Oh good! You’re having a panic attack!
Panic attacks can happen for a lot of different reasons. You may be in a situation where panic is the appropriate sensation. If you are facing down a grizzly bear, or your plane engine has caught fire, or you’re being mugged, you should be panicking. That’s what panic is for! The problem is for a lot of us, we panic in situations where you don’t really need to panic, or our panic response is not helping us.
These kinds of panic attacks can come from benign but frightening situations, like public speaking, or a regular plane flight, or your boss calling you into her office, or they can seem to come out of nowhere. Intellectually, with our big fancy frontal cortices, we can distinguish between social threats like public speaking, status threats like potential demotions, and just weird sensations like getting into a big flying metal tube. However, our 100 million year old limbic systems only know that shit is going down.
The difference between anxiety and panic is what happens when that fear response gets going. For everyone, some adrenaline gets released into our system, stimulating increased heart rate, rapid breathing, sweat, increased stomach acidity (AKA butterflies!) and tense, twitchy muscles. Now, your brain is helpfully always running some background checks on your body status, just processing signals from your nerve endings. What can happen is that this part of your brain can start noticing that, oh shit, my heart’s racing, my muscles are twitchy, something must be going down, better release some more adrenaline. In Psychology we call this a vicious cycle but engineers might recognize this as a feedback loop.
So What Now?
Anyone who’s had a panic attack can tell you that the brain isn’t too helpful in these situations. You can sit there and tell yourself that everything’s fine all day long, but it doesn’t do one bit of good. That’s partially because all of these processes are meant to bypass your thinking brain entirely. The fight-or-flight (or freeze) response is designed for physical confrontations, so part of what it does is redirect resources, like glucose or oxygen, away from those thinking parts of you and towards those acting parts of you. So if we’re going to send that “all clear” signal, we have to send it through your body.
There are plenty of ways to do this, and they all basically work by acting opposite to some of those general fear responses. The goal is to stop your insular cortex from getting that “shit’s about to go down” signal. Someone much smarter than me came up with the TIPP skills which do exactly this. I added one skill and did some re-branding to come up with MEDIC skills, which sound a lot cooler which is important to me, damn it.
I should note that this works equally as well for rage attacks, but those are generally rarer and less problematic.
I absolutely love this skill, so I might write a whole blog post just for this, but for right now I’ll give the quick-and-dirty. For some of these responses, instead of actively working against them, we first have to retake conscious control of the process. If I told you to relax a muscle, how would you go about that? Relaxation isn’t really a conscious process. But if I tell you to tense that muscle, you can probably figure it out pretty easily. Then once you release that tension, you have relaxation.
So go muscle group by muscle group, and then just tense that muscle up for 2-3 breaths, and then release the tension. Really focus your attention on the physical sensations – remember that you’re trying to convince your brain that your muscles are relaxed, so dive into the physical sensations of both the tension state and the relaxation state. It’s helpful to think about it part-by-part, so go:
- Feet (fists with your feet)
- Core (stomach and lower back)
- Chest and back
- Upper arms (biceps and triceps)
- Lower arms/hands
Once again, we’re starting off by taking conscious control of an unconscious process. In this case, it’s your heart rate. If I told you to just slow down your heart, would you have any idea how to do it? You might say meditation, deep breathing, lying down, etc., but none of those are really certain. On the other hand, if you were to jump up right now and flat out sprint to the point of exhaustion, I can goddamn well guarantee that your heart rate is going to go up.
So how does this actually help? Two ways:
- After the exercise, your heart rate (and breathing, etc.) will naturally go down, and this will stimulate that “all clear” signal that we’re looking for.
- This gives a reasonable explanation that your brain will accept for the original anxiety response, and it won’t keep sending out the panic alarm until the threat is found.
So wind sprints, jumping jacks, squats, push-ups, whatever you have at hand just get that heart rate UP!
Breathing is really one of the processes that connects the conscious with the automatic. You can take a breath any time you want it, but 99% of the time it’s totally automatic. Almost every mindfulness exercise will start with a few deep breaths.
The trick is that a time dilation thing happens when you’re panicking, so just counting them out for yourself can be hard. Also, and this is a weird thing about humans, we’re not all that great at breathing. So:
- Put your hand onto your belly.
- Inhale through your nose for 5 seconds.
- You should be breathing into your abdomen, so you should feel your hand rise.
- Hold for 5 seconds.
- Exhale through your mouth for 5 seconds.
- Repeat for at least 1 minute.
The fight-or-flight response is partially an inflammatory response, which is why our faces get flushed and partially why we sweat. I love watching this happen in public speaking situations, as the blush starts travelling up from the neck. I had a teacher call it the red creep.
So it’s simple enough – to make something less hot, add some cold. Fill up a basin with some cold water – almost ice cold – and just dunk (or immerse) your face into it. Or run a cold tap until it’s as cold as you can get, and splash some onto your face. Take an ice pack and rub it on your face. Focus on your nose.
In addition to acting against the panic sensations, this activates the Mammalian Dive Reflex – a particular evolutionary adaptation that allows us to stay alive underwater longer by making sure our heart and brain are the primary receivers of oxygen.
Generally when you’re in an actual fight for your life, you’re going to spit out the bubble gum. The reason that we get the butterfly sensation or some nausea when we’re anxious is because our body is shutting down the resource-intensive process of digestion until the threat has passed. However, if you can keep your jaw muscles going and some flavor coming in, you can convince your limbic system that hey, how bad can things be if you’re still eating?
In a series of studies that I’m convinced must be financed by Bazooka Joe, chewing gum has been shown to improve mood, reduce anxiety, and decrease the amount of the stress hormone cortisol in your system. Water is also good, maybe some chocolate for the dopamine boost, chamomile tea, you pick your poison. Just don’t get trapped into the cycle of emotional eating.
- An ounce of prevention is worth a pound of cure. If you’re in a full out panic attack there was probably a point about a half hour ago that these would have been a lot more helpful.
- Panic is temporary. Your body can only physically sustain a full fight-or-flight response for a short time (I have this number of 23 minutes in my head, but I can track down where I saw it. So internet detectives, help me out here.) Even if nothing seems to help, the panic will naturally end.
- Practice makes perfect. These are skills, and like any skill you get better at them the more you do them. To use a sports metaphor here in my blog for nerds: you don’t try out a new formation on game day. You want to be really good at this before you have a panic attack. For a more pandering nerd reference: don’t be a coping noob, be a coping pro!