I was standing, facing my boyfriend, in the 34th street subway station in New York City. The fluorescent lights shone above my head and subway cars darted left and right on the tracks around me. It was summer in New York City, so it was humid, sticky, and stuffy. Hundreds of people were squished into the narrow halls of the subway station waiting eagerly for the next train.
Out of nowhere, I was struck with a hot flash, and my vision shifted, showing my world off-kilter. I broke out in a raging sweat and my vision wasn’t correcting itself. My knees shook and I couldn’t hold my own weight anymore. I fell to the ground as my heart beat with an intensity so frightful I was convinced I was dying. So convinced that I was dying, I muttered a goodbye to my boyfriend, as he cradled me in his arms on the filthy wooden bench to wait out whatever was happening to me. I looked at him desperately and told him to call 911 because I knew I needed help.
Contrary to my belief, this was not a heart attack. It wasn’t until several weeks later that I learned what I had suffered was in fact a panic attack.
But, how could I have a panic attack if I wasn’t panicked, I wondered. In that moment, preceding the episode, I wasn’t nervous or worried, or feeling particularly scared about anything. I had always thought you needed to be in a state of stress or anxiety in order to have a panic attack…
I was wrong.
This panic attack came out of nowhere and it came with a vengeance. It attacked so strongly and screamed at me so loudly that I was instantly awoken to the fact that my anxiety had gotten out of my control. Having just started graduate school and going through a break up with whom I thought was my forever love, I was understandably distraught but I thought I had been doing a good job of keeping my pot of anxiety from boiling over.
This panic attack was literally a wake up call. I knew I needed to start taking control of my underlying anxiety, because ignoring it only worked as a coping mechanism for so long.
Panic attacks are terrifying, and unfortunately they seem to be quite common. Although there is no cure or quick-fix solution to lessening the symptoms or reducing the occurrence of panic attacks, there are techniques that can help.
In facing my panic attacks and anxiety in general I think the best thing I ever did for myself was seeking therapy. I am such a believer in therapy that I now recommend it to any and everyone. You don’t even need to have a diagnosis to benefit from a third party professional helping you out with your problems.
I resisted the idea of seeing a therapist since I was 16. I think it’s because I wanted to be able to handle my problems on my own, and to prove my own strength in a way. Seeking therapy, to me, was surrendering to the fact that I needed help I couldn’t provide myself. But I’m so glad I did. And I think if you find the right therapist that practices the kind of therapy that is right for you, it will provide you some relief and help you to navigate this world with more ease.
This article isn’t about therapy, however. It’s about shorter-term techniques I enacted to help me deal with panic attacks in the moment to buy myself some time before I could see a therapist.
Since I’ve faced panic attacks head on, and have grown successful in fending them off and calming my body naturally, I want to share my experience.
I have dabbled in self-experimentation and playing detective to my own or others’ medical problems from a young age. When I was younger, my ER doctor father would consult me with challenging medical cases that needed a creative solution and I would ponder over them for weeks. I was obsessed with the scientific method, and this likely inspired my constant self-experimentation and academic pursuit of Epidemiology.
Growing up, whenever I was faced with an ailment, it was a new challenge for me to solve. For example, in college I used to suffer horrible, debilitating migraines with auras. Yet, after testing out dietary modifications and discovering that vegetarianism reduced my migraines, I haven’t had a migraine since.
Similarly, when I had my first panic attack at 22 years old, opposed to the idea of daily anxiety medication (another way of acknowledging that maybe I had a condition or needed help I couldn’t give myself), I instead decided to try different mental techniques at the onset of a panic attack, or for occurrences of heightened anxiety. With dedication to these techniques, I have now been panic attack-free for 4 years.
As I’m not a medical doctor or a therapist, I can in no way properly endorse the techniques I’ve tried, but they’ve worked for me in combatting my anxiety and panic attacks and so if you are willing to try something different, then my advice is here.
Since I had my first panic attack in a NYC subway station, I understandably was scared to revisit that setting where I could be susceptible to it happening again. Instead, I thought that if I could slowly get myself to be ok and not nervous in a subway station, that I would win against anxiety. I took it on as a challenge and actually started to spend more time in subway stations. I’d sit on a bench and take the time to examine myself internally. How was my breathing? How was my heart rate? What was I thinking about? How was I feeling? Was I nervous? If so, what’s triggering me to be nervous?
Immersing myself in the setting that had previously brought on a panic attack was risky. But I kept telling myself that a panic attack would not kill me, and I needed to understand why it happened. Evaluating my body and my mind while in the subway helped me to understand the way I was feeling in this environment. I understood my triggers, which was being in a cramped space and feeling claustrophobic and stuck. I also came to understand that I was over stimulated by the combination of people, lights and sounds.
As I came to learn what was making me anxious, I felt that I had a better grasp on the anxiety, and that it was something that could be managed. It was like the anxiety literally shrunk from a large black cloud to something that could fit in the palm of my hand. It was a manageable size and I was bigger and stronger in comparison to it.
After taking the time to learn and understand my nervous triggers, instead of avoiding these triggers, which would seem intuitive, I actually sought to immerse myself in them. I think this practice is somewhat akin to immersion therapy, but I felt stronger facing my fears head-on rather than avoiding them, and I felt like they had less power over me and like I was the one in control.
Granted, facing the sources of my nervousness was not easy. I would still suffer from pre-panic attack symptoms while riding the subway quite often. I realized I needed to go a step further than just understanding my symptoms.
When symptoms of anxiety and pre-panic attack, like feelings of hot flashes, band-like headaches around my head, shallow breathing, increased heart rate, and flustered thoughts would set in, I decided I had to take myself somewhere else. Not physically, but mentally.
