Laura opens today’s episode with a sketch depicting what a panic attack feels like. She describes this example as the birth of a panic cycle. Panic attacks can be debilitating. They can come out of nowhere or they can be provoked by a trigger. Whatever the case, the fear of having another attack creates a vicious cycle of fear of more panic attacks to come.
When Laura sees a client for their first session, she assesses for panic attacks. She’s learned that she cannot ask if someone has panic attacks because most people do not know the difference between panic attacks and anxiety attacks. So what is the difference? AND, how can you help a loved one who is having them?
What Brings Someone to Counseling for Anxiety?
Usually something more than someone’s self-awareness about their anxiety brings them to a counselor. Sometimes people are bothered enough on an individual level with their anxiety to come to counseling, but more often than not, they go because of how their anxiety is hampering their relationships. Maybe their anxiety makes them controlling over a spouse, or their work relationships suffer because they are unable to function well at work.
Anxiety Can Harm Relationships
Oftentimes it is other people who encourage the person with anxiety to get help because their relationship is suffering. Sometimes couples suffer because the anxiety sufferer is so ruled by fear that they limit the activities they will participate in with their spouse. For instance, you may have a spouse that has a strong fear of driving and because of this the couple is unable to travel or make important trips. This limiting behavior could be particularly debilitating if that spouse refuses to drive to important appointments or struggles to drive to get to work.
Another problem could be the controlling behavior of a loved one. We sometimes laugh at the label “control freak”, but in all actuality it’s not funny. When you’re on the receiving end of a controlling person, you can feel pretty miserable. The person doing the controlling is miserable, too. So, this controlling person is generally motivated by fear. That means whatever limits they place are determined by their fears. Being motivated by fear does not grow a relationship and can make a relationship become stagnant and unproductive.
People struggling with anxiety are often mind-readers. This puts couples in particular trouble because the anxiety sufferer will come up with assumptions about their spouse because in their minds they are being self-protective. This often backfires because their assumptions are false. Then the loved one calls them on their false assumptions and the anxiety sufferer becomes defensive. They become defensive because they are afraid to change a behavior that they believe protects them.
ER Visits for Panic Attacks Are Not Uncommon
Laura finds that people come to her for counseling after a single or multiple visits to the ER. Many times the person fears they are having a heart attack or think they are dying and go to the hospital only to find out they are physically sound. A doctor then recommends that the person seek therapy or anti-depressants. Or both.
So What is the Difference Between Panic Attacks and Anxiety Attacks
They share many similar characteristics. Both share increased heart rate. A panic attack may be even more elevated. Both have increased respirations, a panic sufferer even more so. Both can be sweaty. Both can have a fixation on something, or have a rumination about something. The main difference is that when someone is suffering from a panic attack, they feel that they are about to die. Both anxiety and panic attacks are very physical events, however, panic attacks will shut someone down to the point of being incapacitated. You cannot work while having a full-on panic attack. You may be able to collect yourself during an anxiety attack, but a panic attack is abject dysfunction.
How To Help a Loved One Who Is Having an Anxiety or Panic Attack
It’s very important to not get sucked into that person’s experience. If you do, it’s like someone is drowning and someone intends to jump in and save them but gets pulled under the waves with them. Try to get an idea of what you’re dealing with. Is it a panic attack or anxiety attack? Someone suffering from a panic attack often feels as though they are dying. Don’t dismiss this feeling—it’s very real to them. Be aware that panic attacks work in cycles. Panic disorder can get progressively worse without treatment because of the panic cycle.
What is a Panic Cycle?
A panic cycle is having a fear that leads to a panic attack. The person feels as though they are dying, and have a panic attack. The attack resolves itself after several minutes. Later, the person is afraid of having another panic attack. The fear of having another panic attack perpetuates the cycle. The cycle is almost more like a spiral because they can get worse.
Fight or Flight
Someone has an anxiety or panic attack because they are reacting to a perceived threat. The body responds to a perceived threat by releasing hormones, such as adrenaline, to prepare the body to protect itself from danger. When there is a legitimate threat, this system, also known as fight or flight, works great. However, sometimes our minds have difficulty determining when a threat is legitimate. In these cases, the body is going into fight or flight mode as a result of anxious thinking. The heart rate quickens and respirations increase. The pupils dilate creating a headache if the anxiety persists.
