How to Handle Panic Attacks

Remember the first episode of The Sopranos? In that groundbreaking HBO series, mafia don Tony Soprano finds himself losing it when the ducks leave his pool. When he goes to a psychiatrist, he learns that he has suffered a panic attack.

What is a panic attack? Where do they come from? Why do people get them? Can they be prevented? What do you do when you have one?

A panic attack can come on without an obvious reason. A person can wake in the middle of the night and find their heart pounding out of their chest, they are drenched in sweat, they have a hard time breathing, and they believe they are dying. Other times, the attack happens in the same kind of situation where a person has had the attack before. This can be on a train, plane, or elevator, for example.

To understand panic attacks, we need to know that the body has an emergency system. When a person is in mortal danger, their body goes into a mode to protect it. This is known as the fight-flight-freeze system. In technical language, this is called the sympathetic nervous system. Let’s call this the Panic System. The sympathetic nervous system, or the Panic System, not only helps us when we are in danger, but it gets turned on when we are excited, or need extra energy to complete a task. A panic attack is what happens when the Panic System gets turned on full even though we are not in any real danger. The body is freaking out, as if we are about to get eaten by a shark, even though we are lying in our bed.

No one knows for sure why the body’s systems can go haywire like that sometimes. What we do know is that the body can learn that a certain situation is dangerous and if we reacted with panic in a situation before, we are more likely to do so again in the same kind of situation. For example, if Tony had a panic attack at his pool, he is more apt to have one there again.

What do you do if you have regular panic attacks? Though there is no sure way to prevent this kind of anxiety, it is important to do everything you can to lessen your general stress and anxiety. One good way to do this is to do everything you can to take care of your body. It is important to stop eating junk food and eat healthy, clean foods instead. You can eliminate sodas with sugar and caffeine, limit alcohol and recreational drugs, get plenty of rest, exercise, do yoga, be creative, spend time in nature, and be with people you love who love you.

If you find it difficult to change your lifestyle and you find yourself living an imbalanced life with a great deal of stress, working with a good therapist is a great idea.

What do you do when you are in the middle of a panic attack? Medications like Xanax, Klonipin, or Ativan can help in the moment. Unfortunately, these medications are habit-forming and should only be used sparingly or on a short-term basis.

Here is something else you can do. In the same way that the body learns to turn on the sympathetic nervous system in certain situations, and so the more times you have a panic attack when you are near an elevator the more likely you are to have that panic attack, you can teach your body to turn on the antidote to the panic system, which is called the parasympathetic nervous system. This is the system that calms down the body and tells it that everything is safe and ok. Let’s call this the Safe System. How can you turn off the Panic System and turn on the Safe System?

When people start feeling the symptoms of a panic attack, the bad feelings usually build on themselves. For example, a person may feel a small twinge in their chest and then they tell themselves that they are having a heart attack. In this way, they scare themselves, which turns on the Panic System more. This increases the symptoms and this makes the person more afraid. This cycle keeps building on itself until the person is in a full blown panic attack.

Instead of frightening yourself further, the solution is to begin by reminding yourself to say, “Oh, I’m experiencing anxiety. This is just a feeling in my body, and the solution is to turn off the Panic System and turn on the Safe System.” Then instead of scaring yourself, you can remember to breathe, feel your feet on the ground, and use known techniques to turn on the Safe System. The more you use this system, the more it will become a habit and you will be able to calm yourself, and keep yourself calm, more and more of the time.

To learn this system and practice it, try Shrinky, available here.


Dr. Glenn Berger is a psychotherapist, relationship counselor, business and artist’s coach, and young person’s mentor. He sees patients in New York City, in Mt. Kisco, NY, and around the world by Skype.

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One comment

  1. A panic attack may be a one-time occurrence, but many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public. Much better to know the symptoms of it to prevent sadden causes great content.