Here are some suggestions on how to cope with Anxiety and Panic and how you can help prevent and alleviate the symptoms. 

The Power of Positive Thinking

One way of tackling panic attacks is to look at the way you talk to yourself, especially during times of stress and pressure. Panic attacks often begin or escalate when you tell yourself scary things, like "I feel light-headed . . . I'm about to faint!" or "I'm trapped in this traffic jam and something terrible is gonna happen!" or "If I go outside, I'll freak out." These are called "negative predictions" and they have a strong influence on the way your body feels. If you're mentally predicting a disaster, your body's alarm response goes off and the "fight-flight response" kicks in.

To combat this, try to focus on calming, positive thoughts, like "I'm learning to deal with panicky feelings and I know that people overcome panic all the time" or "This will pass quickly, and I can help myself by concentrating on my breathing and imagining a relaxing place" or "These feelings are uncomfortable, but they won't last forever."

Sometimes it's helpful to remind yourself of these FACTS about panic attacks:

• A panic attack cannot cause heart failure or a heart attack.
• A panic attack cannot cause you to stop breathing.
• A panic attack cannot cause you to faint.
• A panic attack cannot cause you to "go crazy."
• A panic attack cannot cause you to lose control of yourself.
  

If it's too hard for you to think calming thoughts or to concentrate on relaxation strategies when you're having a panic attack, find ways to distract yourself from the negative thoughts and feelings. Some people do this by talking to other people when they feel the panic coming on. Others prefer to exercise or work on a detailed project or hobby.  Changing scenery can sometimes be helpful, too, but it's important not to get into a pattern of avoiding necessary daily tasks. If you notice that you're regularly avoiding things like driving, going shopping, going to work, or taking public transport, it's probably time to get some professional help.

Put a stop to the thoughts that lead to anxiety, and to replace those thoughts with realistic, rational thoughts. Then, when these self-statements are practiced and learned, your brain takes over automatically. This is a form of conditioning, meaning that your brain chemistry (neurotransmission) actually changes as a result of your new thinking habits.

First, use thought stoppage. Be gentle but firm about it.

"STOP! These thoughts are not good for me. They are not healthy or helpful thoughts, and I have decided to move in a better direction and learn to think differently." (You are reminding and reinforcing your brain each and every time you make this rational and realistic statement.)

Then, pick two or three statements from the list below that seem to help you, and repeat them to yourself OUT LOUD each day. (You don’t have to believe them fully yet – that will happen later).

When Anxiety is Near:
General Statements

1. I’m going to be all right. My feelings are not always rational. I’m just going to relax, calm down, and everything will be all right.

2. Anxiety is not dangerous -- it’s just uncomfortable. I am fine; I’ll just continue with what I’m doing or find something more active to do.

3. Right now I have some feelings I don’t like. They are really just phantoms, however, because they are disappearing. I will be fine.

4. Right now I have feelings I don’t like. They will be over with soon and I’ll be fine. For now, I am going to focus on doing something else around me.

5. That picture (image) in my head is not a healthy or rational picture. Instead, I’m going to focus on something healthy like _________________________.

6. I’ve stopped my negative thoughts before and I’m going to do it again now. I am becoming better and better at deflecting these automatic negative thoughts (ANTs) and that makes me happy.

7. So I feel a little anxiety now, SO WHAT? It’s not like it’s the first time. I am going to take some nice deep breaths and keep on going. This will help me continue to get better."

Statements to use when
Preparing for a Stressful Situation

1. I’ve done this before so I know I can do it again.

2. When this is over, I’ll be glad that I did it.

3. The feeling I have about this trip doesn’t make much sense. This anxiety is like a mirage in the desert. I’ll just continue to "walk" forward until I pass right through it.

4. This may seem hard now, but it will become easier and easier over time.

5. I think I have more control over these thoughts and feelings than I once imagined. I am very gently going to turn away from my old feelings and move in a new, better direction.

Statements to use when
I feel overwhelmed

1. I can be anxious and still focus on the task at hand. As I focus on the task, my anxiety will go down.

2. Anxiety is a old habit pattern that my body responds to. I am going to calmly and nicely change this old habit. I feel a little bit of peace, despite my anxiety, and this peace is going to grow and grow. As my peace and security grow, then anxiety and panic will have to shrink.

3. At first, my anxiety was powerful and scary, but as time goes by it doesn’t have the hold on me that I once thought it had. I am moving forward gently and nicely all the time.

4. I don’t need to fight my feelings. I realize that these feelings won’t be allowed to stay around very much longer. I just accept my new feelings of peace, contentment, security, and confidence.

5. All these things that are happening to me seem overwhelming. But I’ve caught myself this time and I refuse to focus on these things. Instead, I’m going to talk slowly to myself, focus away from my problem, and continue with what I have to do. In this way, my anxiety will have to shrink away and disappear.

