Managing an anxiety attack

An anxiety attack, which is also called a panic attack, is considered an anxiety disorder. It can also be thought of as a functional disruption where the body goes on full alert, ready to face a serious imminent danger.

Because of this, it manifests as an intense, sudden, brief fear that triggers physical reactions and associated distressing thoughts. It occurs suddenly and intensely, without always warning and lasts a few (long) minutes, and can last up to about half an hour.

This anxiety occurs when no real danger is perceived. Moreover, it is sometimes difficult for the sufferer to understand the reason for his or her anxiety. Indeed, there is not always a particular reason: these crises can happen at any time and provide the person experiencing them with a feeling of imminent danger, an intense fear of loss of control about the situation or excessive anxiety about the idea of death in this situation. While all of these ideas are associated with physical sensations, the end of the anxiety attack usually causes exhaustion both physically and morally latent.

The anxiety attack usually leads to entering a vicious cycle, since one will be faced with anticipation of the anxiety attack. The person is therefore afraid that a panic attack could arise at any time in a similar situation.

Symptoms are specific to a person and an experience. They are therefore variable and difficult to list in a strict manner. From then on, the manifestation of his symptoms during the crisis passes in a few minutes, or lasts up to a half hour. Although, always unique to individuals, its sensations always seem to be powerful, unbearable and uncontrollable.

Hyperventilation

One of the symptoms found in almost all anxiety attacks is hyperventilation. Indeed, hyperventilation is when one's breathing accelerates to the point of becoming particularly rapid, with a need for abundant air and still having the sensation of lacking oxygen. The body is looking for oxygen to fight the stress and escape the anxiety-provoking situation as quickly as possible.

Thus, associated with hyperventilation, there are regular sensations of choking where regaining breath is complicated. The heart speeds up, beats fast and causes heat waves that are complicated to manage.

Other physical symptoms

Many other physical symptoms may be associated with it such as severe transpiration: you sweat especially hard all at once. This is usually accompanied by strong hot flashes or hot sensations that are unpleasant to you.

On the other hand, heat can also be accompanied or not by chills. You have the feeling that your body no longer regulates its temperature and that you are just enduring it.

You may also experience tremors, muscle tension or tingling in various limbs. It can also be accompanied by dizziness, lightheadedness, wobbly legs, headaches… Some parts of your body may also feel engorged.

Finally, you may experience nausea, stomach pain, the feeling of numbness or a sore throat.

Psychological symptoms of an anxiety attack

While we often think of the symptoms of the body, it is not uncommon to regularly find psychological symptoms in the anxiety attack.

In this category, we find the feeling of unreality and loss of control. This sensation involves feeling detached from oneself, like being a spectator of one's own life. It gives the impression of no longer having control over one's life or of going insane.

These thoughts are usually accompanied by catastrophic thinking. These thoughts are linked to the situation and always anticipate the worst possible outcome. For example, if I have an exam and I have prepared for it, I will always imagine that my alarm won't go off, that I will be late, that they will ask me questions I won't be able to answer, that I will fail the exam, and that it will affect my entire academic and professional future. Generally, these catastrophic thoughts lead to a particularly intense fear of dying. One imagines that the anxiety attack will lead to death, which is especially frightening.

Other Symptoms of Anxiety Attacks Related to Culture

The symptoms of an anxiety attack can vary from person to person and from culture to culture. It is possible to observe certain pains (neck pain, arm pain…) or other physical reactions (tinnitus, dizziness, etc.).

An anxiety attack can be experienced by anyone at any age. It is estimated that over 20% of the population has experienced or will experience at least one anxiety attack in their lifetime. However, certain people are more at risk of experiencing one.

Firstly, women are twice as likely to experience a panic attack as men. Additionally, younger individuals, with a peak in attacks from late adolescence to the early forties, are more susceptible to panic attacks. For older individuals, acute panic attacks can sometimes feel like a heart attack, making it more challenging to recognize the attack for what it is beyond the age of 40.

Lastly, people who are naturally anxious are more prone to having a panic attack. It is possible that, in their youth, anxious individuals suffered from separation anxiety or early trauma, which created a particularly sensitive alert system and emotional regulation difficulties.

There is no single, universal reason for a panic attack. The factors are varied and multiple. They may be situational, stem from past experiences, arise from current difficulties, or be triggered by the consumption of certain substances.

