The Key to
Overcoming Panic Attacks

by Dave Carbonell, PhD

The surest path to overcoming panic attacks is to train yourself to respond to panic in accepting and calming ways. Here are five steps you can use to guide your responses during a panic attack.

The regular use of this approach will go a long way towards your goal of overcoming panic attacks. I have adapted these steps, with some modifications of my own, from Anxiety Disorders and Phobias: A Cognitive Perspective, an excellent professional text by Beck, Greenberg, and Emery.

You will probably find, as you read these five steps, that you have been doing something very different. This is why people are often so baffled and frustrated by panic attacks, because they tend, naturally, to struggle against the panic. The key to overcoming panic attacks is to work with, not against, the panic experience. That's what makes this a solvable problem.

The Five Steps of AWARE

The five steps to overcoming panic attacks are:

Acknowledge & Accept

Wait & Watch (and maybe, Work)

Actions (to make myself more comfortable)

Repeat

End

Let's take a look at what each step entails.

1. Acknowledge & Accept

All progress starts here. This is the most important single step to overcoming panic attacks.

1A. Acknowledge

Here I acknowledge the present reality, that I'm afraid and starting to panic. I won't try to ignore it, or pretend it's not there. I won't struggle to distract myself, tell myself to "stop thinking about it!", or snap rubber bands on my wrist.

I'm acknowledging simply that I am afraid, not that I am in danger. The thought that I am in danger is just another symptom of panic, not an important or useful thought.

1B. Accept

Here I accept the fact that I'm afraid at this moment. I don't fight the feeling; ask God to take it away; blame myself, or anybody else; or pour myself a beer. I accept, as best I can, that I'm afraid in the same way I would accept a headache. I don't like headaches, but I don't bang my head against the wall in an effort to get rid of them, because that makes them worse. Overcoming panic attacks begins with working with, not against, my panic and anxiety symptoms.

How Can I Accept a Panic Attack?

What makes a panic attack acceptable (not desirable, but acceptable) is that, while it feels awful and fills me with dread, it isn't dangerous. It won't kill me or make me crazy. Someone pointing a gun at me, that's not acceptable. I might get hurt or killed. If someone points a gun at me, I have to do whatever I can to change that: run, hide, fight, yell, bribe, or beg, because the consequence of being shot is so terrible that I must try to avoid it.

On the other hand - a policeman giving me a ticket, even if I don't deserve it, I can live with that, and can hopefully keep my temper in check so I don't make things worse for myself.

Accepting the symptoms, not resisting, is a powerful step to overcoming panic attacks.

What Can a Panic Attack Do to Me?

It makes me feel afraid, that's what a panic attack does. And, if I'm having a panic attack, I'm already there! I'm already experiencing the worst that will happen. I just need to ride it out. That's the surest path to overcoming panic attacks.

Why should I accept a panic attack? Because the more I resist panic, the worse it gets. The more I develop the habit of acceptance, the more progress I make toward my goal of overcoming panic attacks.

That's Acknowledge & Accept. How does that compare to what you usually do during a panic attack?

2. Wait & Watch (and maybe, Work)

2A. Wait

What I mean by "Wait" is this: don't just do something, stand there. It's similar to the suggestion "count to ten before you get mad".

One of the hallmarks of a panic attack is that it temporarily robs you of your ability to think, remember, and concentrate. This step will buy you a little time to regain those abilities before you take any action.

When you react before you have a chance to think straight, what do you do? If you're like most people, you probably flee, or struggle. You do things that actually make it worse. This is what people mean when they say things like "I know I'm doing it to myself" and the harder I try, the worse it gets.

Jumping into action too quickly is a big obstacle to overcoming panic attacks.

So, even though you have a powerful urge to leave, postpone that decision for a little bit. Don't tell yourself you CAN'T leave - keep that option open so you don't feel trapped - but put off the decision about whether or not to leave. Stay in the situation. You don't need to run away to get relief. Let relief come to you.

2B. Watch

Use the occasion to observe how the panic works, and how you respond to it. The best way to do this is to fill out a panic diary. The diary is a questionnaire which helps you notice important aspects of a panic attack, so you can respond more effectively over time. Feel free to download and reproduce it for your own personal use. You can also download a set of instructions.

I know, this probably sounds like a crazy idea to you at first. But my patients often report that just filling out a diary helps them to calm down. How does this work? It's not that they're distracted from the subject of panic, because the diary questions are all about panic. It helps you get a little distance from your emotions. It works because, while you complete a diary, you're in the role of an observer, rather than feeling like a victim.

The best way to use the diary is to fill it out during the attack, rather than after. If you're in a situation where writing is impractical, perhaps while driving a car, maybe you can use a digital recorder, or have your support person read the questions to you and record your answers.

