Coping with panic attacks

As society has opened up to mental health issues in general, people are more forthcoming about anxiety, including many well-known and accomplished people, who have beaten anxiety to have very successful careers. Panic attacks can happen to anyone and they’re nothing to be ashamed of.

What are panic attacks?

‘Panic attacks happen when we, either seemingly randomly or due to an excess of anxious thoughts, are triggered into “fight, flight or freeze” mode, a rather outdated and strong response from the older part of the brain originally designed to prepare the body to fight off attacks from things like wild animals,’ says Dr Sheri Jacobson, founder and CEO of Harley Therapy.

A panic attack is the result of a build-up of stress hormones that eventually spill over and flood your system with adrenaline, says Christine Ingham, author of the book Panic Attacks: ‘That’s the same hormone that gives you the scary/exciting “whoosh” feeling when you’re on a rollercoaster. But because it seems to come out of nowhere, it can be truly terrifying. In fact, it’s so frightening that you genuinely think you’re about to die or mentally lose your grip on reality forever. There are distressing physical effects too like shaking, sweating, difficulty breathing, needing the toilet and chest pains. Many people think they’re having a heart attack.’

Unfortunately, this adrenaline ‘spill’ can happen at anytime – even at what might seem like inappropriate moments, such as when you’re relaxing, says Ingham: ‘This is because the hormones have been slowly building up in the background while you juggle yet another deadline along with finishing that report, plus handling more than a few very difficult clients. Plus, all this can then be layered on top of things like commuting difficulties, a stormy patch on the home front, personal money problems, drinking a bit too much or having a poor diet.’

Panic attacks are not like lightening – they don’t strike randomly, explains Jacobson: ‘When a traumatic experience hits we can go into emotional shock, but it’s different, it’s more a numb, dissociated experience. A panic attack is a very visceral experience. They are the result of untreated anxiety or other mental health issues. Usually the person has had anxiety for weeks, months, or even years before the attacks begin. Or perhaps they have a past trauma that has recently begun to surface, or even a brain injury.’

Ingham says one of the characteristics of people who have panic attacks is that they’re good ‘copers’. ‘They handle whatever gets thrown their way, managing one stressful thing after another. Eventually all that adrenaline that has been slowly drip-fed into your system day-in and day-out reaches the limit of your body’s capacity to manage it. And, bang! There goes a panic attack.’

‘Anxiety is not rational and is fear-based, and can be triggered by any environment. If we don’t feel safe at work, if we don’t get along with colleagues, if we feel the boss hates us, or we feel we aren’t up to the job, then any anxiety we have could be made worse and an attack can be triggered’

What can cause panic attacks?

‘Some panic attacks seem completely random and triggered by tiny things – a smell we don't like, a flickering light; some are triggered by something that pushes us into anxious thinking,’ says Jacobson. ‘Anxiety is not rational and is fear-based, and can be triggered by any environment. If we don’t feel safe at work, if we don’t get along with colleagues, if we feel the boss hates us, or we feel we aren’t up to the job, then any anxiety we have could be made worse and an attack can be triggered.

But the anxiety does not need to stem from the workplace to happen at work. ‘We could be anxious about all manner of things. Indeed, the exact root cause of how we end up severely anxious is actually rarely certain (if it is, it’s possibly stress over anxiety),’ says Jacobson.

How do you manage a panic attack at work?

‘To be honest,’ says Ingham, who has not suffered an attack for many years, ’once one is upon you, there’s nothing you can do to stop it. Remember, you’ve suddenly got a load of adrenaline whizzing around your body. You can’t suddenly stop it. However, knowing that it is just adrenaline that is short-acting, you can reassure yourself that it will soon pass and that, in the meantime, you’re safe. Trying to resist it only makes it worse.’

Therefore, managing a panic attack at work is the same as anywhere else, says Jacobson. ‘The idea is to separate yourself from the anxiety and panicked thoughts, relax into – instead of resist – the experience (resisting tends to escalate the panic), and then engage tactics to trigger the parasympathetic nervous system and slow down the very physical response that panic brings.’

The flight aspect of an attack can lead to a need for privacy, a challenge in many workplaces, with their open plan offices. If you’re on good terms with colleagues and superiors, and feel comfortable with them knowing you’re suffering panic attacks, this can help manage and to even relieve them. If comfortable, make HR aware and ask them to put aside a quiet private space, like an empty boardroom.

But there are many other more imperceptible ways to manage panic attacks, which may be your first line of defence at work, an environment in which you may not want to be seen to be ‘not coping’ or ‘stressing out’; as much as panic attacks are becoming more widely acknowledged, unfortunately some people will still be inconsiderate or ignorant to their existence, severity and ability to affect anyone.

Jacobson recommends mindfulness, or being in the present moment: ‘This is the best tool to separate yourself from any panicked thoughts, which are always about a past that is behind you or a future that is not proven. Mindfulness pulls you into what is around you here and now, and into your body.

‘Focus on your feet and the feeling of the ground beneath them. Take deep breaths and scan your body, relaxing tense muscles – shoulders, hands. Notice five things around you to represent the five senses – a sound, a visual, a smell, etc. If you use earphones at work, you could also switch on a mindfulness track or anti anxiety app and let a recording relax you. Nobody needs to know you aren’t listening to a call playback or to music as you work.’

Always remind yourself that you are not the panic, says Jacobson. ‘When we identify with panic we can become so caught up in fear we lose the logic to use any anti-anxiety or anti-panic tool. Many people think it helps to see the panic just as waves washing by. There is the panic, and here you are, and it’s an experience that is passing through you but will not last.’

Finally, do what you can to trigger the parasympathetic nervous system (deep breathing is already a good start), recommends Jacobson. ‘This can be done discreetly, such as running your finger lightly over your top lip or gently rubbing your arms under your desk. Stretches can help if you have the luxury of a private office or that boardroom.’

When is it time to seek more help?

Not dealing with anxiety and panic attacks can lead to ongoing problems, so if you reach a point where you feel helpless to them, where you feel you’ve exhausted your personal resources, seek help.

‘Panic attacks can develop into panic disorder: repeated, regular panic attacks can be very debilitating,’ says Ingham. ‘If having an attack becomes associated with a particular place, activity or event, then an unhelpful pattern of avoidance can develop. For some people this can turn into full-blown agoraphobia.’

‘A one-off “panic attack” when you’re in a period of stress is probably just severe stress,’ says Jacobson. ‘If you’re getting help with the stress and you can see the end of the tunnel, then you might just need the support of friends and colleagues. If you’re having constant panic attacks, however, then it’s more than time to seek help. Your workplace might cover sessions with a therapist. If not, it’s very easy these days to find a counsellor or psychotherapist – there are many online booking platforms that guide you through finding the right therapist.

‘If you feel you can wait until your recommendation comes through and need to save money, you can of course also talk to your GP or, in some cases, do a self-referral if that is available to you. You might be referred to an online course you can do in your own time, or be given a round of cognitive behavioural therapy (CBT). CBT is evidence-based to help with anxiety, helping you gain control of your thoughts before they get to the point that panic is triggered.’