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Helpful Reminders for Managing Panic Attacks

1. Anxiety is often driven by anticipation. Try not to indulge thoughts about what could happen. Allow your thoughts to focus on what you are doing now or where you are now. Stay out of the past and out of the future. If you "stay in the now," your anxiety level will come down. If you are anticipating upset, planning your escape, checking your watch or thinking about past "failures," your anxiety level will go up. Focus on your immediate surroundings to help you stay in the present, (e.g., colors, textures, the details of a conversation, etc.). Tell yourself: "Stay in the here-and-now." "Keep your feet on the floor." "Keep your mind where your body is." "What am I doing now? What do I need to do now?" "I'll deal with that when the time comes."


2. Accept your "first feelings" of anxiety. Don't try to fight off, control or ignore these initial feelings. You cannot make them go away and trying to do so will only make your anxiety get worse. Rate your anxiety from 1 (none) to 10 (panic) and observe that it fluctuates up and down. If you find yourself rushing, slow down. Tell yourself: "Accept--don't fight." "I can be anxious and still do this." "I will accept this anxiety and continue doing what I must." "It is okay to be anxious. It is okay not to feel in control."


3. Don't add "second fear." This is the fear associated with your anxiety, like the fear of dying, fainting, going crazy, losing control or embarrassing yourself. It often starts with sudden thoughts like "What if...?"/"Suppose...?"/"If I don't get out of here soon, I'm going to..." If you tell yourself you are in danger, your body will dutifully react as if you really are in danger and it will scare you more. Sometimes thoughts are so automatic or feelings follow them so quickly that you won't see the connections, but look for them. In time, you will become more skilled at seeing and interrupting such connections. Tell youself: "It's just what-ifing!" "I've felt like this before and the worst didn't happen." "I'm not going to (die, faint, go crazy, etc.). This is still just anxiety." "This is very uncomfortable, but it is not dangerous."


4. Accept panic when it happens. If you are having a panic attack, label it as such and remind yourself that it is self-limiting. That is, it will pass shortly on its own if you don't add second fear, don't fight it or don't try to make it go away. Try to bring on a panic attack or try to make your symptoms worse. This is the paradox: You can't do either by willing it. Truly trying to do so is a move toward acceptance and will help the feeling pass. Try to make your symptoms worse: If your heart is beating fast, make it beat faster. If your legs are weak and shaky, make them feel weaker and shakier. If your hands are sweating, make them sweat more. Tell yourself: "If I'm going to have a panic attack, let's go ahead and have it right here and now." "It is an adrenalin surge. It will pass--just accept." "Even with panic, I can do what I need to do." "What I resist persists."


5. Strive not to escape or avoid. To do so only reinforces the idea that there is something genuinely dangerous about your feelings. Always stop and consider your options, rather than making decisions based only on how you feel. Remember that it is not the place, but rather your catastrophic thought that makes you anxious. Each time you face your fears and accept your feelings is a step forward. Each time you escape or avoid is one less opportunity to take a step forward. If something you are avoiding seems too big, try to break it up into steps you can do. Remember that your recovery lies in the places, situations and anxious feelings you have fearfully avoided. Tell yourself: "It's not the place, it's the thought." "I can be here (or do this) even with panic." "I will not run or avoid--that only causes more problems." "Face the fear and the fear will disappear."  In general, be willing to have symptoms and be willing to do the opposite of what the symptoms demand of you.


6. Practice diaphragmatic breathing but take smaller breaths. To practice, lie on your back, with one hand on your chest and one hand on your belly. Observe the movement of your two hands as you breathe regularly. Now try to focus your breathing in your belly so that hand moves while the one on your chest stays virtually still. Allow your breathing to be calm and rhythmic rather than hurried or forced. As you breathe in this manner, allow relaxation to flow into your muscles throughout your body. Instead of "taking deep breaths" as commonly advised, try to take smaller breaths--you will still get enough oxygen and it will help to counteract the symptoms of hyperventilation that can compound panic. Once you have developed some skill with this method of breathing, try it in other positions, such as sitting or walking. Try it while you're in a conversation with someone. Eventually, practice your abdominal breathing skills when you feel anxious. Although such breathing skills usually help anxiety, the goal of such breathing is not to get rid of your symptoms. Such breathing activates the part of your nervous system that counteracts panic, may directly reduce any symptoms due to hyperventilation, gives you something to do rather than catastrophize or flee, and encourages willing acceptance of symptoms. Tell yourself: "Breathe low and slow." "Small breaths." "Breathe and accept."


7. Practice and be patient. Remember that recovery lies in changing your relationship with your anxiety and panic symptoms rather than in making them go away. Oddly, you have to be entirely willing to have them before they can begin to subside. Consider your options for practice every day. Be committed to recovery, but don't be rigid and perfectionistic. It's okay not to be perfect. Give yourself credit for small successes--don't diminish them with thoughts like "Yes, but I used to..." or "So what, anybody can..." There will be times when you feel you are no better--you may even fear that you are getting worse. Remind yourself to be patient and not to be too harsh in your judgments at any given point in time. Strive for a sense of perspective about progress over time. Recovery is accomplished in thousands of small steps, one step at a time. Do not try to control things outside yourself that are beyond your control. Nothing in your future is prevented by worry. Tell yourself: "It took time to get this way. It will take time to recover." "Each time I face the fear, I learn that I can see it through by accepting the anxiety." "It's okay to make mistakes. I'll just try not to make the same mistakes repeatedly." "I do not have to judge my progress by how bad I feel today." "I can recover just as others before me have recovered." "The more willing I am to have symptoms, the more the symptoms will subside and the more I'll get my life back."



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