a better idea of which case you the most concern. You can start tackling the most troublesome thoughts first.

Practice Self-Compassion

·         What are some kind things you can tell yourself about your own self-worth?

·         Which aspects of yourself do you feel most positive about?

·         What do you believe you are capable of?

Common Thinking Errors

·         Filtering – During a anxiety/panic attack, your mind decides it will save you some mental energy by ignoring what it deems unimportant (safe, positive things) so you can focuses on the perceived negatives or dangers) Your goal is to broaden your thinking to see if you can find positives.

·         Polarized thinking – This is black and white thinking; where something is either all bad or all good. Your goal is to think of the shades of grey and realize you don’t have to fear the worst.

·         Control fallacies – This is the belief that you should be able to control things that you have no control over. This reinforces the panic because not everything is in your control. The goal is to learn to let go of things you can’t control.

·         Overgeneralizing – This kind of thinking is where you focus on one (usually negative) situation and believe that that will be the situation forever. Remember – one incident is not a trend and one person is not a representative sample of all people.

·         Catastrophizing – This is when your mind jumps to the worst case scenario and believes it to be the case here and now. The goal is to slow down and notice that maybe things aren’t as bad as they seem.

What is your thinking error? Keep a thought log. Record your thoughts next time you have an anxiety/panic attack. What is the thinking error? How can reframe and re-interpret it?

Thought

Thinking Error

Is it actually true?

Is it actually a problem?

More realistic interpretation

Reframing

·         Technique to seeing your thoughts in a less scary, more tolerable way

·         Make sure you are labeling the behavior and not a trait – I am an anxious person vs I struggle with panic attacks

·         When you have a negative thought, say it out loud, but with a funny voice or thick accent

·         Ex: My life is over if these panic attacks continue – Panic attacks are a challenge that I have to face right now and my life will go on. I am so weak – I have many strengths, and when I learn and practice strategies to deal with panic attacks. I will be even stronger.  The physical symptoms of panic attacks are very similar to engaging in heave exercise, not just having a heart attack.

Avoidance

·         Avoiding situations that might cause anxiety/panic attacks might seem like a good idea, but it shrinks your lifestyle and strengthens anxiety over time.

·         The less you avoid, the more you are letting your direct experience teach you that you don’t have to buy into your thoughts about them.

·         What situations do you find yourself avoiding? What thoughts, feelings, and sensations are you trying to escape?

·         Recall times you got over your fears and everything worked out.

·         Create a distraction toolbox – play a game on your phone, watch a video, read an article, walk outside, or play with a pet.

Exposure Therapy

This is a way to mimic the physical symptoms and sensations of a panic attack in a safer and more relaxed situation to help you realize they aren’t as scary or life-threatening as your mind makes them out to be. You can do these with a therapist or another safe person.

·         Hold your breath until it feels like you really can’t anymore (diaphragm spasms)

·         Breath through a straw, constricting your airflow (mimicking the feeling of suffocation)

·         Spin in a chair for 20 seconds (dizziness)

·         Do jumping jacks or run upstairs (heart racing)

·         Stand in front of a mirror and stare into your eyes without moving your gaze for two minutes (may elicit feelings of depersonalization; feeling out of it)

·         Hang your head down in front of you while seated for one minute, then stand quickly (lightheaded)

·         Tense all your muscles and hold for one minute (shaking or muscle tension)

Track your behavior daily

·         Any avoidance or escape behaviors you used throughout the day

·         Common thinking errors and reframes

·         General healthy habits

·         Any accomplishments

·         Helpful strategies you used