If a person has been diagnosed with panic attacks, gently, but firmly remind them that they are experiencing a panic attack. If not, you can feed into the intensity of the emotional environment. At this point, you can help “ground” them.
A particular coping skill set called “grounding techniques.” Grounding basically means becoming refocused on your surroundings. When someone becomes particularly anxious, they are so focused on fears, usually about the future–using “what ifs”– that they lose sight of being in the moment.
If a loved one is suffering from a panic attack, help them reconnect with their breath. You can’t get anywhere with someone whose brain is having to deal with hyperventilation. Slowing and deepening the breath helps to create a consistent and steady supply of the appropriate level of oxygen to the brain.
Another way to ground the panic sufferer is to help them notice their safety. If they are having a panic attack on a sofa. Ask them about the sofa. Ask them where they are. What does the sofa feel like? What are the lights like in the room? You may offer them a pillow or a stuffed animal and ask them what that feels like.
Get Them “In The Moment”
Anxiety and panic are rooted in trying to control the future out of fear. Because of this, the sufferer is rarely in the moment. Learning to ground oneself helps that person to be more present and functional.
Four Square Breathing
If your loved one already knows how to do it, remind them of the breathing technique, if not, you can walk them through the process.
- They need to breathe in through their nose for a count of four.
- Pause for a count of four.
- Exhale through the mouth for a count of four (as if blowing out a birthday candle).
- Pause for a count of four. (Then repeat.)
There are four steps done in four counts, hence “Four Square Breathing.” Do this for a while.
Coping Skills Tool Box
A coping skills tool box is a useful way to deal with anxiety or panic. Collect your favorite scents, such as scented candles or essential oils. Create a special playlist of your favorite calming music. Comfy blankets or t-shirts are a nice thing to keep in your box. All of these can be at your fingertips when needed to quell an attack.
Don’t Get Sucked In!
Someone can get caught in the attack by feeding the fears of the sufferer. If you start acting anxious or out of control, it will make the environment more high energy. It’s important to lower the emotional intensity in the environment. You can be there for someone who is having an attack by learning grounding skills. Another issue that you may have to face is that of reassurance-seeking behaviors of the anxiety sufferer.
An anxiety or panic sufferer often seeks reassurance from loved ones. This often falls into Obsessive Compulsive Disordered behavior. Laura gives the example of a person who has a fear of germs. They could be with a loved one in a restaurant and see a patron across the room sneeze. Then they could ask their loved one if that will make them sick. You could play the game of logic with them, but you will lose. The obsessive/compulsion is like a rollercoaster you won’t be able to get off of.
By engaging them in the discussion, they will come up with more reasons they are going to get sick. That’s the progressive nature of it. The best way to handle it is to answer their question once, and then after that respond to more questions with something to the effect of “Asked and answered.” Meaning you are not going to continue trying to play the brain games of trying to make them feel better. The truth is, they will only feel better momentarily if you answer them. They will feel best when they develop confidence over their fear, and the only way to do that is not to enable the compulsion.
Today’s topic is larger than we can cover in a podcast episode, but we hope that you have gained some helpful knowledge about recognizing panic and anxiety, and how to help a loved one cope. If you are experiencing strain in your family or marriage or you are struggling with your own fears, we highly advise seeking out professional help.
A licensed counselor or therapist can come alongside you and help you determine healthy ways to improve your relationships and healthy ways to cope with your fears. Anxiety is often the result of Generalized Anxiety Disorder, Obsessive Compulsive Disorder and/or Post Traumatic Stress Disorder. Panic attacks are often the result of these or Panic Disorder. A qualified therapist can identify these disorders and help you cope.
If your loved one is suffering from anxiety and/or panic, it’s important to not be dismissive of how they feel. You may have to learn how to do the “Asked and answered” response mentioned earlier, but you do not have to do it in an aggressive way. And you do not have to lord their anxieties over them by saying that “they” are the problem in the relationship. This is only baiting the sufferer for a fight.
For additional reading try the following articles:
“Do You Know the Difference Between an Anxiety Attack and a Panic Attack?” By Laura Ketchie
“I’m Worried I Have Anxiety.” By Vincent Ketchie