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7 Steps to Help Stop Your Clients’ Panic Attacks

A guide to treating panic attacks and high anxiety in therapy

A panic attack is the body behaving as if it's exercising when it's not.

Breathing fast, Becky broke into guttural sobs. She was describing – or trying to – her first panic attack.

“It’s okay,” I interjected, “you don’t need to tell me anything you’d rather not.”

“I know,” she sniffed.

But a little later she was calm enough to broach the topic again.

“I didn’t know what was happening! I just felt really weird, like I wasn’t really there! My heart was going like a bullet. I was sweating even though it was a cold day. I was shaking and felt like I couldn’t breathe!”

Becky described how, once upon a time, she’d been fun-loving, bubbly, sociable, and “free”.

“But now I avoid all kinds of situations. I run and hide like some timid creature unable to face life… and I hate it!”

When our clients overcome panic attacks, they get their lives back. Those horrible feelings either disappear completely or become easily controllable. But Becky’s panic attacks were so powerful that she couldn’t bring herself to believe they would ever stop. She needed reassurance, fast.

What causes panic attacks?

Becky was at a loss. “Why me?” she wondered aloud.

Panic attacks often start during times of higher than normal stress, whether that’s a result of one particular thing or a build-up of many things. The high ‘background stress’ can ‘overspill’ into a panic.

Becky’s panic attacks started after she’d made a career change, her mother had fallen ill, and her relationship had run into problems. She had been driving along, fretting about her new job, when suddenly all that stress bubbled over and she panicked. “I actually felt more terrified than I’d ever felt in my life,” she remembered.

I spoke to Becky in terms of ‘panic attacks’, and she used those words too. But the first thing I did was reframe the very idea of a ‘panic attack’.

‘Panic attack’ is a cruel metaphor

‘Panic attack’ is simply a metaphor – and a cruel one at that, especially since it is generally applied to people already prone to anxiety. I had a feeling that simply acknowledging this might help Becky feel a little less victimized.

“‘Panic attack’ is actually a misnomer,” I told Becky, “since nothing is ‘attacked’.” A house alarm doesn’t ‘attack’ the house it’s protecting, but it can sound when it doesn’t need to. Stopping panic attacks isn’t about getting rid of panic altogether; it’s about aligning the panic response so it only happens when it really needs to.

The scary changes – fast breathing, sweating, raised heart rate, shaking – that characterize a ‘panic attack’ would all feel perfectly natural if you were running in the gym. Really, a panic attack is the body behaving as if it’s exercising when it’s not.

All the ‘weird’ symptoms would be completely normal in the right circumstances. In fact, they evolved for very good reasons.

Fast breathing and an increased heart rate help your body to exercise, which is highly useful if you need to outrun a predator. It only feels weird if you are not exercising at the time.

Sweaty palms will give your hands better grip when the sweat dries, so you can climb a tree or hold a weapon.

The need to vomit or defecate, if taken to its logical conclusion, would help deter a potential predator from eating you!

So these are all, in extreme circumstances, useful reactions. But if they happen when we’re driving, sitting in a restaurant, or taking the kids to school, then of course they feel weird.

“‘Inappropriate exercise response’ sure isn’t as catchy as ‘panic attack’,” I told Becky, “but it is more accurate.”

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First, reassure

Becky already felt reassured, even relieved, to think about it like this. She had never even considered that ‘attack’ was merely a metaphor, and it made it somehow easier to think about all these ‘symptoms’ as characteristic of a perfectly normal exercise response that is just activating when it doesn’t need to. She also liked the metaphor of an alarm that can be reset rather than completely removed.

I also reassured her that panic is meant to be ‘switched off’ because our systems don’t like to waste energy. We simply needed to realign her panic response to go off only on the rare occasions it might actually be useful – and that was exactly what we were going to do.

After looking at some of the ways Becky could stop panicking about panic attacks, we looked at what we could do to actually stop them.

Tip one: Let the panic know who’s boss

“Stopping panic attacks is all about reasserting your independence,” I suggested to Becky. “It’s useful to think about so-called ‘panic attacks’ (aka ‘inappropriate exercise responses’) in a very specific way.”

“Panic is powerful but stupid. We’re all born with the capacity to panic, but panic is ‘blind’. That means it doesn’t know what to fear, so it takes its lead from you. It’s a follower, not a leader. You can be the leader.”

