Panic Attacks

Managing Acute Attacks of Shortness of Breath

The goal of breathing retraining is to help you avoid sudden periods of shortness of breath. There still may be times when your breathing control gets away from you. Imagine one of the following:
*You are feeling pressured to hurry to keep up with someone while walking.
*You have forgotten to pace yourself and tried to get up a flight of stairs in record time.
*You just had a breathing treatment and can feel secretions (mucus, sputum or phlegm) clogging your breathing passages.
*All of these situations and some added ones of your own can lead to acute shortness of breath. What do you do?

The tendency of many people is to gasp for breath. You may notice that you are using your neck and shoulders to help you breathe (using your accessory muscles) and you may be inhaling and exhaling for the same length of time.

For such times try the following steps: POSITION, BREATHING, RELAXATION.

POSITION: Get in a position that helps your breathing muscles work most efficiently (and takes the load off your other muscles that are not involved in breathing). Sit, leaning slightly forward, rest your arms on a table or your lap. If you are standing and have no place to sit down, lean against a wall.

BREATHING: Get your breathing under control. Start by breathing out through pursed lips. Gradually breathe out for longer and longer. As this gets easier slow your breathing down even more. Remember, breathe in the nose, out the mouth. Breathe out for twice as long as you breathe in.

RELAXATION: As you are getting your breathing under control, consciously relax all the muscles not involved in breathing. Pay special attention to your shoulders and arms. Drop your shoulders down, let your arms go limp.

Close your eyes if this helps you to relax. You may even try saying the word relax in your mind.
Once your breathing is under control, resume your activity, but at a slower pace. If secretions are your problem, spend some time on the techniques to help you clear secretions. There may also be times when you need to use inhaled medication to help you control some of your shortness of breath.
Your doctor or a member of the pulmonary rehabilitation team can help you determine when inhaled medications might be helpful.

A WORD OF CAUTION: Prolonged shortness of breath more than your usual may be a sign that something else is going on. If you cannot get your breathing under control, or shortness of breath seems to be increasing for you, it may be time to contact your doctor.

Courtesy of the Good Health Cooperative   

Panic attacks often cause a "vicious cycle" of over-breathing. The faster you breathe, the more short of breath you feel. Many of the physical symptoms of panic (dizziness, chest pains, feeling faint) are caused or made worse by rapid, shallow breathing.
 
Practice a slow, relaxed breathing pattern: Start by holding your breath for five seconds. Then breathe in slowly and gradually for three seconds, pause, and breathe out slowly while saying to yourself "RELAX". Continue this cycle, taking six to eight seconds for each breath. Practice this breathing pattern for at least five minutes four times a day.
       
Use this breathing pattern whenever you feel panic symptoms starting. At the first sign of anxiety, tell yourself: "I'm starting to
feel anxious. I'll use my relaxed breathing pattern and it will pass in a few minutes." Begin your relaxed breathing pattern and continue until the anxiety symptoms pass.
 
Change your "Self-Talk
Panic attacks often bring a rush of fearful or negative thoughts. Chest pains, pounding heart, or other physical symptoms may make you feel you're having a heart attack or some other frightening medical problem. These fearful thoughts are symptoms of anxiety which you can learn to control.
Learn to spot anxiety thoughts as soon as they begin. What are the fearful thoughts you often have with anxiety attacks? Tie a mental "red flag" to those thoughts so you'll notice when they start to appear.
    
Learn to "re-label" anxiety symptoms.       When anxious thoughts appear, call them for what they are. For example, when you feel pounding in your chest and fear you're having a heart attack, you might say to yourself "I'm starting to feel those anxiety symptoms and think those heart attack thoughts again. That means I'm having an anxiety attack. I know that these attacks are unpleasant, but they always pass in a few minutes."

Don't Give in to Avoidance
Panic attacks can cause a strong urge to avoid places where attacks have occurred or where you feel anxious. Avoiding feared situations, though, will only reinforce the fear.     If you have an anxiety attack, try to stay put. The attack will pass
in a few minutes (whether you stay or leave). Remind yourself of this and make a point of staying until you feel calm.

If you avoid situations because of anxiety, slowly try to increase your tolerance for them. Do things in small, manageable steps. For example, if you are afraid to drive, try driving only a few blocks when you have a trusted friend along. Gradually build up to driving further or driving on your own. As you do more, the fear and urge to avoid will grow weaker.

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