29/08/2024 | News release | Archived content
Aug 29, 2024 Nicole Levine
Your heart is racing, and you're breathing hard, like a horror movie character hiding in a closet. Maybe your palms are slick, or your throat is tight. Your thoughts are racing, and most of those thoughts are worst-case scenarios.
When panic attacks or severe emotional distress like that take over, there is a suite of tools you can have at the ready.
"We talk about paying attention to our breathing or relaxing our muscles all the time, and it sounds so simple," said Rebecca Hedrick, MD, director of Consultation Liaison Psychiatry program at Cedars-Sinai. "In those really tough moments, they can make a significant difference."
"When we're feeling this huge amount of stress and we're overwhelmed, our bodies have flipped into the fight, flight or freeze response. It's as though there's some kind of tiger, and you've got to either fight it, run away from it or freeze so it can't see you."
Panic attacks are sudden, intense episodes of fear without a clear cause. Symptoms can include a sense of impending danger, fear you're losing control or going to die, rapid heart rate, sweating, shortness of breath, shaking, chills, chest pain, dizziness, headache and cramping.
Here are a few go-to tips:
Often, strong emotions stimulate an action urge in the brain and the body.
"When we're feeling this huge amount of stress and we're overwhelmed, our bodies have flipped into the fight, flight or freeze response," Hedrick said. "It's as though there's some kind of tiger, and you've got to either fight it, run away from it or freeze so it can't see you."
Blood rushes into the limbs, the heart rate increases and blood moves out of the gut-priming the body to move. One way to manage this feeling is to go with it: run, walk briskly or engage in some other vigorous exercise that will help the body release some of this pent-up energy.
Another evidence-based technique is called progressive muscle relaxation, Hedrick said. Begin in the hands or feet, and clench your muscles as tight as you can for several seconds, then release. Move from the feet to the legs, to the abdomen, and so forth until you've progressed through each of the major muscle groups.
"As you do this, pay attention to what this actually feels like," she said. "What do these tight, tight muscles feel like, and then what does it feel like when I let go of that tightness?"
This is a good technique to practice when trying to fall asleep, as well.
When struggling in a panicky moment, try taking a deep breath and then, when exhaling, make a loud sigh or "ah" sound a few times.
"When we're anxious, we start using our chest muscles to breathe," Hedrick said. "We're contracting those muscles and our stomach."
This takes space away from the lungs, which branch from the throat and shoulders down into the belly. When anxiety causes the body to contract and limits how much the lungs can expand, we must work harder to get the same amount of oxygen. Cleansing breaths can help relax the chest and let the lungs fill more completely. One way to practice is to put one hand on your chest and the other on your stomach, then try to allow only the hand on your stomach to move with each breath.
A small grab-bag of essentials can assist with tolerating emotional distress. Think of something small enough to be stashed in a glove box, desk drawer, purse or backpack. Consider items that will appeal to the senses to help ground you.
In the Consultation Liaison Psychiatry program, Hedrick routinely sees patients who are in the hospital for serious medical issues, facing some of the most stressful circumstances of their lives.
"When I talk to them about learning new coping strategies while they're in the midst of a tough time, they often feel like it's more than they can manage," she said.
Hedrick advises patience.
"Coping strategies take practice," she explained. "It cannot fix everything this second, but it can help decrease your stress in the moment. And, with a few months of practicing, it will be even more powerful."
Start with a practice such as progressive muscle relaxation, or even a body scan-in which you just start with your scalp and check in with how each part of your body feels, all the way down to your toes. Practicing these techniques in times when you feel good or you're experiencing low-level distress will make you an expert in using them when a painful or challenging moment comes along.