How to Deal with Anxiety or Panic Attacks

The article also includes expert answers by Dr. Armin Hoes, MD.

A panic attack can be described as a sudden surge of overwhelming anxiety, intense fear, and apprehension.

People often describe it as a feeling of fear in response to a threat, even though there is no actual threat.

Panic attacks occur suddenly, without any warning. They can last for a few minutes or more but rarely persist for more than an hour.

Recurring attacks may lead a person to avoid certain situations or places when in fact there is rarely a correlation between the activity or place and the attacks.

Symptoms of Anxiety or Panic Attacks

Along with anxiety and fear, panic attacks can have physical symptoms, such as:

  • Chest pain or discomfort
  • Shortness of breath
  • Hyperventilation
  • Rapid heartbeat
  • Sweating
  • Trembling
  • Hot or cold flashes
  • Nausea
  • Numbness or tingling sensations
  • A choking feeling in the throat

Some people who experience panic attacks also report feeling as if they might die or feeling unreal and detached from their surroundings. After the attack subsides, the person may feel fatigued and worn out.

Causes of Anxiety or Panic Attacks

The exact cause of panic attacks is not known, but there is evidence that suggests panic attacks result from a combination of genetic, environmental, psychological, and biological factors.

It is believed that major life changes (like moving out, getting a job, getting married, or having a baby) can also be linked to panic attacks.

For frequent and recurring panic attacks, proper diagnosis and treatment are a must.

Without proper treatment, panic attacks can take a toll on your emotional and physical health. There are also some simple techniques that can help you cope with this condition.

Here are the top 10 ways to deal with anxiety or panic attacks.

1. Slow Breathing

You may be able to put an end to a panic attack before it begins by practicing proper breathing techniques. Taking in more oxygen has a calming effect on your mind and body. This is due to the breath-activated pathways to all major networks involved in emotion regulation, perception, and subjective awareness, as has been shown in brain imaging studies. Slow, deep breaths can ease many symptoms of a panic attack.

Plus, practicing breathing exercises and techniques daily can help prevent panic attacks.

  1. Sit in a relaxing position and try to relax your muscles.
  2. Breathe in deeply through your nose.
  3. Go, breathe out slowly through your mouth.
  4. At the same time, focus on the word “calm.”
  5. Repeat until you feel relaxed.

Technology-based programs to help teach and guide people through therapeutic breathing exercises are also available. These programs include audio and video tutorials, web-based and mobile breathing pacers, and even mobile physiologic monitoring devices.

2. Chamomile

A study published in the Journal of Clinical Psychopharmacology found that chamomile can help reduce symptoms of mild to moderate generalized anxiety disorder.

Chamomile is a rich source of calcium and magnesium, two important nutrients that can help ease the severity of panic attacks. It also contains flavonoids, which employ benzodiazepine-like activity to help ease panic symptoms.

  • Add two teaspoons of dried chamomile flowers to a cup of hot water. Cover and steep for 10 minutes. Strain, add some honey to the solution, and drink it. Try to drink two cups of chamomile tea daily to promote relaxation and prevent panic attacks.
  • Alternatively, you can take chamomile supplements (400 mg to 1,600 mg). Consult your doctor for the proper dosage.

3. Valerian

Another popular herbal remedy that can help manage panic attacks is valerian. It aids in calming the nerves by increasing GABA (g-aminobutyric acid), an inhibitory neurotransmitter in the central nervous system.

A 2017 study demonstrated evidence that valerian has potent anxiolytic properties and revealed valerian’s action mechanism of regulating GABA level. Valerian has also been shown to help promote sleep and relaxation.

  • Soak two teaspoons of chopped valerian root in cold water for 8 to 10 hours. Strain the water and sip it throughout the day.
  • Alternatively, take 400 mg to 900 mg of valerian extract a few hours before going to bed. Consult a doctor for the proper dosage.
Note: Do not take valerian on a regular basis for more than four weeks. Also, pregnant women and nursing mothers must avoid this herb.

