UNDERSTANDING PANIC ATTACKS 

If you have ever experienced or witnessed a panic attack, then you will know that they can include a combination of mental and physical symptoms that arise quickly and intensely. Whether you have or haven’t experienced this, you may be able to recognise a panic attack in someone else, and provide them with the support they need.

Panic attacks may be a recurrent, new, or one-off experience brought on by heightened stress, immediate circumstances, or distressing thoughts. Sometimes there is no real trigger and they can seem to appear ‘out of the blue’.

A person experiencing a panic attack will often have little time to prepare themselves. This means they could happen anywhere including at a home, in the workplace, in an isolated location, or at a public venue.

What if you need to support someone through a panic attack? During a panic attack, the person may have difficulty processing or reacting to their surroundings and need time to calm down and recover. They may need space, understanding and support to do this. You can also help to connect someone with ongoing care, if they think they will need it.

Why do people have panic attacks?

Panic can be the body and mind’s response to a real or perceived fear or threat. In the moments of a panic attack the amygdala and midbrain may become hyperactive and cause confusion about what is a real threat and what is not. This results in a rush of negative symptoms. For the most part, a panic attack in isolation is not physically dangerous – but it can feel like it to the person going through it.

Unfortunately, panic attacks are often self-perpetuating. A person experiencing an attack is likely to feel overwhelmed and distressed, and in turn may panic even more over the symptoms they are experiencing. If it is occurring in public, worrying about the reactions of others may also affect the panic attack. It is also not uncommon for those who experience panic attacks to have worries that they might happen again, even when they are feeling otherwise normal.

Who experiences panic attacks?

In Australia, more than 25% of people have experienced a panic attack at some point in their life. Most will not go on to have a problem with panic attacks. There are many risk factors for panic attacks:

  • A history of anxiety or panic disorder – though not everyone who experiences a panic attack has a mental illness.
  • Past trauma that can continue to cause recurring distress
  • A particularly mentally or emotionally stressful situation
  • Becoming overwhelmed by their current commitments or expectations
  • Being in a place where a panic attack has previously occurred.

Some panic attacks do not seem to have any specific trigger. For some people, this increases the worry that they may experience another one.

Other factors that may play a role in panic attacks:

  • Genetic factors
  • Lifestyle factors
  • Experiences with mental health problems
  • Personality traits such as being highly sensitive or worrying a great deal.

As a care giver, it is not important to understand the cause or trigger, but more so what to do to help in the immediate situation.

Recognising a panic attack

If someone near you is experiencing a panic attack, you may not immediately recognise what is happening. The person may also be confused and not know what is occurring, depending on their experience and familiarity with panic attacks.

They may at first appear ‘not quite right’ or have a sudden change in their mood, demeanour, speech, breathing or behaviours. For a particularly overwhelming panic attack, the person may appear to be experiencing a medical emergency. As some of the symptoms of panic attacks can mimic medical emergencies such as heart attack, respiratory distress, or stroke, it is important to pay attention, ask questions, and respond appropriately.

Some of the symptoms a person might experience include:   

  • Shortness of breath or difficulty breathing normally
  • Heart palpitations, rapid heart rate, or pounding feeling in their chest (may or may not be accompanied by chest tightness)
  • Trembling, such as shaking hands or body
  • Nausea or stomach symptoms
  • Numbness or tingling
  • Light-headedness
  • Chills or hot flushes
  • Weakness, disorientation, or trouble standing
  • Trouble swallowing or tightness in the throat
  • Belief or fear that something terrible is happening
  • Belief or fear that they are dying
  • Fear of losing control or not being able calm down
  • Other symptoms unique to the person and their reaction to the panic.

Some things to remember: 

  • The person’s symptoms may be pronounced or subtle. Some people may go to lengths to hide what they are experiencing from those around them. Some people may think they are drawing a lot of attention to themselves when in fact they look a little bit pale and troubled.
  • They may be quiet or alternatively may use words to convey their panic but will often not be able to respond easily or rationally to conversation.
  • Many panic attacks have a similar pattern and occur over a defined period. For most people, a panic attack will last for no longer than eight or ten minutes, though it can feel much longer to the person experiencing it. The mental and physical aftereffects may remain for some time, depending on the person.