Abdominal Breathing

One of the most important things that will help you during a Panic Attack is to control your breathing. Although it is the last thing on your mind, and very hard to control, it is very important as it will calm you down. Panic Attack sufferers will almost inevitably suffer from hyperventilation and must learn abdominal breathing.

Slow, abdominal breathing alone has been shown to abort panic attacks and prevent them. But for a person with panic disorder, learning slow abdominal breathing can be quite difficult. People with panic disorder are almost always chest breathers. The worst thing you can tell a person during a panic attack is to breathe deeply. It takes a lot of practice to breathe with the diaphragm without a great deal of training, but if you can learn to breathe slowly with your diaphragm, you will not panic!

You must practice abdominal breathing so that when you have a Panic Attack you can put it into action.

Here are some tips on learning diaphragmatic breathing. Start while lying on your back. Place one hand on your chest and one hand on your belly (between navel and ribs). Focus on allowing the belly to rise easily when inhaling and fall when exhaling. HOLD THE CHEST STILL with your hand on your chest. The objective is to breathe all the time with the belly (diaphragm) and not the chest. You are aiming at about 6 breaths per minute. This is a slow relaxed process. There should be no sense of effort. 

If the belly won't move and the chest continues to move, put a weight on the belly between the navel and ribs (where the hand was). A heavy book will do, but something that is not painful and weighs 3 - 5 pounds is best. Focus on allowing the  weight to rise on inhale and sink on exhale. Again - no effort! 

If still no success, kneel on all fours, i.e., assume a position of a four-legged animal. In this position, the chest tends to be locked in place,  forcing the diaphragm to take over the breathing task. Slow and easy, no effort.  Once you learn to breathe with your belly, you must practice, practice, practice. 

The first week, you should practice for only a few breaths at a time while lying on your back. Then gradually extend the practice time to 15 minutes. When this can be done comfortably, you should start to practice while sitting. Then standing. Then walking.

After you can breathe with the belly in all positions, you should practice in different situations. Start with easy situations like sitting in a car. Then sitting in a restaurant. Progress until you can breathe with the belly in situations that previously felt un-natural and uncomfortable.

IMPORTANT: If at any time during the breathing training, you feel dizzy or light-headed, then stop the exercise, rest, and try again in a few minutes. The breathing training is not about being tough or facing your fear. It is about learning to breathe to normalize the bodily functions.

You may find it helpful to have someone doing this breathing exercise with you as they 'take control' and get you to breathe on their command.

Ok, so these techniques may not be very sophisticated but they work and may help you:

Distraction

If you think about what is happening to you in a Panic Attack, you actually get worse, so you need something to distract you from the feelings and make you concentrate on something else.

Talk! talk! talk!

One of the best coping techniques is to keep talking. Whilst you are talking, about anything and everything, you will be distracted from the feelings of panic. Do not talk about how ill you feel but get someone just to chat generally with you about a subject you are interested in so you need to concentrate on the conversation. It will help if you can smile, laugh or run around! Do anything but sit down and wallow in the feelings - tell yourself that they will soon pass and just for the time being you need to 'waffle' to someone about anything at all. 

I have actually done this in a supermarket when I was feeling panicky and I have started chatting to the person in the queue behind me just to take my mind off things. Try it - it may work! If it doesn't then say "ok" and try another coping technique.

Whilst Driving:

You must distract your mind from feeling Panicky and frightened whilst driving as you may feel even more frightened as you're in control of a potentially dangerous piece of machinery. Here are a few coping techniques (believe me they work, no matter how mad they sound):

1)    Add up number plates - look at the car in front and add up any numbers on the number plate, try to see what car number plate gives the highest score.

2)    Select a colour and start counting the number of cars you can see in that colour.

3)    Select a make of care and start counting how many cars of that make pass you.

4)    Take the letters in a car number plate and work out an amusing phrase for it.

5)    Sing! - put some music on and sing along. If you start singing you will automatically start to breathe correctly and it will also take your mind off the problem.

Cut down on Stimulants

The last thing a panic attack needs is more fuel to 'feed' it. Certain stimulants are known to aggravate and even bring on Panic and Anxiety: 

   Alcohol

Some people see Alcohol as a relaxant and start drinking to try and deal with the devastating effects of an anxiety disorder. This of course is no solution. How do you know the difference between a hang-over and anxiety symptoms? The alcohol withdrawal or hangover tends to reinforce the physical symptoms which people interpret as increasing anxiety levels. This only keeps the cycle of anxiety and panic going. Alcohol will also not help you sleep - yes it may make you fall asleep but the sleep will be disturbed, intermittent and you still wake up feeling even worse! 