4. Ginseng

Being an adaptogen, ginseng can also be used for the management of symptoms associated with panic attacks. Adaptogens are plants that improve the nonspecific response to and promote recovery from stress.

Several studies have demonstrated that administration of Panax ginseng or its active components produced an enhanced response to physical or chemical stress. A multivitamin in addition to ginseng can have an additive adaptogenic effect.

  • Simmer 5 to 8 thin slices of ginseng in 3 cups of water for 15 minutes on low heat. Strain, add a little honey, and drink the solution when it is cool. Drink one to three cups of ginseng tea daily as required.
  • A ginseng supplement can also help prevent panic attacks. Consult your doctor for proper dosage.
Note: Avoid ginseng if you are taking high blood pressure medication.

5. Hot Bath

A hot bath or shower can help in providing immediate relief from the symptoms of a panic attack. Warm water has a relaxing effect on the body. It also helps combat stress and promotes better sleep.

In response to warm water, your skin releases endorphins, which can help reduce stress and enhance relaxation.

  1. In a bathtub filled with hot water, add a few drops of any essential oil of your choice like lavender, chamomile, or rose oil.
  2. Also, add some carrier oil (like jojoba oil).
  3. Soak in this relaxing bath for 15 to 20 minutes.
  4. Follow this remedy whenever you are stressed or having a panic attack.

6. Massage

A daily massage may also help in reducing the intensity as well as the frequency of panic attacks. The entire process of massage helps calm the nerves and keep your mind more relaxed.

Sesame oil, olive oil, and coconut oil are commonly used for massages. You may also add a few drops of plant-based aromatic oils (essential oils) to promote relaxation.

A 20-minute massage, three times a week, using aromatherapy with lavender, chamomile, rosemary, and lemon significantly reduces anxiety and increases self-esteem, according to a 2005 study.

  1. Slightly warm the oil of your choice.
  2. Use the warm oil to massage your shoulders, neck, back, and bottom of your feet.
  3. Massage your body daily or as needed.

7. Relaxation Therapies

Relaxation therapies or activities like yoga and meditation can also help you deal with panic attacks. These elevate the levels of “feel good” hormones like serotonin in your body. Yoga has also been shown to increase GABA activity, which leads to a reduction in anxiety symptoms.

Yoga, along with meditation, has been associated with decreased cortisol levels, another indication of reduced stress.

A 2010 review of research found that meditation improves symptoms of anxiety and depression, further suggesting that meditation may be associated with a general reduction in stress.

To reap the benefits of yoga and meditation, you must do it on regular basis and in the correct way. Seek the help of a yoga expert to learn the correct postures and techniques.

8. Green Tea

Green tea is good for your mind as well as your body. This healthy beverage has several essential vitamins and minerals that help in managing panic attacks. Green tea contains L-theanine, an amino acid that has been shown to increase levels of dopamine, serotonin, and glycine. These neurotransmitters are commonly associated with the treatment of depression and anxiety.

In a 1998 study, administration of L-theanine induced alpha-brain wave activity, which is associated with a state of relaxation.[14] One may think that since green tea contains caffeine, it would cause stimulation instead of relaxation. However, it was discovered that L-theanine suppresses the stimulating effects of caffeine.

  1. Add two teaspoons of green tea leaves to a cup of hot water.
  2. Cover and steep for 5 minutes.
  3. Strain and add some lemon juice and honey.
  4. Drink this tea two or three times a day.

9. Passionflower

A number of herbalists are of the view that passionflower is very effective in managing panic attacks. Like ginseng, passionflower can also increase GABA levels in the brain, helping to decrease stress and anxiety.

A study done in 2008 showed that administration of oral passionflower reduced anxiety in preoperative patients without inducing sedation. Another study found passionflower to be equally effective as oxazepam, a benzodiazepine used to treat anxiety disorders.

  • Passionflower is available in the market in various forms, including tea, tincture, and capsule. It is recommended to take this herb under the supervision of an herbalist.
Note: You must not take this herb in excess as it may disrupt mental and motor functions. Also, passionflower is not recommended for pregnant and breastfeeding women.

