A shared universe › Blog › What to do during a panic attack · Español
It comes out of nowhere. Your heart races, you can’t get your breath, your hands tingle, and you become certain that something terrible is happening: a heart attack, a faint, losing control. Few experiences are so frightening, and understanding what is going on helps you get through them with less fear.
A panic attack is a sudden wave of intense fear that reaches its peak within a few minutes. It comes with physical symptoms: palpitations, sweating, trembling, a feeling of choking, pressure in the chest, dizziness, nausea, tingling, chills or heat, and sometimes the impression that nothing is real. According to the UK’s National Health Service (NHS), most last between 5 and 20 minutes. They are very unpleasant, but they are not dangerous: a panic attack does not cause any physical harm.
It is more common than it seems. In a large survey led by Ronald Kessler of Harvard Medical School and published in 2006, covering more than nine thousand adults in the United States, 22.7% had had at least one isolated panic attack in their lives. Only a minority, around 5%, went on to have panic disorder: attacks that recur without warning and leave, for at least a month, a constant fear that they will come back.
In 1986 the psychologist David M. Clark of the University of Oxford published an explanation that changed the way panic is treated. According to his model, the attack begins when an ordinary bodily sensation is interpreted as a sign of catastrophe. The heart speeds up a little, because of a coffee, a flight of stairs or a fright, and the mind reads it as “I’m having a heart attack”. That thought is frightening; the fear speeds the heart up further and adds breathlessness and dizziness; and each new symptom seems to confirm the worst. Within minutes, the circle reaches its peak.
Other sensations follow the same path: shortness of breath is read as “I’m going to suffocate”, dizziness as “I’m going to faint” and racing thoughts as “I’m losing my mind”.
Clark and his team added another piece: the things people do to protect themselves, such as sitting down, holding on to something or running away. In an experiment that Paul Salkovskis published with Clark himself in 1999, people with panic who dropped those safety behaviours during a period of exposure afterwards believed less in the catastrophe and felt less anxious than those who carried on with them. If you always hold on, you never find out that you weren’t going to fall.
The cognitive therapy that came out of this model has given good results. In his team’s trials at Oxford it was more effective than applied relaxation, another therapy widely used at the time, and the University of Oxford estimates that between 70 and 80% of the people treated recover.
But the model doesn’t explain everything. In 1988 Clark reported that 83% of his patients with panic disorder had an attack simply from reading pairs of words such as “palpitations” and “dying”. In 2013 a team at Maastricht University repeated the test with more controls: the patients became more anxious with those words, but none of them had an attack. The authors concluded that catastrophic thoughts matter mostly in the fear that the next attack will come, rather than in setting off each one. Learning to read what the body feels in a different way is still useful, even if it isn’t the whole story.
If you feel one starting, you can try this:
Seeing another person in the middle of an attack is frightening, and the most useful thing you can give them is your calm. The guidance from British mental health services runs along these lines:
When it has passed, ask them what they need: a glass of water, a short walk, to go home. It is normal for them to feel tired or embarrassed afterwards. If they want to talk later, listening without playing it down helps; there are ideas in “I understand why you feel that way”. And if the fright was also yours, give yourself a while.
If it is the first time, if the pain or tightness in your chest doesn’t ease or spreads to your arm, jaw, neck or back, or if you have heart problems, get urgent medical help. If in doubt, it is better to be seen: only an examination can rule out another cause.
If the attacks keep coming back, if you live in dread of the next one or you start to avoid places, mention it to your GP. Panic disorder can be treated. In the meantime, the NHS advises cutting down on coffee, alcohol, tobacco and sugary drinks, which can make attacks worse. And if fear is closing your life in, tell someone. In Spain you can talk to a person at the Teléfono de la Esperanza, 717 003 717, at any time. If you are thinking of ending your life, call 024: it is free and answered 24 hours a day. If you are in another country, call your local emergency number or a helpline there.
After the fright, that question often stays behind. You can write it just as it is on a star with “What weighs on me”, without anyone knowing it is yours. Whoever passes by will keep you company with a touch.