The process of metabolizing alcohol can use up all the body's B vitamins.

If you are using alcohol on a daily basis as a way to 'relax', you should contact either your doctor or your drug/alcohol unit or Alcohol Anonymous (AA) in your city/town.

       Caffeine

Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic (it increases urine production). Recreationally, it is used to provide a "boost of energy" or a feeling of heightened alertness. It's often used to stay awake longer - college students and drivers use it to stay awake late into the night. Many people feel as though they "cannot function" in the morning without a cup of coffee to provide caffeine and the boost it gives them.

Caffeine is an addictive drug. Among its many actions, it operates using the same mechanisms that amphetamines, cocaine and heroin use to stimulate the brain. On a spectrum, caffeine's effects are more mild than amphetamines, cocaine and heroin, but it is manipulating the same channels and that is one of the things that gives caffeine its addictive qualities. If you feel like you cannot function without it and must consume it every day, then you are addicted to caffeine.

Panic sufferers are usually advised to cut out caffeine because of the stimulant effects it has on the brain and body.

Caffeine is commonly found in coffee, tea, chocolate, cocoa and don't forget that some soft drinks contain caffeine as well : Coca-Cola, Pepsi-Cola and Dr Pepper to name just 3!

I stopped drinking tea, coffee and any soft drinks containing caffeine in September 2000 and it has had a dramatic effects on my Panic attacks. If I now drink a soft drink containing caffeine then I end up shaking and feeling quite ill! For the first few months I really missed a cup of tea in the morning but it was worth the sacrifice for my health. I now drink water instead so I get more than my recommended 8 glasses a day. If you really can't face a day with tea or coffee then use the decaffeinated varieties - they aren't that bad!

             Smoking

Daily smoking is associated with an elevated risk of new onset of panic attack, according to study results published in the December issue of Archives of General Psychiatry.

Although there is no real evidence to suggest that smoking can cause panic and Anxiety, it's use does aggravate the condition. 

Try cutting down or giving up and see for yourself what difference it makes.

                              Exercise

A minimum of three to five times a week of some form of exercise is recommended. This should include a cardiovascular workout as well.

Although you may not feel like exercising, you can make significant progress with Panic and Anxiety once you start a regular exercise program.

I was not a believer in this until recently (Feb 2002) when I decided to go on a diet and thought that exercise was probably going to help as well. So, I embarked on a daily exercise program. I do either an hour's aerobic workout video or go swimming for 30 - 40 minutes every day. 

Wow - the difference this had made to my Anxiety and Panic. I had no episodes of Panic again until July 2002 (when a death in the family brought them back to a small extent) but I generally feel so much better for it. I never believed that it would ever help but the results are amazing and I now wish I had done at least some exercise years ago. 

Please give it a go and see how you get on - I wish I had taken my own advice years ago !

           Mind-body workout

Explore the possibilities of meditation, hypnotherapy and other forms of healing such as Reiki (laying-of-hands) and yoga.  I have tried both of these so click on the links to read about my experiences.

          Nutrition

This is the cornerstone of good health. Cut out fats and processed foods and eat fresh greens and white meats instead. It's easier than you think - two weeks is all it takes to recondition your taste buds for a lifetime of benefits and well being.

Take your vitamins

The B vitamins are stress relievers, so start on a course. Other vitamin supplements you should incorporate in your diet are calcium, magnesium, selenium, and omega-3 fatty acids. Potassium in its natural form in fresh orange juice and bananas is good for regulating the heart - get some every day. Potassium supplements in the form of tablets, however, should be discussed with your doctor. The health stores have tons of natural stress cures but be very wary of side effects.

C.B.T.

C.B.T. is an acronym for Cognitive Behavioral Therapy. This is therapy that can modify or eliminate thought patterns contributing to the patient's symptoms, and aims to help the patient to change his or her behavior.

In simple terms it is used to change a person's thoughts and feelings from negative ones to positive ones.

Patients are taught that typical thoughts such as "I'm going to have a panic attack" or "I'm going to have a heart attack" can be replaced with substitutes such as "It's only uneasiness—it will pass", "I am not going to die" and "I can overcome this".

You are taught to replace phrases such as "I suffer from Panic Attacks" with "I used to suffer from Panic Attacks but I am ok now". In cognitive therapy, discussions between the patient and the therapist are not usually focused on the patient's past, as is the case with some forms of psychotherapy. Instead, conversations focus on the difficulties and successes the patient is having at the present time, and on skills the patient needs to learn.

The behavioral portion of cognitive-behavioral therapy may involve systematic training in relaxation techniques. By learning to relax, the patient may acquire the ability to reduce generalized anxiety and stress that often sets the stage for panic attacks.

