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When panic attacks — the first aid kit

This is a summary of the core concepts you will need when you get an attack, to remind you of what most efficiently brings the sensations under control.


1 Be still: resist escaping

When you perceive the initial whispers in your body telling you that an attack is on the way, making attempts to escape or planning to run is the equivalent of telling yourself that you're going to be overwhelmed, that you are helpless in the face of what is coming, and that you'd better ‘get to safety'. This misinformation generates more adrenaline and makes matters worse. By deciding to remain, you are giving yourself a powerful message, which is that:


I will still be safe if I don't run.


This also prevents your muscles responding with a further increase in tension, which happens if you are physically running, pacing around or restlessly fidgeting.


2 Go with your body's reaction: don't fight it

Although you obviously didn't want to get an attack, if it has been triggered, acceptance is the stance which holds the least fear. Resisting only increases and prolongs the adrenaline surge, and makes you more tense and afraid, whereas flowing with it allows it to spend itself in the quickest time. Trying to deny it's begun (“Oh no, not here! I don't believe it, it can't be happening again! Please, please not now in front of all these people!”) is like closing the stable door after the horse has bolted, a waste of energy.

Once panic has begun it won't finish until the molecules of the chemical have left your bloodstream. This obviously takes time, just like an alcohol hangover takes time to clear out of your system. You cannot just ‘wish' it gone, it has to run its course, so you might as well adjust to allowing that time to elapse and the concentration of molecules to eventually dissipate.

Floating with the ‘wave of molecules' as it washes over you, going with whatever physical reactions your body is having, allows it to spend itself more quickly because you're not creating any more. Make a statement of acceptance such as:

All the sensations I am feeling now will pass.
I can allow this to wash over me.


3 Stay in the present: don't 'futurise'

Although every fibre of your being may be thinking of how to prevent the ‘disaster' about to occur, try to stay with what's happening right now. By allowing your thoughts and actions to prepare for the worst, you are again sending powerful messages of helplessness to yourself, not safety.

By keeping your attention only on what's happening now, rather than what could happen in the future, you reduce your mind's field of observation to:

  • your racing heart: a highly unpleasant sensation (rather than a predicted heart attack and presumed death)
  • your uncomfortable tight chest (rather than imminent suffocation)
  • the confused, dizzy feelings in your head, (as opposed to future admission to a mental hospital, or an operation for a brain tumour)


4 Deflate the danger: tell yourself the facts

This means reminding yourself of what you know about what the sensations mean and why you get them.

For example:

“Boy, it's hot in here. I've suddenly begun sweating — but then there are a lot of people dancing, and alcohol always makes me a bit sticky, so it's nothing to worry about.”
“My heart has begun to race; no wonder, I suppose, since I've been fighting against the clock all day. I'll try to slow down and that'll help.”
“My fingers are tingling and that dizziness is here a bit — I've obviously let my breathing get too fast again.”
“I feel shaky and peculiar, my adrenaline is obviously higher today than I thought.”
“I feel faint and a bit nauseous — I must be more careful not to let myself get so wound up, I'd better calm down the reaction now by easing up on myself.”


Always remember:
All the sensations of panic are harmless, no matter how intense — the response is protective in nature.
You will never stop breathing because of panic.
Your heart is not at risk during a panic attack.
Nobody has ever gone mad, died or lost control as a result of a panic attack.
All panic attacks end: they are time limited.


5 Dampen down the reaction

Put into action the strategies you've learned:

  • Breathe slowly and abdominally, counting from one to ten.
  • Let your muscles go slack and quiet.
  • Stabilise your energy.


Behaviours that would be consistent with these might include relaxing in a hot bath, placing a cold towel over your face if you're sweaty, listening to calming music, or taking a walk or in some way using your limbs as a method of ‘grounding' your energy if you're feeling spaced out.


6 Be consistent: don't resort to bad habits

The overall objective in this programme is to decrease the intensity of your reaction to the uncomfortable sensations, and in time persuade yourself that they won't harm you. It's important to be consistent in holding that intention, so that all your strategies are pulling in the one direction. So, for example, it undermines the overall premise of the programme if you've been having success with teaching your muscles to relax and your breathing to slow down, but then try to use them while rushing round frantically looking for an exit. The overall intention isn't clear - if you are you feeling safe enough to stay then why are you planning your escape?

Most panickers have their own individual methods of calming themselves, but many of these are with the intention of staving off an attack so that ‘dire consequences' won't result. It's contradictory to be too urgently forcing your body to relax, or slowing your breaths ‘so you won't die of suffocation'. Both of these stances are motivated by fear, although on the surface it looks like you're trying to decrease arousal levels.

Some find that distraction or keeping busy prevents them thinking too much, and then they forget to worry. This may work in the short term, but in the long term it's perpetuating the incorrect belief that 'I had better get my mind off the subject quick, or it will escalate out of control'.

The ultimate goal is that you learn to select (and have confidence in) safe truisms to replace scary lies which take over your thoughts, rather than dodge them through distraction.



This is an edited version of chapter 17 of When Panic Attacks by Dr Áine Tubridy. The book is accompanied by a CD which includes all the exercises mentioned here. It's published by Gill and Macmillan and is available via their website for €19.99


More first aid kits


Podcasts for panic

We have a full set of podcasts to help you deal with panic attacks. There are five in all, and you can find them HERE.

If you would like to download a podcast, click on the podcast title inside the player. This takes you to our podcast host, Podomatic, and the podcast you have picked will play. At the bottom left of the page you will see 'Download episode'. Click this to download and play on your iPod, iPhone, mp3 player, or in iTunes.


Post Traumatic Stress

Trauma refers to the wounding of our will to live, our existential beliefs about the self and the world, our dignity, and sense of security or permanence as an organism. The assault on the psyche is so great that traditional ways of thinking, feeling and behaving are inadequate.

PTSD first aid kit: HERE

Article on PTSD: HERE

Audio and video podcasts

Apart from the panic podcasts, we now have audio podcasts including a tribute to Dr Michael Corry, 'What is Psychosis?', a discussion of SSRIs and the financing of an AWARE website by drug maker Wyeth, and an interview on EastCoast FM about the Shane Clancy inquest. All HERE.

We are planning a series of video podcasts which we will start to make available later this year. More information in our regular newsletter.

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  1. Be still: resist escaping.

  2. Go with your body's reaction: don't fight it.

  3. Stay in the present: don't futurise.

  4. Deflate the danger: tell yourself the facts.

  5. Dampen down the

    • Breathe slowly
      into your belly

    • Relax your

    • Stabilise your

  6. Be consistent: don't resort to bad habits.