2C. What About "Work"?

If you're in a relatively passive situation during the panic attack - a passenger in a vehicle, getting your hair cut, or waiting in a waiting room - "Wait & Watch" is all you need. If you're in a more active role - driving a car, giving a presentation, or taking a test - then you also need to attend to the "Work" of conducting that activity. Do "Wait & Watch", but also remain engaged in your task. You can probably do those tasks in a variety of emotional states.

That's "Wait & Watch (and maybe, Work)". How does that compare to what you usually do during a panic attack?

3. Actions (to make myself more comfortable)

Now, having already gone through the two most important steps to overcoming panic attacks, is a good time to consider what to do, how to act. Most people jump into action immediately, and this often leads them to do something that makes it worse, like telling off that cop who's about to give you a ticket. First, stop and remember what your job is now.

What's Your Job During an Attack?

It's not your job to bring the panic attack to an end; that will happen no matter what you do. Don't take my word for it. Review your personal history with panic attacks. Have you ever had one that didn't end?

The fact is, every panic attack ends no matter what you do. If you respond in the most cogent way possible, and do a good job at bringing it in for a soft landing, that panic attack will end. And if you do everything the most unhelpful way possible - struggling and resisting and fleeing in ways that make the panic worse - that one will end also. Even the first panic attack a person has, when they have the least idea of what's happening, those end as well.

The end of a panic attack is a part of a panic attack, just as much as the start of one is a part of it. It's not something you need to supply or make happen. The panic attack will end no matter what you do. Even when you don't believe it will end, when you have the fearful thoughts that it will last forever, it still ends.

So what is your job during a panic attack? It's a more modest task than you probably supposed. Your job is to see if you can make yourself a little more comfortable while waiting for the attack to end. And if you can't even make yourself a little more comfortable, then your job is just to wait for it to end.

Here are a few techniques that my patients have found particularly useful while waiting for an attack to end.

Belly Breathing

Regardless of what else you do, do belly breathing. It's also known as diaphragmatic breathing, but I think "belly breathing" is more descriptive. Many people think they know how to do deep breathing, but don't do it correctly, so they don't get good results. A good belly breathing technique is a very powerful tool in the work of overcoming panic attacks!

How to Talk to Yourself

Talk to yourself (silently!) about what is happening, and what you need to do. One question my patients find very helpful is this: is it Danger or Discomfort? Some of the other responses my patients like include the following:

1. Fine, let's have an attack! It's a good chance to practice my coping techniques.

2. Answer your "what if...?" fears by saying "So what? I'll get afraid, then calm down again."

3. It's okay to be afraid.

Get Involved in the Present

People don't panic in the present. People panic when they imagine something bad happening to them in the future or in the past. This is why your panic attacks are almost always accompanied by some "what if...?" thought. The reason you say "what if...?" is because what you fear is not actually happening!

Get back into the activity you were engaged in prior to the attack, and become involved with the people and objects around you. If you're in a store, resume shopping, reading labels, comparing prices, asking questions, etc. It will move you closer to your goal of overcoming panic attacks when you bring your focus and energy back to the present environment. By this I mean, work with what is around you.

Work with Your Body

Identify, and relax, the parts of your body that get most tense during a panic attack. This typically involves first tensing, and then relaxing, the muscles of your jaw, neck, shoulders, back and legs. Do not allow yourself to stand rigid, muscles tensed, and holding your breath. That just makes you feel worse! If you feel like you "can't move a muscle", start with just one finger!

That's "Actions (to make myself more comfortable)". How does that compare with what you usually do during a panic attack?

4. Repeat

This step is here because you might start feeling better, then feel another wave of panic. Your first reaction might then be to think "Oh No, it didn't work!". The Repeat step is here to remind you that it's OK if that happens. Just take it from the top again. It's not unusual or dangerous. You may go through several cycles, and you just need to repeat the AWARE steps again, as often as you need.

How does that compare with what you usually do?

5. End

This is here to remind you that your panic attack will end; that all panic attacks end; that they end regardless of how you respond; that it's not your job to make the attack end; and that your only job is to make yourself as comfortable as possible while waiting for the attack to end.

Have these statements been true for you? Don't take my word for it. Review your own history of panic attacks and see.

And maybe the next time you panic, when you notice yourself thinking, once again, "Will this ever end?", you'll find yourself answering, "YES!"

If you prefer listening to reading, or want to hear more detail, here's a radio interview in which I discuss these steps.

Overcoming Panic Attacks

Want a copy of my Panic Attacks Workbook? It'll take you through the steps, from A to Z, of how to handle panic attacks in ways that lead them to fade away, as well as how to overcome the phobias and avoidance that usually accompany panic. It's pretty affordable, and you'll find it here.

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