10. Exercise Daily

Several studies have proven that regular exercise can help in reducing the occurrence of panic attacks. In fact, people who exercise regularly experience fewer panic attack symptoms than those who do not exercise.

Exercise helps reduce the stress hormones and increase the “feel good” hormones in your body.

Plus, physical activity will allow your body to use up the energy that may be contributing to feelings of panic.

Numerous studies have shown that exercise is associated with decreased symptoms of anxiety and depression. In one study done in 2003, it was shown that regular physical activity significantly decreased the prevalence of both major depression and anxiety disorders.

Regular aerobic exercise at 70%-90% of maximum heart rate for 20 minutes three times a week has been associated with reduced anxiety sensitivity.

However, you need not necessarily indulge in strenuous physical activity to reap the benefits. An activity as simple as walking (preferably brisk walking) can also be of great help when done regularly.

A study done in 2009 showed that in addition to regular exercise, an acute bout of exercise may be used to further reduce anxiety, along with reducing the frequency and intensity of panic attacks.

Additional Tips

  • Reduce your intake of alcohol, caffeine, sugar, and foods that are high in fat.
  • Sleep better by following a strict sleep routine.
  • Eat more fresh fruits and vegetables.
  • Individual and family therapy may help.
  • Join a support group. You don’t have to handle this problem alone.
  • Use stress management methods if your panic attacks are related to excessive tension.
  • Take more breaks from day-to-day life. Go for short weekend breaks or a holiday with your family and friends.
  • Consider keeping a pet to give you company and keep yourself busy.
  • Keep a journal to help deal with your feelings, and track stressors that trigger your panic attacks so that you can manage them.
  • Get out and enjoy nature. Taking a walk through a park can help you feel better.
  • When you feel a panic attack coming on, try drinking a glass of cold water to help you relax.
  • Consider taking nutritional supplements with B vitamins, magnesium, and antioxidants.

Expert Answers (Q&A)

Answered by Dr. Armin Hoes, MD (Psychiatrist)

What are the repercussions of leaving anxiety and panic attacks untreated?

Anxiety and panic represent the most common psychiatric conditions in the U.S., with lifetime prevalence rates approaching 30%. Approximately 1 in 5 people in the country are diagnosed with some form of anxiety.

Anxiety can be experienced as either a primary condition in which symptoms occur independent of other medical problems, or as a secondary medical condition in which symptoms occur as a result of having another medical problem.

Left untreated, anxiety and panic can cause tremendous suffering as well as long term disability. The differences between anxiety and panic are primarily related to the onset, timing, and intensity.

How can one differentiate between a panic attack and an anxiety attack?

The term anxiety generally refers to a cascade of biological and psychological responses generated by our bodies as a response to an impending threat. Under most circumstances, anxiety symptoms are a normal adaptive mechanism useful for survival, in a way alerting us to potential harm.

In pathological sense, however, during anxiety, our minds tend to overestimate the potential for danger, and we feel a sense of danger or discomfort even in the absence of a clear threat.

In terms of onset and duration, anxiety presents in either intense, rapidly developing episodes (acute) or as a less intense but longstanding, progressive syndrome (chronic) that affects daily functioning.

Panic is a common form of acute anxiety typically characterized by discrete episodes of intense physical and psychological distress. Attacks may last for several minutes or even hours. Commonly reported symptoms include rapid heart rate, hyperventilation, profuse sweating, difficulty swallowing, abdominal distress, tremulousness, hot flashes, tingling sensations (paresthesias), chest pain, and dizziness.

People who experience panic often rush to the Emergency Department because they believe they’re having a heart attack. Untreated panic may compel those who suffer to isolate themselves from others and avoid social interactions in order to prevent exposure to triggers.

Chronic anxiety conditions like Generalized Anxiety Disorder or Social Phobias are generally associated with less intense symptoms than panic, but one major difference with chronic anxiety is that it tends to be more persistent and often lasts throughout the day.

When anxiety symptoms are experienced throughout the day, on most days, for at least six consecutive months, we consider them chronic. While chronic anxiety is not thought of as episodic, symptoms can vary in tone and intensity over the course of days or weeks depending on external factors.