3 Steps you can take to help someone experiencing a panic attack

While not everyone who experiences a panic attack, will require assistance, being aware of what they are and how to help, can prepare you to provide support if required. The steps for supporting someone can be simple and effective.

1. Ask and Respond

It can be hard to know if someone is experiencing a panic attack of physical episode. Asking the person can help you decide how to respond.

Ask – if they know what is happening and wait for a response.

Ask – if they have ever had a panic attack. If they say yes, ask if they believe they are having one now.

Act – If they think it’s a panic attack: If the person indicates that they think they are having a panic attack, then be direct in asking what they need and respond to these needs for help. Stay with them and practice calm, supportive reassurance. Keep an eye on any worsening symptoms.

ActIf they don’t think they are having a panic attack or their physical symptoms worsen: Follow physical first aid guidelines and call for help immediately, as they may be having a heart attack or other serious medical problem. At this point you should place the person into the supported sitting position, loosen any restrictive clothing and call 000. If a medical situation is happening in the workplace, contact your First Aid Officer or someone else skilled in first aid.

Stay with the person until the situation resolves (panic attack) or help arrives (medical emergency).
If a person is unable to indicate either way, whether they are having a panic attack, you will need to take the same precautions as you would for a medical emergency. Ambulance Officers and hospital staff are experienced in dealing with panic attacks, and you and the person will not be judged negatively for making the call.

2. Be a calming presence

If the person is having a panic attack, then they will be struggling to find calm and control. You can improve the situation by maintaining a calm manner. This should be conveyed by your voice, words, and movements.

  • Speak in a reassuring but direct manner
  • Do not raise your voice or become frustrated
  • Use short, clear sentences, and speak slowly
  • Use reassuring language e.g. “I understand this is frightening”, “this will pass soon”, “do you need anything?”,I’ll stay with you.”
  • Slow your own movements and mannerisms down and avoid making sudden or rushed movements.
  • Show the person that you are not ‘put out’ by their panic attack and demonstrate that you are ok to stay with them until it passes.
  • Respect the person, their experience, and feelings, try to remain genuine and non-judgemental, avoid being condescending or dismissive.

3. Follow-up

Most people who experience a panic attack will not develop a problem such as panic disorder or agoraphobia. However, if the person worries a lot about having another panic attack, this increases the risk. Ask the person if it is a regular occurrence and whether they have received help. Suggest resources that might be useful to them if they have not accessed them, or suggest a follow up with their GP, a counsellor or appropriate helpline. If the panic attacks are frequent or causing distress, they may indicate an underlying mental health problem, and the person would benefit from seeking professional help.

Beyond the panic attack, you may find you have continued contact with the person if they are a family member, friend, colleague, or peer. This will provide an opportunity to follow up, and connect the person in conversation, to see how they are coping. It may also provide a chance to reassure the person that you do not pass judgement on their panic attack and that they can come to you in future if they feel they are not coping.

Taking care of yourself

Witnessing or supporting someone through a panic attack can be distressing. Watching someone overwhelmed and experiencing physical symptoms can cause distress. This is especially true when it is difficult to determine if the person is experiencing a medical emergency, or where you may have to provide physical first aid.

Additionally, speaking to the person about their experience with panic attacks or broader wellbeing issues can bring up negative emotions. It is important to take time to calm yourself after such an experience by practicing self-care. If you feel you need to talk to someone about it, you too should connect with someone you feel comfortable with, while maintaining the person’s right to privacy.

CONTINUE YOUR LEARNING

Understanding how to talk about mental health is an important skill. Many people feel uncomfortable and unprepared and this can mean the conversation never starts at all. Mental Health First Aid courses teach you how to recognise the signs and symptoms of mental health problems or a crisis such as thoughts of suicide. You’ll gain the confidence to give the most effective support you can and when and how to access professional help.

A conversation could change a life and learning the right skills can make the difference.

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