Breathing exercises are often included in the behavioral therapy. The patient learns to control his or her breathing and avoid hyperventilation—a pattern of rapid, shallow breathing that can trigger or exacerbate some people's panic attacks.

Another important aspect of behavioral therapy is exposure to internal sensations called interoceptive exposure. During interoceptive exposure the therapist will do an individual assessment of internal sensations associated with panic. Depending on the assessment, the therapist may then encourage the patient to bring on some of the sensations of a panic attack by, for example, exercising to increase heart rate, breathing rapidly to trigger lightheadedness and respiratory symptoms, or spinning around to trigger dizziness. Exercises to produce feelings of unreality may also be used. Then the therapist teaches the patient to cope effectively with these sensations and to replace alarmist thoughts such as "I am going to die," with more appropriate ones, such as "It's just a little dizziness—I can handle it."

Another important aspect of behavioral therapy is "in vivo" or real-life exposure. The therapist and the patient determine whether the patient has been avoiding particular places and situations, and which patterns of avoidance are causing the patient problems. They agree to work on the avoidance behaviors that are most seriously interfering with the patient's life. For example, fear of driving may be of paramount importance for one patient, while inability to go to the supermarket may be most handicapping for another.

Some therapists will go to an agoraphobic patient's home to conduct the initial sessions. Often therapists take their patients on excursions to shopping malls and other places the patients have been avoiding. Or they may accompany their patients who are trying to overcome fear of driving a car.

The patient approaches a feared situation gradually, attempting to stay in spite of rising levels of anxiety. In this way the patient sees that as frightening as the feelings are, they are not dangerous, and they do pass. On each attempt, the patient faces as much fear as he or she can stand. Patients find that with this step-by-step approach, aided by encouragement and skilled advice from the therapist, they can gradually master their fears and enter situations that had seemed unapproachable.

Many therapists assign the patient "homework" to do between sessions. Sometimes patients spend only a few sessions in one-on-one contact with a therapist and continue to work on their own with the aid of a printed manual.

Often the patient will join a therapy group with others striving to overcome panic disorder or phobias, meeting with them weekly to discuss progress, exchange encouragement, and receive guidance from the therapist.

Cognitive-behavioral therapy generally requires at least 8 to 12 weeks. Some people may need a longer time in treatment to learn and implement the skills. This kind of therapy, which is reported to have a low relapse rate, is effective in eliminating panic attacks or reducing their frequency. It also reduces anticipatory anxiety and the avoidance of feared situations.

Here is another description of CBT that I found:

If we are serious about overcoming an anxiety disorder, we need to approach anxiety from every positive angle and perspective that we have available to us. Therefore, we focus on three main areas, all three of which must be addressed in therapy:

1. COGNITIVE

(thinking processes)

Here we learn new methods and ways to change our old thinking patterns and habits. If we’re always thinking and expecting the worst, then we will continue to suffer. We train or condition our minds to think and respond differently than we have in the past. Or think of it this way – if we can be conditioned to think and feel negatively, then we can be reconditioned to think healthfully.

We have dozens of specific methods and techniques that we use -- and you only need to find several methods that work well for you. We usually start CBT (cognitive-behavioral therapy) at this stage.

Some effective techniques are:

Slow-talk/slow walk/slowing down

Stopping automatic negative thinking (ANTs)

The acceptance paradox: how we keep the fires burning and how to put them out

Rational and helpful self-statements that can become permanent and "automatic"

Continuing  to move our self-statements up

Whose voice are you listening to, anyhow? Do we have to listen and believe all those old lies?

The determination factor

Focusing: What are you paying attention to?

Later, it’s important we address:

perfectionism, anger, frustration, setbacks, and our view of the world

2. BEHAVIORAL

(what we do)

The behavioral aspect of therapy is the part where we actually put everything into place in everyday, real-life situations where we are bothered by anxiety and depression.

This area is always handled LAST, because we need a strong foundation of cognitive and emotional skills/strategies so that we can begin living and acting differently before we confront real-life challenges.

This stage is essential for people with some of the anxiety problems (such as social anxiety disorder) and serves as a powerful adjunct to individual treatment for others.

3. EMOTIONAL

(relaxation/peaceful/strength and power strategies)

It is important to have some type of relaxation or "de-stress" strategy that is accessible. In this area, calmness and peace are the goals.

The more your brain is quiet and relaxed, the easier therapeutic information can get into it and be processed. This is simply another way to let the therapy reach your brain and gently sink in.

Our focus is on peace and calmness here. We do not focus on decreasing anxiety by using these methods. Why? As peace and calmness become a little stronger, they tend to "crowd" out the anxieties and fears we have. Therefore, we never need to focus on the anxiety, the nervousness, or the fear. Our focus is on healing, healthiness, and inner peace.