Imagine entering the gallery of a crowded museum, a busy department store during the holidays, a bustling train station at rush-hour, or the packed lobby of a concert hall. Suddenly, you have trouble breathing, and your breaths become short and rapid. You are hyperventilating. Meanwhile, you are shaking. Your heart races and palpitates. You can feel your heart thumping wildly in your chest and pounding in your ears. You grow dizzy and faint. Your knees become weak and almost buckle. You are hit with hot flashes, muscle aches, and a feeling of chemical imbalance, as if poisoned. You become emotionally disturbed--thinking desperate, dreadful thoughts about dying, all the while wanting to scream and collapse on the floor.
You have just experienced a "panic attack." So, do you pop an anti-anxiety med such as Xanax? Maybe, but perhaps you can actually avoid having to rely on that highly addictive, short-term remedy.
However, can anything short of psychiatric medication help with anything as severe as a panic attack? There are anxiety and stress management techniques, which are easy to learn and to apply to relieve moderate anxiety, or before a panic attack gets out of control. Many of these techniques are detailed in The Anxiety and Phobia Workbook by Edmund Bourne. As a manic depressive and schizoaffective patient with panic, I have been learning Bourne's methods and others in an anxiety and stress workshop at my clinic in New York City.
You are able to maintain slight control of your severe panic attacks by practicing these methods. It works surprisingly well for mild anxiety. Ultimately, these stress management methods help one relax enough to enable one's medications to work more effectively.
The best way to begin is with the "breathing technique." It involves breathing deeply and slowly from the diaphragm near the lower lungs at the upper abdomen. The upper abdomen should be inflated with air as the lower lungs are filled with each deep breath (not the upper chest and shoulder region). Slowing the inhaling/exhaling process makes sure that enough, not too much, oxygen gets to the brain. Hyperventilation occurs with rapid, short breaths. The slower, deeper breaths relax the body and mind, and can actually help prevent panic. One can whisper the word "calm" while exhaling. You should begin the deep breathing before you enter a crowded room to prepare yourself for the stress ahead.
The "self-talk technique" involves positive verbal reinforcement. For example, if one says to oneself, "I will take a short walk," or "I will cook a small meal," one begins to feel better physically, and mentally. Negative language defeats us, but saying, "I am a good person," or "Everything will be all right," somehow truly makes us feel better. Saying to oneself, "calm, calm, calm" with each breath and with each step in a crowded room really makes a difference in controlling panic.
The "bubble technique" requires imagining a large, clear bubble around you which is filled with comforting, soothing air. No one outside can come too close to you. You are "safe" in your bubble. This method helps in crowded public spaces. You feel special, because only you can see your bubble, and no one else has one.
"Grounding" involves focusing on something in the environment and studying it intensely. This can safely pull one out of panic. Focus, for instance, on an oriental carpet. Observe all of the detail in the patterns, its colors, and the carefully tied knots on its fringe. Thinking exhaustively about something mundane can be relaxing, and distracts one from getting overly emotional and panicking. Grounding can also be as simple as splashing cold water on the face and hands, or holding firmly onto a railing, or bench. Finally, "visualization" is imagining a scene such as a walk on the beach, or a hike in the woods. At the beach, you imagine feeling the soft sand under your bare feet. You hear the churning waves. You feel the sea breeze. You collect shells along the way, and let the bright sun warm your head and shoulders. This image can be very relaxing. It can help you drift off to sleep, especially when combined with the other techniques, such as deep breathing.
Now, here are some of my own ideas to calm down: hot showers with a fragrant soap, letting very warm water massage your head and neck is very soothing to the nerves and helps to relax you when you are emotionally upset, anxious, depressed, or manic; a cup of hot tea with honey is calming; and listening to soft classical music is very soothing. I have my Xanax handy in case the above methods fail, but so far I rarely use it.