The extra step lurch: coping skills for anxiety and panic attacks
Unless you have generalized anxiety disorder (GAD), you probably wonder what it feels like. Is it just like being stressed only more intense? Is it hyperventilating sometimes? Is it just have an occasional anxiety attack but the rest of the time you feel normal?
No. It’s not like any of those things. But I promise everyone has felt what GAD feels like before. For people without GAD though, it’s just for a brief moment.
I remember the first time someone asked me what it felt like to have anxiety. I explained it like this:
Think of a time when you weren’t just stressed, but had tipped over the “just stressed” point. When you heard some really bad news. Like the moment after getting your test back to see a big red “F” circled on the top. Or when you were about to give a speech you didn’t want to give in front of a ton of people, and your hands were sweating, and your heart racing. Well, anxiety feels like that. Only it’s ALL THE TIME.
Since that first time I ever described it, I’ve learned an even better way of describing anxiety. You know that feeling you get, when you’re walking down a flight of stairs and you think there are no more steps, but there’s one more step, and when you put your foot down you hit air instead of solid ground. Your whole body lurches as your leg moves down to what’s really the last step.
That almost painful jump of your heart and stomach, that catch of your breath that tightens in your throat and lungs, THAT’S anxiety. And for someone with GAD, that’s the feeling they have at almost every moment of the day, with no rational cause. It’s not always as intense as that stair moment, but if you live with GAD, you experience it that intense (and more) on a pretty regular basis. Sometimes the more intense anxiety moments have an obvious trigger. Sometimes they seem to have absolutely no rational cause at all. But even without all that, someone like me, someone living with GAD, feels at least a little pang in their heart and/or stomach almost constantly.
Now, an anxiety attack is when that pang becomes more intense, to the point that it overwhelms you so entirely you start to shut down. Whatever is stressing you is occupying your mind entirely. Your heart races, it can feel difficult to breath, some people (like me) may not be able to communicate during some anxiety attacks. Usually anxiety attacks are short, in the sense that they don’t stay at the same intensity level for very long after the stressor leaves. But they will linger, sometimes even for days. The sufferer may be able to function again, but will still feel they cannot breath or like their heart is pounding painfully.
Panic attacks are different. People tend to label panic and anxiety attacks interchangeably but they are not the same thing. An anxiety attack may not always be noticeable to an outside observer. Panic attacks almost always are. A panic attack usually has no noticeable stressor triggering it, coming seemingly out of the blue. For someone with GAD though, a panic attack can arise out of an anxiety attack, although usually the person doesn’t know why it changed to panic. A panic attack can cause hyperventilation, repeating the same words or phrases over and over, intense and sometimes violent movement (like rocking back and forth or wringing your hands), sobbing or gasping, or quick jittery motions in the arms or legs. Panic attacks can be short, a couple minutes, or very long, a couple hours.
Panic attacks don’t only happen to people suffering with GAD. Anyone can suffer from a panic attack. It’s a type of extreme fight or flight response. Also, someone with a panic disorder (which is different from GAD) will have very frequent panic attacks, but otherwise usually feel fine.
People without GAD can feel anxiety too. Just like someone who doesn’t have chronic depression can feel depressed. The difference is how often those feelings occur.
If you have felt anxious or depressed before, hopefully you can have more empathy for those who suffer from disorders, and recognize that their lives truly are daily, even hourly struggles. Hopefully this will help you to be more compassionate during a loved one’s attack.
People who suffer from anxiety and panic attacks will have different needs. Instead of making assumptions, if someone close to you suffers with one or both of these frequently, ask them now what helps and hinders. The more you know, the better support you can be for them when they need it most. You may have to experiment with things, but eventually you will discover a pattern.
Some people can’t have anything touch them during an attack –so hugging will not help! Some like physical contact and pressure, but only if they feel in control of it. So either provide them with some kind of blanket or jacket they can hold tight around themselves, or ask before giving them a hug. Some people want to talk, some don’t. Simply asking if they want to talk is ok.
Sometimes my husband doesn’t realize I’m having an anxiety attack. He asks me something and doesn’t understand why I’m not answering him. So we have a signal. When anxiety has taken my voice, I touch my fingers to my husband’s lips. At this point, he understands what is happening and can switch over to coping mode.
