Do you or a loved one suffer from panic attacks? If so, you are not alone.
In the UK, according to the Adult Psychiatric Morbidity Survey, around 5.9% of the population suffer from Generalised Anxiety Disorder, and 0.6% suffer from panic disorder.  Panic disorder is a an anxiety disorder characterised by the sudden onset of panic attacks, often without any obvious source.
In this article, we give you our five top tips for coping with panic attacks.
There are two different kinds of anxiety. There’s normal anxiety, which involves worrying about bad things that could happen. Then there’s anxiety about anxiety. This is what Sarah Scheinbaum refers to as ‘anxiety overlay’.
‘When you’re anxious about being anxious, maybe you think twice about engaging in an activity or going to a particular place where you previously had a panic attack. I refer to these states as “overlays,” or fear of fear. In other words, panicking about the possibility of having a panic attack.’ 
According to Scheinbaum, when people start panicking about the possibility of panic attacks, it causes avoidance behaviours. In other words, people become so anxious about having a panic attack that they begin to avoid situations and places which have led to panic attacks in the past.
Typical avoidance behaviours include turning down invitations to social events, staying away from restaurants, not travelling by plane, avoiding large crowds, and so on.
Though perfectly natural, these avoidance behaviours are damaging, since they make life harder for the person who suffers from panic attacks.
The solution? Train yourself to ignore the ‘avoidance impulse’. Accept that ‘anxiety about anxiety’ is natural, but don’t modify your behaviour in order to cope with a panic attack that may never arrive.
This is by no means a quick fix. It takes time and effort to overcome the avoidance impulse and learn not to worry about the possibility of having a panic attack.
People who experience panic attacks will often talk about an attack happening without warning. Yet it is often possible – if they stop and think about what was going through their brain before the panic attack occurred – to identify a thought which led to the panic attack.
Panic is not a random, unnatural phenomenon. It happens for a reason, and understanding the biological and evolutionary role of panic can help people to deal with panic attacks more effectively.
So what causes panic? The answer is the ‘fight or flight’ mechanism. This is a biological system that protects us from danger, and has done for thousands of years. If your brain identifies a threat, the adrenal glands begin producing adrenaline, a hormone which causes the cardiovascular system to start pumping blood around the muscles. This is to help you either deal with the threat, or run away – hence, ‘fight or flight’.
Other consequences of the ‘fight or flight’ impulse include: rapid breathing, to help your body get oxygen quickly; sweating, to help you cool down; muscles contracting, to help you run or fight, and so on.
All of these things are symptoms of panic attacks. If you want to look at it positively, they are evidence that the fight or flight response is working effectively.
Knowing that panic comes from the fight or flight response, how can we use this information to deal with panic attacks?
Panic comes on quickly; however, it takes longer to dissipate. This is because panic is a response to danger, and we need our bodies in fight or flight mode for a little while in order to cope with danger.
Understanding this can help to deal with a panic attack. If you are having a panic attack, remember that it takes time to switch out of panic mode. Try to be patient, and allow your body to naturally calm down.
People with anxiety often make mistakes with their breathing. One common mistake is to breathe with the chest, rather than the belly. Indeed, as Sarah Scheinbaum points out, ‘nearly 100% of people who suffer from anxiety breathe with their chest.’
Here’s an exercise you can do to work out whether you breathe from the chest or the belly. Place one hand on your chest, and one on your belly. Take a deep breath. Which hand moves more: the one on your belly or the one on your chest? If it’s the one on your belly, then well done: you breathe with your diaphragm. This is the best way to fill your lungs. If it’s the one on your chest, then you may want to practise breathing with your diaphragm instead. Chest breathing only fills the top part of your lungs.
During a panic attack, the impulse is to try and draw as much oxygen in as quickly as possible, which means breathing quickly. However, in order to stop panicking and calm your body down, you actually need to breathe slowly.
A simple trick for breathing slowly is to count as you breathe. This will help you to slow down your breathing and match your inhalations with your exhalations.
For some, focusing on breathing actually increases stress. For these people, it may be helpful to use breathing imagery instead.
One common trick is to imagine your breaths as waves in a turbulent sea. As you slow your breathing, the waves become smaller, and the sea slowly becomes flatter and calmer.
One of the hallmarks of anxiety disorder is irrational thoughts. These often take the form of worries about hypothetical situations. They may be expressed in the form of a ‘what if’. For example, ‘what if I say something silly’, or ‘what if he/she doesn’t like me.’
‘What if’ thoughts can lead to panic attacks. For instance, if you have a symptom such as tightness in your chest, this may cause you to think a thought such as ‘What if I am having a panic attack?’ Then, even though the chest tightness was caused by something else, you may start having a real panic attack.
Given the link between ‘what if’ thoughts and panic attacks, it is important to learn how to spot these thoughts, and how to deal with them effectively.
Turn ‘what ifs’ into ‘so what ifs’. Another tip from Sandra Scheinbaum is to turn ‘what if’ thoughts into ‘so what if’ thoughts.
For instance, a typical ‘what if’ thought might be: ‘What if I’m late?’
If left unchecked, this thought could cause anxiety. It might even cause a panic attack.
When you are able to identify a thought like this, you can turn it into a ‘so what if’ thought, such as: ‘So what if I’m late? I’ve been late before, and it didn’t really matter.’
This is just one example of a technique which turns irrational thoughts into rational ones. You can find more here.
If you feel yourself getting anxious, a good way to prevent this anxiety from developing into a full panic attack is to distract yourself.
There are infinite ways to distract yourself, and each person has their personal favourite. We go through a few of the many effective distraction techniques below.
First, a note on mindfulness.
What is mindfulness? Mindfulness refers to the practise of being fully aware of the present moment. Unlike traditional meditation, in which you might try to let your mind go blank (something people with anxiety often struggle with), mindfulness teaches people to focus intensely on the evidence of a particular sense, such as sight, hearing or touch. This can help to dispel anxious thoughts.
Mindfulness distraction techniques include:
We hope you’ve found something useful in this set of tips for dealing with panic attacks. We know how difficult it can be to cope when the threat of a panic attack is always just around the corner.
Remember: try not to live in fear of panic attacks. With practice, you will learn to identify the warning signs of a panic attack, and calm yourself down before it strikes.
If you have panic disorder or anxiety disorder, you should read our tips for dealing with anxiety. You should also strongly consider getting treatment (if you haven’t already). There are lots of excellent treatments for anxiety and panic, including talking therapies and medication.
 NHS England. (2016). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England.
 Whiteford, H. A. et al. (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 382 (9904). pp. 1575- 1586.
 Sandra Scheinbaum, Stop Panic Attacks in 10 Easy Steps: Using Functional Medicine to Calm Your Mind and Body with Drug-Free Techniques, (Singing Dragon, 2015).
 Stefan G. Hofmann et al, ‘The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review.’ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848393/