Tool Kit for Beating
Do you experience rapid surges of anxiety that come out of the blue?
If so, you might have panic attacks.
Unlike normal anxiety that
different illness to anxiety
builds gradually, a panic
or panic disorder.
attack peaks in a few
minutes and is frightening
because it is accompanied
by sudden physical
symptoms. These can
Panic attacks often occur
include a pounding heart
during or immediately
or rapid heart rate,
after a period of stress.
Stress is produced by an
sweating, chest discomfort,
event that hypes you up.
nausea, and numb or
It can be positive
(marriage, a new job),
neutral (a heavy work-
Fearful thoughts, such as,
load, rushing to meet
“I’m going to die, I’m going
deadlines) or negative (loss of a loved person or
to have a heart attack, …” often occur during
panic attacks, making them more distressing.
The body responds to stress by going up a gear
If your main problems are anxiety and panic
or two, and continual stress can result in a stuck
attacks, you most likely have an anxiety disorder
gear, where your psychological levels don’t return
which can be effectively treated. If panic attacks are
to neutral. Remaining in high gear increases the
one of many symptoms, this may indicate another
chance that your brain will trigger its alarm
mechanism and produce a panic attack.
Studies show up to 12% of people have had an
unexpected panic attack at some time in their lives.
You are not going crazy
1. See a
A panic attack is like an alarm reaction in the
brain. It is a normal reaction in a crisis (say an
Panic attacks are not
intruder threatens you with a gun) but in some
heart attacks and don’t
people the alarm goes off without being triggered
by an emergency.
cause heart attacks in
a healthy person.
The most frightening thing is not knowing what is
happening to you or why it is happening. A
a simple ECG
common worry is: am I going crazy? People who
(electrocardiogram) test can help identify heart
experience panic attacks often believe they might
attacks, and because in rare instances heart attacks
lose their minds but this fear is baseless. Becoming
are dismissed as anxiety, it is best to see a doctor to
psychotic (a major mental breakdown) is a
check the diagnosis.
2. Learn to relax
around four minutes to allow the balance of
oxygen and carbon dioxide to return to normal.
Relaxation is the key to overcoming panic attacks.
Many of the other skills described below build on
b) Progressive muscle relaxation
the ability to relax. The key to the effective use of
relaxation is regular daily practice for 20–30
In this technique, the body’s major muscle groups
minutes. Several weeks of daily practice will result
are alternately tensed and relaxed. You can use
in less anxiety and tension, as well as improved
this technique to give yourself a period of deep
concentration, memory, self-confidence and sleep.
physical and mental relaxation.
Deep relaxation actually leads to a change in the
Find a quiet place and a comfortable position.
physiological state of the body. Changes include
Your whole body should be supported so try a
decreases in heart rate, breathing rate, blood
sofa, bed or reclining chair.
pressure, muscular tension and brain activity.
Take the phone off the hook, loosen any tight
clothes, remove your watch, glasses, shoes.
There are many ways to learn to relax. Try the
Take two or three deep breaths and, as you
breathe out, imagine the tension in your body
a) Learn breathing control
Start with your hands. Clench your fists and hold
Breathlessness is a common symptom of a panic
for 10 seconds. Release and enjoy the feeling of
attack. During an attack people either take shallow
relaxation for 15–20 seconds.
breaths, breathing high in the chest, or they
Tense your arms, tightening your biceps and
hyperventilate, breathing out too much carbon
triceps. Hold for 10 seconds, then relax for
dioxide. Because the brain and body are already
revved up, excessive oxygen only worsens the
problem. Learning slow and regular breathing will
Focus on your head. Raise your eyebrows
help you prevent this problem in future.
and tense the muscles in your forehead, hold
and relax; screw up your eyes and tense the
muscles around them, hold and relax; yawn
Place one hand on your stomach.
and stretch the muscles around your jaw,
hold and relax. Be aware of the sensation
Breathe in slowly and deeply into the bottom
of your lungs. You should be able to feel your
stomach expand while your chest and
Tighten your neck muscles. Hold and relax.
shoulders move only slightly.
Continue down through your body: shoulders,
Pause for a moment, then breathe out slowly.
upper back, abdomen, groin, legs, hips, thighs,
As you breathe out, allow your body to relax.
buttocks, calves and feet. Enjoy the sensation of
relaxation. If any area still seems tense, repeat
Repeat at least 10 times, keeping your
the exercise in that area.
breathing smooth and regular.
Some people find it helpful to record these
After five minutes of abdominal breathing you will
instructions on an audio tape and use it until they
begin to notice that you are much less anxious.
feel confident of the steps. With practice it is possible
This exercise should be practised at least daily.
to learn to relax quickly in any situation. For
information on this technique, refer to the first two
books listed on the back page (under Self-help
Breathe in slowly, counting silently to yourself:
books and the Internet) or visit a professional
experienced in Cognitive Behaviour Therapy for
Hold your breath for a moment.
