“I woke up today and everything felt just a little bit different…there was a more dream like quality to things…my ears were flushed…I was sitting in a group of people and all the voices were mixing together into a big ball of mush. Focusing on any particular thing seemed like I was asking too much of myself. I could hear my heart beating in my ear…my chest felt tight, constricting my lungs…I was breathing but the oxygen was going someplace else…My legs were suddenly more jelly than bone…I had to double over my knees…I felt panic…I’m unsure why exactly or what had brought this on…But I just had this ominous feeling…like I might die. I felt fear…All these negative thoughts flooded my head. I knew somewhere in my heart that they might be “irrational” and things weren’t as bad as they seemed in that moment…but I just couldn’t shake the fear that had suddenly gripped me so tight. I tried to talk myself out of it…tell myself everything is okay… But the pit in my stomach told me otherwise… Slowly…after what felt like eternity…my breathing returned to normal…my pounding erratic heart beat slowed down to a calmer rhythm…I felt like I may just live a little longer…I’m drained though…Nothing left to do but pass out.”
That was an attempt to explain what a panic attack can feel like. Most such episodes end within 20-30 minutes, and never exceed an hour. Those 20 odd minutes, can however feel like a lifetime. Going through something like this can be such an isolating experience. Isolating because after a certain point it can be really hard to repeatedly talk to people about the same concerns and fears. It’s also rather hard to explain why a seemingly small ‘situation’ can cause such a ferocious onslaught on one’s mind and body, also because many a times they are just random. It is hard to be the one in constant need of validation and support. After a certain point it’s just you and your mental health, really.
A dear friend of mine has been suffering from severe generalized anxiety disorder. We were about the age of 18 and living in an undergraduate accommodation. This was my first exposure to this mental health condition. We would spend a wonderful and uneventful day together and a few hours later, I’d get a rather panic-stricken call asking me to come over. I used to get bewildered by exactly what caused so much panic in her. I’d be holding her while she struggled to breathe and crying hopelessly. Helping her through a very rough patch proved to be a pivotal point in my decision to become a Clinical Psychologist. But that’s not why I spoke about her. The point is, for a person suffering from anxiety, there are these irrational amplifiers that take a small doubt or fear and exaggerate them to such a high level that the body gets tricked into believing it’s under siege and that’s what precedes a panic attack.
A full-blown panic attack includes a combination of the following signs and symptoms:
- Shortness of breath or hyperventilation
- Heart palpitations or a racing heart
- Chest pain or discomfort
- Trembling or shaking
- Choking feeling
- Feeling unreal or detached from your surroundings
- Nausea or upset stomach
- Feeling dizzy, light-headed, or faint
- Numbness or tingling sensations
- Hot or cold flashes
- Fear of dying, losing control, or going crazy
Certain techniques that we give to our patients to cope with this ordeal may seem rather simple or obvious, but they work.
The 4-7-8 Exercise
Although you can do the exercise in any position, sit with your back straight while learning the exercise. Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward.
- Exhale completely through your mouth, making a whoosh sound.
- Close your mouth and inhale quietly through your nose to a mental count of four.
- Hold your breath for a count of seven.
- Exhale completely through your mouth, making a whoosh sound to a count of eight.
- This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.
*Note that the tongue stays in position the whole time. Exhalation takes twice as long as inhalation. The absolute time you spend on each phase is not important; the ratio of 4:7:8 is important. If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases
Sit in a comfortable position with the spine straight and head inclined slightly forward. Gently close your eyes and take a few deep breaths. Then let the breath come naturally without trying to influence it. Ideally it will be quiet and slow, but depth and rhythm may vary.
- To begin the exercise, count “one” to yourself as you exhale.
- The next time you exhale, count “two,” and so on up to “five.”
- Then begin a new cycle, counting “one” on the next exhalation.
Never count higher than “five,” and count only when you exhale. You will know your attention has wandered when you find yourself up to “eight,” “12,” even “19.”
Find a few minutes everyday in the morning or evening.
Be aware of how and what you’re thinking and feeling. Learn your patterns of thought and acknowledge when you go down an anxiety spiral (basically a chain of thought that will slowly add on to your anxiety).
Exercise for at least 30 minutes everyday.
In addition to the few relaxation techniques mentioned above, I think it is important to understand anxiety in order to control it. There are cases that require psychopharmacological interventions but even there knowledge brings mindfullness, which gives you the upper hand. It is important to understand that anxiety can be caused by cognitive or “thought” processes that mediate anticipation, interpretation, or recollection of perceived stressors/ threat. Once you know understand the basis or emotional conflict or the root fear behind a particular situation, it is easier to calm your mind.