Panic is powerful but stupid. We're all born with the capacity to panic, but panic is 'blind'. That means it doesn't know what to fear, so it takes its lead from you. It's a follower, not a leader. You can be the leader. Click to Tweet

Becky was intrigued by this idea.

“If you avoid or run from something (say, the library in which the panic attack happens), then your panic response will tag that place as threatening. You have to teach it that there is nothing inherently threatening about the library.”

Becky got it. “So it’s like a pet that needs to be trained!”

I loved that Becky saw it that way. “Yes, absolutely. If a dog barks at a burglar, great, but if it barks at an elderly person or someone delivering mail, then it needs more training.”

“Just like panic!” she added.

I continued. “In fact, that panic is positively looking for a reason to stand down. You can let it know very easily that it’s not needed. That this situation does not require muscle, but something more subtle.”

Tip two: Stop running

And it’s true. If the panic gets just one whiff of a hint that a situation is really not dangerous, it will ‘call back’ its big investment of energy. Breathing will slow, blood pressure will return to normal, the sweat response will calm down, and clear thought will return, like firefighters returning to their depot after discovering that it was a false alarm: “Nothing to see here. Stand down!”

So how can we convince the panic that it isn’t needed?

First, we need to avoid engaging in behaviours that support the lie that the situation is dangerous. We need to avoid fleeing from it because, in nature, what we avoid (even what we avoid thinking about) is tagged by our brains as something deadly.

If you panic in a supermarket and flee the scene, then your panic response will conclude that the supermarket holds life-threatening horrors because you ran away from it. The panic takes its lead from you. If you flee from something, it tries to help you out by making sure you remember how scary it is in future. Remember, it doesn’t know what is actually dangerous and what is not.

It’s so ‘helpful’ it may try to make you afraid of anywhere even remotely resembling a supermarket, such as any crowded indoor place. And that’s how panic spreads from one situation to another – through this process of faulty pattern matching.

If you panic but stay in the situation until you calm down, your panic response will learn that it’s not a situation to be feared. In nature, we avoid what is dangerous. The more you avoid something, the more the fear builds. But the opposite is also true.

The more ‘normal’ our clients can act, the more panic gets the message it’s not needed. But our clients don’t even need to physically seek out panic-inducing situations in order to start to reshape these associations.

We can help our clients back to work or into the supermarket by guiding them to hypnotically experience these places while deeply calm. This can switch off the panic association before they even go back into the previously feared situation.

Tip three: Breathe deeply… or not at all!

The first part of a ‘panic attack’ is altered breathing. When we panic, we breathe quickly and high in the chest. This is because your body wrongly assumes it needs to exercise and so breathes as if you were running hard or fighting. So certainly we can help our clients breathe their way to calm as another way of letting panic know who is boss.

When our breathing becomes shallow and rapid but we are not exercising, we call this hyperventilation. Hyperventilation is not serious, but it feels dramatic. Symptoms of hyperventilation include light-headedness, giddiness, shortness of breath, heart palpitations, and feelings of weakness.

“Yes,” said Becky, “I feel like I can’t breathe!”

I reassured her that although it may feel as if she hasn’t got enough air, this feeling actually occurs when we take in too much air.

To ‘switch off’ hyperventilation, our clients can:

  • Hold their breath. This seems counterintuitive, but holding the breath for as long as comfortably possible can alleviate the feeling of breathlessness by preventing the release of carbon dioxide. Feeling breathless isn’t actually caused by not breathing in enough oxygen, but by breathing out too much carbon dioxide – and holding your breath prevents this. Holding the breath for 10–15 seconds and repeating a few times will ‘reset’ breathing to a normal pattern.
  • Engage in deep, slow, diaphragmatic breathing, right down to the bottom of the lungs. Breathing should be through the nose, with the out-breath taking longer than the in-breath. Clients can quick-count in their mind to 7 as they breathe in and 11 as they breathe out. This ‘7/11 technique’ also works as a distraction technique, as the client focuses on their breathing rather than what they were busily mis-tagging as threatening. It’s important to emphasize that they are not counting seconds (11 seconds is a long time to breathe out!), just doing a quick count in the mind.

