The good news is that panic attacks are very treatable. You may find that your panic attacks have already started to reduce because you have begun to recognize and understand, and accept that they are not harmful.

As we have seen, panic affects your body, your mind and your behavior. It makes sense to try to deal with each of these. You may find some techniques more helpful than others. Not everyone finds the same things helpful. Also, if you have been having panic attacks for a while, it may take some time for these techniques to work. Don't expect miracles straight away, but keep at it and you should see the benefits soon, when you’ve found the techniques that work best for you.

Your Body

There are at least two things you can do to help with the physical symptoms of anxiety:

1. Relaxation
2. Controlled breathing

These techniques are helpful for a number of reasons:

Panic attacks often start in periods of stress. These techniques can help you to deal with stressful situations better, and reduce overall levels of anxiety.

They can "nip anxiety in the bud" stopping the cycle that leads to full blown panic, by reducing anxiety symptoms and preventing hyperventilation.

They can be used when avoidance is being cut down, to help you cope with situations you fear.

Being relaxed and breathing calmly is the opposite of panic.

To begin with it is best to practice regularly when you are not anxious. Look on it as getting into training. You would not enter a marathon without training for a while first!

Relaxation

People relax in many different ways. It might be that looking at your lifestyle would be helpful. What do you do to relax? Write down six things you do, or could do to relax. For example, swimming, reading, walking. As well as finding everyday ways of relaxing, there are special relaxation techniques which can help with the specific symptoms of panic.

We have already seen that one of the things that happens when you panic is that your muscles tense up. To help yourself you should try to relax your muscles whenever you start to feel anxious. Relaxing in this sense is different from the everyday ways of relaxing like putting your feet up (although that is just as important!). It is a skill, to be learnt and practiced. There are relaxation tapes or CDs, and sometimes classes, which can help. Yoga classes can also be helpful. Your doctor may be able to lend you a relaxation tape, so please ask.

Relaxation tapes teach you to go through the main muscle groups in your body, tensing and relaxing your muscles. The tape will come with instructions and some people find them very helpful.

Remember
Relaxation can help to reduce symptoms of panic, but it is not preventing something terrible happening - because nothing terrible is going to happen, whether you relax or not.

Controlled Breathing

As we saw earlier, when someone becomes frightened they start to breathe more quickly, so that oxygen is pumped more quickly round the body. However, breathing too fast, deeply or irregularly can lead to more symptoms of panic, such as faintness, tingling and dizziness. If breathing can be controlled during panic, these symptoms may be reduced and so the vicious circle described earlier can be broken. You must breathe more slowly.

If you breathe calmly and slowly for at least 3 minutes, the alarm bell should stop ringing. This is not as easy as it sounds. Sometimes in the middle of a panic attack, focusing on breathing can be difficult. One of the effects of over-breathing is that you feel you need more air, so it is difficult to do something which makes you feel as though you are getting less!

Again, practice while you are not panicking to begin with. This technique will only work if you have practiced and if it is used for at least three minutes. It works much better in the very early stages of panic. Practice the following as often as you can:

Fill your lungs with air. Imagine you are filling up a bottle, so it fills from the bottom up. Your stomach should push out too.

Do not breathe in a shallow way, from your chest, or too deeply. Keep your breathing nice and slow and calm. Breathe out from your mouth and in through your nose.

Try breathing in slowly saying to yourself: 1 elephant, 2 elephant, 3 elephant, 4.
Then let the breath out slowly to six: 4 elephant, 5 elephant, 6.

Keep doing this until you feel calm. Sometimes looking at a second hand on a watch can help to slow breathing down.

Remember - Even if you didn't control your breathing, nothing awful is going to happen.

Your Mind

There are at least four things you can do to help with the way your mind fuels a panic attack:

1. Stop focusing on your body
2. Distract yourself from frightening thoughts
3. Question and test your frightening thoughts
4. Try to work out whether something else is making you tense

Stop Focusing

Try to notice whether you are focusing on your symptoms, or scanning your body for something wrong. There really is no need to do this and it makes the problem far worse. It may be helpful to use the next technique to help you stop the habit. In particular, focus on what is going on outside rather than inside you.

Distraction

This is a very simple but effective technique. Again, you need to keep distracting yourself for at least three minutes for the symptoms to reduce. There are lots of ways you can distract yourself. For example, look at other people, and try to think what they do for a job. Count the number of red doors you see on the way home. Listen very carefully to someone talking. You can also try thinking of a pleasant scene in your mind, or an object, like a flower or your favorite car. Really concentrate on it. You can try doing calculations in your mind, or singing a song. The important thing is that your attention is taken off your body and on to something else. Use what works best for you.

Distraction really does work. Have you ever been in the middle of a panic attack when something happened that totally took over your attention, for example the phone ringing, or a child falling over?

Remember - Distraction breaks the vicious circle, but it is important to remember that distraction is not preventing something terrible from happening. In fact, as distraction works, this is evidence that nothing awful was going to happen after all. For example, could the fact that the phone rang really have prevented a heart attack?

Question your thoughts

Sometimes, rather than distracting yourself from your anxious thoughts it is more helpful to challenge them. In the long run, it is most helpful to challenge your worrying thoughts, so that you no longer believe them.

For thought challenging you need to do two things:

1.  Work out what your anxious thoughts and worst fears are. Everyone's are different, you should already have a good idea from the work done so far.

2. Start to challenge these thoughts and come up with more realistic and helpful thoughts.

Once you are aware of your thoughts and pictures in your mind, ask yourself:

What is the evidence for and against them?

How many times have you had these thoughts and has your worst fear ever happened?

Do your experiences fit more with panic or with something more serious. For example, if thinking about panic brings a panic attack on, is it likely that a stroke or heart attack could be caused in this way?

If you can come up with more realistic helpful thoughts, write them down and keep them with you. It is often much more difficult to come up with these thoughts when you are actually panicking.

Some examples of unrealistic and unhelpful thoughts, with more realistic alternatives are given below.

 Whilst it is really useful to challenge thoughts in this way, probably the best way is to challenge the thoughts through the things we do, which is the next section.

Before looking at how we can alter our behavior to help reduce panic, it is useful to look at one other way in which your mind may be contributing to panic. Not through unhelpful anxious thoughts, but because there may be other things bothering you, as mentioned earlier.

Remember that panic can arise as a result of difficult feelings not being dealt with. It may be helpful to work out whether anything like that is bothering you. Is there anything from your past that you haven't sorted out that is preying on your mind? Are there difficulties in your relationship?

Do you feel angry or sad? Has someone or something upset you or is something troubling you? Panic is less likely to happen if you face up to emotional difficulties, either through talking to a friend or a professional counselor.