Origin from a Specific Situation

It is possible to experience a panic attack whenever confronted with the same situation. This is often the case with phobias (heights, social phobia, spiders, etc.). If we find ourselves in an uncomfortable, unpleasant, and anxiety-inducing situation, our alert system triggers and causes an anxiety attack. However, the origin of these anxiety attacks in specific situations can stem from trauma, upbringing, genetics, etc.

Origin from Past Experiences

Our past shapes us and can sometimes be a factor of anxiety, making us more vulnerable to panic attacks. Parents who were themselves anxious might have instilled the value of "alertness," fostering hypersensitivity and a significant alert system. Hence, the living environment, particularly during the early years, can generate vulnerability to panic attacks.

Moreover, childhood stress or trauma might have led our body to develop a defense and vigilance system against similar or different situations. Experiencing a first anxiety attack increases the likelihood of another. The body remembers its sensations during an anxiety attack and anticipates its possible recurrence, generating additional anxiety and a higher risk of panic attacks.

An Anxiety Attack as a Body Alert

Stressful periods, overwork (at work, school, or personal life), financial or relationship difficulties, etc., can trigger anxiety attacks. Our body and mind suffer, mobilizing all our thoughts and energy to manage anxiety and all the associated emotions and sensations. Anxiety attacks are exhausting and, combined with existing pressure, significantly drain our energy.

Certain Substances Trigger Anxiety Attacks

Consumption of substances such as alcohol or drugs (cocaine, cannabis, hallucinogens, ecstasy…) can cause anxiety attacks. The panic attack can occur immediately after consumption or even several days later. Short-term use of certain substances can worsen or trigger panic attacks.

Following one or several panic attacks, numerous consequences can arise.

Initially, a panic attack generally triggers a continual apprehension that another panic attack might occur. In our mind, there is then a constant anticipation of the panic attack. Consequently, a change in behavior towards certain situations that provoke panic becomes evident. Indeed, we may start to act inappropriately, which only reinforces our anxiety about the situation, such as avoiding certain actions or situations.

Subsequently, this anxiety and avoidance tend to lead to other forms of phobias or anxieties such as agoraphobia or claustrophobia. Additionally, if a state of panic persists over time (beyond six months), it may be considered a panic disorder.

It is important to address panic attacks and take the time to manage them in order to learn how to control them and avoid being overwhelmed.

Here are a few small exercises to manage a panic attack:

Evaluate Your Panic Attack

Take the time to assess the intensity of your panic attack. Does it feel unbearable and you would rate this anxiety 10/10? Does it seem more transient and manageable?

Evaluating your panic attack helps you become aware of what your body is experiencing and wants to convey. Trying to diminish it at all costs and worrying about its arrival will only increase its intensity and duration.

Manage Your Breathing

Learning to manage your breathing is one of the first steps when you feel a panic attack coming. You need to learn to breathe slowly and consciously. There are several techniques for this:

Square Breathing

This technique is used in "emergency" situations. You feel the panic attack coming, your breathing and heart rate are accelerating, and you feel like you can no longer manage what is happening inside you. Follow these steps:

Inhale for 4 seconds through your nose. Feel the cool air entering your lungs, let in all the emotions that want to accompany you. Make room in your chest for the air you are taking in.

Hold your breath for 4 seconds. Let all your emotions wander inside you. Visualize the air moving through your body.

Exhale for 4 seconds through your mouth. Take the time to let the air leave your body and let go of all the emotions that want to leave you.

Hold your breath again for 4 seconds. Let your body handle the emotions that come into it.

Repeat this exercise 4 or 5 times. Beyond that, you may feel a bit dizzy. The most important thing in this exercise is to steady your breathing so that your heart rate also calms down.

Cardiac Coherence

This method helps regulate heart rate based on our emotions. It emphasizes controlled breathing that aligns heart rate with the rhythm of breathing. Cardiac coherence aims to quickly soothe anxiety. It can be practiced "in emergencies" as well as regularly to reduce anxiety in the long term. The effects are felt immediately after practice and can last up to six hours.

Simply inhale for 5 seconds through your nose, and exhale for 5 seconds through your mouth, repeating this six times.

Practice Relaxation

When you feel anxious, you can do relaxation or meditation for a while.