Breathe out slowly, counting silently to
As you breathe out, say the word relax quietly.
Imagining scenes that are tranquil, safe and relaxing
This exercise is very effective when used at the first
helps many people feel less anxious. Scenes can be
signs of a panic attack. It needs to be continued for
places you know or imagine. Common favourites
include the beach, snow-capped mountains, rolling
4. Learn to control your
green hills and waterfalls.
The more you incorporate all five senses into the
Trying to ignore or fight panic symptoms is likely to
image, the more relaxing it is likely to be. Imagine
make them worse. It is important to acknowledge
yourself as part of the
that you are beginning to
scene: walking on the
experience a panic attack
beach, feeling the sand
and try to avoid tensing up.
between your toes, hearing
the waves crashing, and
At this point, it is often
smelling the salt in the air.
helpful to talk to yourself
about what you are
Once you have imagined
your own peaceful scene,
such as, “I’m having
practise returning to it
another panic attack”,
regularly. You may find it
“I’ve coped with this
helps to combine this with
other relaxation techniques.
before”, “It will pass”,
With practice, you will be
“I can deal with this
able to return to the scene
on the spur of the moment
During a panic attack
and divert your attention at
most people focus on
the first signs of panic.
the physical symptoms such as the pounding
heart, dizziness, sweating and so on. This only
increases anxiety, releases more adrenalin and
worsens the physical symptoms. The first step
Meditation trains your mind to let go of all thoughts
in breaking this vicious circle is to examine the
and just exist in the moment. Meditation practices
thoughts you associate with these symptoms
have been around for thousands of years and have
and to challenge them by looking at them in
been shown to greatly reduce anxiety and produce
a realistic way. For example:
many positive benefits. There are many different
methods. Classes can be found in most areas.
“I’m having a heart attack.”
Contact your local council’s community service
directory or call Lifeline on 13 11 14.
I’ve felt like this before and it wasn’t a heart attack.
“I can’t cope.”
3. Don't let panic control
This has happened before and I can cope with it.
“What will others think of me.”
The fear experienced during panic sometimes
Most people will not even notice.
spreads to other situations in a person’s life.
“Oh no, here it comes again.”
Some people who experience panic attacks become
fearful of entering shopping centres, crowded places
Now I understand what’s happening I can deal
or places from which escape might be difficult. This
is called agoraphobia. Other people become
“I can’t stand these feelings.”
fearful of a harmless sensation (perhaps a rapid
heart rate) and avoid activities (like exercise) that
I don’t like these feelings but they will pass.
produce these sensations.
These new thoughts need to be reassuring but
Avoiding situations that produce fear is not a
realistic, and based on experience, so you know
helpful strategy. It may help you feel better in the
they are true. Imagine you had a friend who was
short term, but it only strengthens the idea that the
suffering panic attacks. What would you say to
situation triggers the panic attack. Try to continue
your friend? You would say something to reassure
with your normal activities and not let panic control
them and help them through the feelings, not
something that would make them feel more
scared. If you begin to panic, talk to yourself as
Three good web sites are:
gently and thoughtfully as you would to a friend.
Australian site run by the University of NSW.
5. Avoid unhelpful drugs
www.algy.com/anxiety/files/barlow.html on the
causes of anxiety and panic attacks.
Alcohol and other drugs may reduce anxiety
temporarily but they worsen the problem in the long
term. Avoid using alcohol or other non-prescribed
by the US National Institute of Mental Health.
drugs to cope with your
anxiety. Coffee, tea and
cola contain caffeine (a
brain stimulant) and
because panickers are
The strategies listed
above are part of
intake of caffeine may
worsen the problem.
therapy (CBT). If
attempts to resolve the
problem yourself are not
successful, see a
psychologist or other
el: 02 4267 3997
Many books expand on
trained in CBT. Your
the above tips. For more
doctor may also be able
raphic Designer T
information try the
to help with medication.
Mastery of Your
properties and can be
Anxiety and Panic, by
used to control panic attacks. Remember, you can
Michelle Craske and David Barlow ($94.00).
always talk your problems over with a Lifeline
Overcoming Panic, by John Franklin ($40.50,
counsellor by phoning 13 11 14.
Australian Psychological Society 03 8662 3300),
a nine-week treatment program.
Many of these tips require practice and effort but
The Anxiety and Phobia Workbook by Edmund
ast revised May 2002. Design: Maria Basaglia G
they have been shown to be very helpful for many
Bourne ($52.45, New Harbinger Publications).
people, so it’s worth persevering. Try a few and
The books are available through bookshops.
find which work for you.
We invite your feedback and comments. Call 1300 13 11 14
This sheet is produced as a public service and you are welcome to reproduce it. L
This project is funded by The
Commonwealth Department of
The assistance of the Illawarra Institute for Mental Health
Health and Ageing under the
in producing this fact sheet is gratefully acknowledged.
National Mental Health Strategy.