Some would rather hear someone else talk during an attack. Asking them, “would you like me to read you something?” Or “would you like to hear about what I ate this week?” Can provide easy options for distractions and calming sensory stimulation for them. Some people find the touch of texture calming, like stroking soft obejects or squeezing something like a stress ball. Most of the time, it’s better for a person in this situation not to be totally alone, but they might need some space. If you can sit on their level far enough away that you wouldn’t be able to touch them if you reached out, that’s usually best for someone who says they want to be alone. Maybe turn away so they don’t feel like you’re staring at them.
Things to never say to someone having an anxiety/panic attack include:
Why is this happening? They probably have no idea why it’s happening, and asking will just make it worse, because it’s scary to not know why or what triggered you.
Just calm down. If it were that simple, they would’ve done it already.
Breath slow/stop hyperventilating. If they are hyperventilating, breathing with them is a lot more helpful than just bossing them around. You need to help guide them. Instead try saying, “breath in 2-3-4, breath out 2-3-4.” And do it with them.
What are you feeling? Anxiety and panic attacks can be caused by trying to suppress feelings. If they weren’t allowing themselves to feel the emotions they needed to, they won’t be able to understand what those emotions are while having an attack.
What should I do? This question seems super helpful, but yes or no questions are the only ones that are helpful to ask during an attack. Sometimes communicating is almost impossible, which means a nod or shake of the head is all you can ask for/expect. Instead ask if doing specific things will help.
Things that are ok to say to someone having an anxiety or panic attack include:
Do you want me to ____? Talk to you? Give you a hug? Just sit over here? Hold your hand? Get you some water? Find you a blanket? Rub your back? If they say no to a few things in a row just sit a short distance away (without staring at them) and stay quiet for awhile. You can say/ask something again in a couple minutes. Sometimes what they need is some silence, especially if they’re sensitive to sensory stimulation.
I’m here. Sometimes this is all they need from you. Just to know you’re there, to stand by them while they suffer something incredibly difficult. They can get through the attack on their own, but not feeling as lonely can make a huge difference.
Breathe with me. If someone is hyperventilating, or feels like their chest or throat are constricted, gently coaching their breathing, and breathing with them can help them regain control.
It’s ok to feel what you’re feeling. Since the attack may have been triggered by suppressed emotions, hearing someone else say it’s ok to feel that way can help them start to accept those emotions and ultimately wind down from the attack. Even if suppressed feelings didn’t trigger the attack, letting them know it’s ok that they’re feeling whatever they’re feeling during the attack will help them feel less ashamed and embarrassed about the attack. *I just need to say this one is the MOST helpful for me during a panic or anxiety attack. It’s honestly blissful to hear these words anytime, but especially helpful during inner turmoil.
If you’re close enough to this person that you can easily recognize and are familiar with their anxiety/panic attacks (e.i. A spouse, parent, or sibling) you can say this as well:
You’re having an anxiety/panic attack. You’re going to be ok, we’re going to get through it together. Ok? Sometimes the best way to wind down from an attack is to accept that it’s happening and stop fighting it. When you fight it, it escalates. Instead, if you accept that it’s happening, and let it happen, you open yourself up to the flood of emotions that are fighting their way through. It can be very painful to do this, but it dissipates the attack sooner and allows you to ride out and face the emotions afterwards. Accepting that your body is trying to send you a message, and letting that message come through, is what will ultimately get you on the path to healing. Having someone very close to you say this phrase can help remind you to allow your body’s message to come through. The “ok?” at the end allows the person having the attack to answer in a simple way that they are going to get through this. This can bring strength and hope. It’s like saying, “I can do this!” But in a way that’s simple enough for them while they’re overwhelmed.
Remember, as always, the advice on my blog is not a replacement for individualized coping skills taught in a one on one setting in therapy. I only hope that by sharing my own experiences and knowledge on the topic, I can offer up ideas to try, and even more important, show any of you who also suffer, that you are not alone. And that if you know someone who suffers, there are ways you can help.
My heart is full this holiday season, as I know so many are filled with conflicting and overwhelming emotions of grief and joy. It is a sensitive and emotional season. Not simple and carefree for many. Anxiety, panic, and despression can increase exponentially during this time, especially when our hearts are confusingly conflicted between the joy of the season and the grief of our life experiences. Know you are not alone. The Savior has felt it all. He has overcome it all for you. Place your burdens on Him, and He will carry you through this winter.