Commonly reported chronic anxiety symptoms include increased muscle tone and tension which can lead to pain and spasm, fatigue, frequent states of worry and ruminating thoughts causing concentration deficits, restlessness, feeling on edge, insomnia, and mood swings/irritability.

Heightened environmental stress invariably intensifies the experience of chronic anxiety and in some instances, may even trigger a panic attack.

Can anxiety and panic attacks be cured for good?

There is no known cure for acute or chronic anxiety, but treatment can be helpful, and in many cases, be life-changing. Particularly for those who suffer from a severe form of chronic anxiety known as agoraphobia in which sufferers have difficulty leaving their home due to having a debilitating preoccupation that something bad will happen.

Can anxiety or panic attacks be treated without any medication?

Available treatments are wide-ranging, however the most effective treatments for anxiety, other than healthy living, regular exercise, and mindfulness and meditation practices, according to the literature, remain prescription medicine (ideally managed by a psychiatrist) and evidence-based psychotherapy.

For severe panic attacks requiring crisis intervention, medicine is often the only reliable solution. But many forms of anxiety can be managed effectively with mindfulness and skill-based therapy programs like cognitive behavior therapy (CBT). If anxiety medicine is available, it is recommended to take it as prescribed to relieve the suffering that accompanies panic attacks.

What immediate action should be taken to calm oneself during anxiety or a panic attack?

If medicine is not available, deep breathing exercises can be helpful as well as progressive muscle relaxation exercises. Breathing into a paper bag should only be used as a last-ditch effort and is especially useful for hyperventilation.

Does anxiety worsen during the night time?

Anxiety doesn’t necessarily have a preference in terms of the time of onset, however, some who suffer do report having increased symptoms at nighttime that are disruptive to sleep. This is seen especially in cases of those with PTSD (post-traumatic stress disorder) who often experience hypervigilance, nightmares, and flashbacks during the night.

Do genes play any role in making a person more susceptible to anxiety or panic attacks?

Genetics play a role in determining susceptibility, however, the degree of influence remains unclear. There are several genes that have been identified as candidates for further study because their expression seems to correlate with increased anxiety symptoms.

But there are many other factors involved with the development of anxiety disorders. Environmental influences can play a major role, such as exposure to childhood trauma.

Are there any medical conditions which can be mistaken for anxiety?

Several notable medical illnesses are accompanied by anxiety symptoms. Many forms of heart disease including coronary artery disease, congestive heart failure, and cardiac arrhythmias; respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD); and hormonal dysregulation like disorders of the thyroid and adrenal glands can precipitate panic attacks.

There are also a group of conditions that include fibromyalgia, irritable bowel syndrome, migraine headache, and non-epileptic seizures where chronic anxiety is not only highly comorbid (occurs simultaneously) but may also be considered a precipitating factor.

Conditions like cancer, dementia, and other progressive medical illnesses can precipitate anxiety symptoms related to a fear of death and dying.

Please provide some additional tips or inputs regarding anxiety and panic attacks.

Overall anxiety and panic can be managed effectively with either medical or non-medical interventions. Deciding which approach is best for you depends largely on the cause and severity of the condition.

As with most medical problems, maintaining a balanced diet combined with regular exercise, having healthy relationships and engaging in pleasurable activities when possible are lifestyle choices that allow us to live with anxiety while preserving a high quality of life.

About Dr. Armin Hoes, MD: Dr. Hoes is the Founder and Medical Director of Latitude Mental Health, a mental health care practice based in Los Angeles, CA. Latitude Mental Health provides comprehensive mental health care services that integrate medicine, therapy, and coaching and go beyond treating the illness by making wellness the primary goal.

completed post-doctoral residency training in Psychiatry at the UCLA-Greater Los Angeles VA Psychiatry Residency Training Program. He has additional post-doctoral training in Neurology at Duke University. attended Medical School at Howard University and completed his Internship in Internal Medicine at Howard University Hospital.

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Patrick Moser, FNP-BC, RN

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