Panic is no picnic.  It is not pleasant nor is it pretty.  It is paralyzing and painstaking.  COVID-19 has impacted more than respiratory systems across the globe. It has and spiked panic and resulted in widespread contagion of infectious anxiety.  Since the onset of the pandemic, many individuals have reportedly experienced a panic attack for the first time in their lives. They hit CEOs, coffee baristas, news correspondents, and civil engineers. Having a panic attack does not mean that there is something broken, wrong with you, or that you are on the brink of losing your mind.

When patients come into my office and tell me they have had a panic attack I ask them to describe with specificity exactly what happened. The term “panic attack” is frequently tossed around in conversation but is a phenomenon that is not well understood by many.  Some people describe a constellation of physiological anxiety symptoms contributing to an “on edge” experience marking a change from a previous baseline that they now carry around for a significant portion of their day. Others misattribute symptoms of panic to medical causes and proceed straight to the ER or to their physician because they believe they are possibly having a heart attack or may be dying. 

“Am I having a panic attack?” 

During a panic attack, there is a sudden spike of fear followed by a fast, sharp crescendo of multiple symptoms (at least four) that peak and subside within a relatively short frame of time (think 15 minutes). 

Signs of a panic attack include:

• racing heart beat
• sweating
• shaking
• a sense that they are being smothered or can’t fully catch their breath
• choking sensations
• tightness in the chest
• nausea
• chills or hot flashes
• dizziness
• lightheadedness
• numbness or tingling in hands or feet
• fear that you may be losing your mind or “going crazy”
• a sense that you don’t fully know what is going on around you or who you are
• fear of dying

Some people cry (or sob).  In the midst of a panic attack, it can be very difficult for someone to speak or be spoken to. Experiencing and witnessing a panic attack can be an incredibly frightening experience.  Some people actually go on to develop marked fear that they will have a panic attack in the future.

“What should I do if I have a panic attack?“

If you find yourself experiencing this kind of plight, keep the following pieces of panic education tucked away in your mind. When your anxiety thermometer is giving you an emotional fever read, administer this five step panic response like a psychological epipen:

1. Repeat to yourself: This is uncomfortable, but I won’t feel like I do right now forever.    When I previously said that symptoms crescendo, I meant that sometimes the volume is so loud you feel as though you are about to lose your hearing and go deaf.  A panic attack is an intense experience that can be quite frightening.  It is important to zoom out trust that the discomfort will peak and the eventually subside like a wave.  When you feel as though you are in the middle of a tsunami about to be swallowed by the tide, this is an important picture to hold on to.
2. Reassure yourself:  This is uncomfortable but it will not kill me.  This is uncomfortable, but I won’t feel like I do right now forever.    It may sound extreme, but if you have experienced a panic attack you know it is right on target.  A reminder that the intense, overwhelming discomfort you are experiencing in the moment will not last forever can be a small comfort.  It can help curb a catastrophizing train of thought with a reality check that this is not the beginning of the end.  It is more akin to a horrible part of a terrifying rollercoaster ride.
3. Reanchor with your senses.  Identify seven things you can see, hear, touch, smell, and taste in the present moment, in your current environment.  List six more from each sense, then five, four, three, two, and finally one.  This will help ground you to your present physical and psychological reality.
4. Make contact with something cold. Squeeze some ice or a piece of frozen fruit (oranges work great). Splash freezing cold water on your face or wipe your skin with a cool washcloth.  Strong temperature can help give your system a startle and small jolt. These strategies can break and shake loose the tight grip of panic symptoms.
5. Breathe deep and count.  During a panic attack your body is revved up and has you prepared to punch (fight) or sprint (flight).   You can’t use your thoughts to tell your heart to stop racing, but you can enlist the help of your parasympathetic nervous system by using something you can consciously control:  your breath.  Sit down and begin to breathe in through your nose to the count of four, hold your breath for four beats, breathe out through your mouth for four moments, hold your breath as you count to four once more, repeat.  Your belly should be moving in and out (picture a balloon in your stomach).  Your shoulders shouldn’t be bouncing up and down (this is a sign your breath is still really shallow). 

If you have a panic attack, you may feel physically fatigued and/or emotionally drained in the hours that follow.  It can be an intense physical and psychological experience.  Rest.  When you have the bandwidth, reach out for emotional support.  If your experience of panic has become part of a problematic pattern, you may benefit from connecting with a professional  who can help you develop skills to manage the symptoms and support you in understanding what is underneath them.