I would close my eyes, and imagine myself on a wide, expansive, airy beach with soft warm sand and crystal blue waters. The ability to create this other world and imagine myself in it provided me with so much relief. I could transport from the bright, loud, crowded, sticky subway car to a place where I could catch my breath.
Seeing this place in my mind allowed my body to follow suit and relax. My chest would open up so I could breath again, my heart rate would slow down, and my muscles would unclench. I was offered relief although physically in a place that caused me stress.
Several months later, I was watching a war movie in a large dark theater, where the loud banging, flashing lights, and commotion of the movie simulated a situation similar to the subway station. I felt a band wrapping around my head and just thought it was some kind of headache coming on until my world tilted and I started hyperventilating. It all happened so fast, and again, I wasn’t actually nervous about anything. The movie itself got my heart pounding, but I had never been affected by a movie like that previously.
I gathered the strength to remove myself from the theater and sit on a bench to collect myself. Luckily a friend was there to help me as I felt absolutely out of it. It felt like I had been hit in the head by a baseball bat and I wasn’t sure what was real and what wasn’t. Although the episode only lasted about 20 minutes I was exhausted for the rest of the night. It felt like I had just ran a marathon and weathered a storm so intense that I could sleep for days.
This experience gave me further insight to my anxiety. It helped me to figure out that I get nervous in cramped spaces, not just subway stations. It helped me to figure out that I get triggered by bright lights, flashing, and loud noises, and not just those in the subway station. Although painful, the experience didn’t kill me and it provided me more information to understand my anxiety and the source of these episodes.
Ultimately, by continuing to immerse myself (in doses) in the places that caused me stress, I was able to face that stress head on and, I wouldn’t go so far as to say I conquered it, but I did decrease it to a manageable level. And that was enough. It was enough to get me through the moment and the collections of moments that turned into days, until I could seek the professional help I needed.
Overall, I would summarize my techniques for managing panic attacks in the following ways:
1. In the moment, sit or lie down. Look around you for:
· 5 things you can see
· 4 things you can touch
· 3 things you can hear
· 2 things you can smell
· 1 thing you can taste
This technique is called grounding, and it will help you to feel more in control of your environment. This is a good technique to help you in the moment, before you start to understand what triggers your panic attacks.
2. Try visualizing a safer space
· This technique is also a more in-the-moment technique, in which you close your eyes and imagine yourself in a space that doesn’t cause you anxiety, space in which you feel comfortable and in control. For me, that space is an open, expansive place. Potentially a clear beach or a large field of dewy grass. Let your mind take you to that place. Once you feel like you are actually in that place, your mind will feel more relieved and you will notice that your body will relax too.
3. Be aware of your anxiety.
· Be a student to your anxiety and the environment you are in when you feel extreme nervousness or a panic attack coming on. Observe and take note of what situations might cause increased anxiety. What exactly is making you anxious, or what in your environment is causing you to feel certain ways? Try recording these observations in a notebook.
4. Understand your anxiety.
· Once you’ve become awake and aware of your anxiety, you can take steps towards understanding it. Try to address questions like why are these situations making you nervous or anxious? Answering a question like this might be rather difficult… and honestly you might not be able to understand it on your own. This is a place in the process where a therapist might be able to help you in finding relief from, or avoiding, panic attacks. Also ask yourself about the feelings accompanying or preceding the anxiety.
5. Sit with your anxiety.
· Once you are aware of your triggers and understand why you are triggered to feel anxious, try sitting with your anxiety. For me, this is incredibly painful. But that pain only lasts about 90 seconds, and once you’ve made it through, you’ll feel somewhat invincible. For me, it felt freeing. Knowing that I could sit with my anxiety and it wouldn’t destroy or kill me helped me to feel like I could mange it.
6. Embrace or Immerse yourself in you anxiety.
· This technique doesn’t work for everyone. Like I explained earlier, I personally saw my anxiety as a challenge to be addressed. Not everyone will have this mindset or see the need to approach their anxiety in this way, and that’s totally fine! By embracing your anxiety I mean going back to those situations that provoked panic, sitting with the anxiety, and fending it off. Doing so has helped me to re-frame my anxiety as something that I can control, rather than something that controls me, and as something that I have the power over. Feeling so provides relief and confidence that you can deal with more situations where you feel anxious.
7. See a therapist.
· While there are techniques to deal with anxiety, seeing a therapist is what has provided me the most long-term relief with underlying anxiety. I have seen therapists that I don’t like, however, so it is important to do some research on therapists in your insurance network before choosing one or several to test out. Do some research to find therapists that specialize in the type of treatment you are seeking. There are many types of therapy, and some are better suited to different issues. In the past, I’ve tried Cognitive Behavioral Therapy (CBT), and the process of diving into my childhood didn’t provide relief for my daily anxiety. It made it worse, actually. More recently, I’ve been seeing a therapist who practices Acceptance and Commitment Therapy (ACT), which is like a mindfulness-based approach to therapy that has helped me to live more easily and address my problems and feelings in the moment. It’s helped me tremendously over the past year or so and it’s the first time in my life that I’ve felt positively about my future. Finding a therapist that works for you can be an arduous process. You cannot benefit from a therapy if you don’t feel comfortable or like you can trust your therapist. You are, after all, putting in yourself in a very vulnerable situation, but one that will provide you so much relief through the process.
Finally, I want to say that there is always hope. There is always hope for controlling your anxiety, and even if you are in a situation where you feel like you’ve surrendered to it, you can recover from it. I know that first-hand. It’s not easy helping yourself, or seeking the help you might need. If you don’t have the strength now, that is OK. As humans, we are not perfect. Some days are dark but without the dark days we don’t appreciate the light ones. Although anxiety might feel like constant dark days, there will be a light one or a light moment where you will discover that you are stronger than your anxiety.