You can practice Jacobson's progressive muscle relaxation, which involves becoming truly aware of your body. Alternatively, close your eyes, play a relaxation audio, and imagine yourself in a place that calms and relaxes you. Feel good. Listen carefully to the instructions and let yourself be guided.

Find Inner Resources to Reassure Yourself

When you find yourself in a difficult situation, and a panic attack seems imminent, clench your fists, focus on the present moment, and the environment around you by taking into account all the small details of things you like. Always have reassuring phrases in mind, such as "It's going to be okay," "You can do it," or "I am strong." You can also recall phrases that a loved one has said to you that comfort you.

5-4-3-2-1 Method

The idea of this technique is to divert attention from your panic attack while staying focused on your body and senses. It helps refocus on the present moment despite the difficulties encountered. Here, we will use all our senses.

Start with sight. Identify five visual elements around you. Be fully aware of five things you see in your environment. Note their color, texture, size, etc. Examine all the visual information you have about them.

Then, pay attention to four sounds around you. Listen to the small noises, their nuances, how pleasant or unpleasant they are. If you're in an especially quiet environment where it's hard to distinguish four sounds, recall a familiar and comforting sound (e.g., your cat's purring, a loved one's voice, a favorite melody, the soft sound of a piano).

Next, use your touch. Be conscious of or touch three elements in your environment. Feel the floor under your feet, bring your hands close to an object. Feel the texture, temperature, softness, or hardness, and be fully aware of what your body touches.

Continue with smell: identify two smells around you. Imagine the path of this smell in your nostrils and what it evokes for you, whether the smell is soft or not, if it tickles your nostrils, etc. If you don't smell anything in your current environment, imagine comforting smells you like that you've associated with calmness.

Finally, use taste. Either drink a beverage, eat something, and think about the taste, or, if those aren't available, be conscious of the taste of your saliva.

This technique should stabilize your state and reduce signs of anxiety.

Pay Attention to Your Physical Sensations

Always be aware of the physical sensations you experience. When you're having a panic attack, try to pay attention to all the associated physical sensations, like a faster heartbeat, your breathing, trembling legs, clammy hands, etc.

Remember that a sensation is just physical. What makes it unpleasant is the thought associated with it. Try to think of a pleasant environment and associate these physical sensations with it.

Panic attacks generally occur spontaneously. However, there are some tips to prevent and avoid frequent recurrence, breaking the vicious cycle.

First, try to identify your anxiety. Ask yourself what specifically causes your anxiety. If your panic attack occurred in a specific place, ask yourself what worries you specifically about that place.

Secondly, remember that lifestyle is particularly important to reduce the frequency of panic attacks. Try to follow different hygienic-dietary rules. These include regular physical activity (2-3 times a week for 20-30 minutes), paying attention to your diet while enjoying yourself (eat sweets if they make you happy, but avoid stimulants like drugs and alcohol), exposure to sunlight (vitamin D is essential!), getting enough sleep, maintaining a proper sleep rhythm, and nurturing your relationships.

Additionally, rationalize your anxiety. Create a chart with your anxieties, listing the "pros" (reasons for your anxiety, validating your fears) and "cons" (ideas that counter the reasons for your anxiety). This way, give credit to the counter thoughts. When anxiety arises, recall the elements you highlighted in this exercise. This idea aligns with Beck's cognitive model used in cognitive-behavioral therapy.

Lastly, consider creating a routine of relaxation, meditation, or yoga. Practice it regularly (without it becoming a constraint). Working on letting go, mindfulness, and self-confidence during relaxation sessions can significantly reduce stress in the long term.

Taking action at the first symptoms or after the first panic attack is fundamental. It helps to understand your anxiety, reduce its occurrences, and prevent it from generalizing to new situations.

Beyond the techniques mentioned above, such as cardiac coherence, breathing techniques, and relaxation, cognitive-behavioral therapy (CBT) is appropriate. This therapy helps understand the origin of anxiety while addressing it through exercises and alternative strategies to cope with it. Thus, it is possible to conduct gradual and appropriate exposures to the anxiety-inducing or panic-attack-triggering situations.

Virtual Reality Exposure Therapy (VRET), which falls under cognitive-behavioral therapies, is particularly suitable as exposures are done gradually and appropriately, saving time for both the user and the therapist. Moreover, relaxation in virtual reality allows for a rapid and immersive experience, significantly reducing anxiety quickly.