I taught 7/11 breathing to Becky and encouraged her to do it for 5 minutes twice a day to generally lower her stress levels.

Just as we can’t drive forward when we have the brakes on in a car, so too, I reassured Becky, we can’t panic and breathe deeply. She was already beginning to feel a greater sense of control.

But we can take it further.

Tip four: Act normal

“Becky, if you do have another panic attack, I want you to make a conscious effort to carry on as if nothing out of the ordinary is happening,” I instructed. “Pretty soon the panic will ‘get bored’, realize it’s not actually needed, and drift away.”

If firefighters come up to a bogus call and find there is nothing at all actually happening they will, pretty soon, go back to the depot. No one and nothing likes to waste resources.

“You wouldn’t carry on talking if a hungry lion was about to pounce on you,” I said. “So keep talking. Keep acting as if nothing untoward is happening. You may not feel like acting normal, but remember, as intelligent as you might be, your panic isn’t. It’s desperately looking for cues from you as to whether it’s needed or not. Panicked behaviours like running away show it is needed. Acting normal shows that it most certainly isn’t.

With that in mind, on to the next tip.

Tip five: Keep thinking

Anxiety, like anger or any strong emotion, makes us dumb, daft, stupid, and simplistic in our thinking. And there’s a good reason for this. During times when panic is really required (a hungry, fractious lion coming right at you), the thinking part of the brain becomes much less active because we need to devote all our resources to the physical – to run or to fight.

But conversely, intelligent, structured thought helps damp down strong emotion. So we can encourage our clients to keep thinking, or at least doing something methodical.

If we purposefully start counting backwards from 100 in jumps of 3 – “100, 97, 94, 91…” – we effectively force our thinking brain to work, which actually dilutes the panic response.

Making yourself do a crossword, read a passage from a book, or even grade/scale the anxiety can quickly show the panic it’s not needed – because, again, no one would be doing these things during an actual emergency – and let it ‘stand down’. It’s as if you’re telling the panic, “This is not a real emergency, so butt out!”

Becky actually did this. While lining up in a store she felt the first stirrings of panic, so she started to count backwards and very soon found that she felt normal again.

Tip six: Use the AWARE technique

Another great way to help clients feel in control of the panic, rather than controlled by it, is to get them AWARE.

I gave Becky a little card we call the AWARE card. She was to carry it around with her and, if she started to feel panicky, take it out, read it, and follow the simple instructions:

A: Accept the anxiety. Don’t try to fight it. (Panic is all about flight or fight, so we don’t need more of that!)

W: Watch the anxiety. Imagine it is outside of you and you are just observing it.

A: Act normal. Carry on as if nothing is happening. The panic will soon ‘get bored’.

R: Repeat the above steps until you start to relax again.

E: Expect the best. The panic will pass more and more quickly the more times you do this.

These are great ways to help clients regain control of their physical and psychological emergency responses. Write these steps down on a card for your client.

I think this last tip is perhaps the most powerful.

Tip seven: Hypnotically prepare not to panic

“This is all good advice!” said Becky. “And I do feel a bit better. But in the heat of the moment, I’ll know I’ll forget it all!”

This is why I worked hypnotically with her. Sure, she could use all the above (and she did), but we wanted her mind and body to naturally feel calm again.

Hypnotic mental rehearsal while very relaxed helps automatically rejig your clients’ responses so that calm naturally starts to replace panic. When we’ve used hypnosis successfully with panicking clients we, and of course they, start to notice that the panic just doesn’t show up so much – sometimes not at all.

I hypnotized Becky into deep relaxation and not only did I have her rehearse, and in doing so embed, the above tips, but I also suggested she imagine feeling she might panic then feeling the panic just drain away. She enjoyed spending plenty of time in all the situations in which she’d previously panicked while feeling calm and confident. In this way a calm association was quickly re-established.

On our third session together Becky told me confidently she no longer needed to see me.

“I have,” she told me calmly, “become the boss of my own mind again.”

In the best possible way, I was happy I wouldn’t be seeing her again.

De-traumatize Your Clients Quickly and Comfortably

You won’t believe just how effective the Rewind Technique is until you use it with a traumatized client. Then you’ll be truly astonished by how quickly it works while maintaining client comfort. Read what our trainees say about it here.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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