Panic attacks can seem as challenging to treat as they are to control.
However, with a systematic approach and adherence to a few simple techniques, panic attacks can become manageable.
In this article, you’ll gain a working understanding of what triggers a panic attack and how to approach treatment for your client. You’ll learn about the options for clinical treatment, as well as exercises and techniques your client can use to manage their panic attacks, both during an attack and in their everyday life to reduce the likelihood of an attack occurring.
Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with a detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.
This Article Contains:
- What Triggers a Panic Attack?
- Treatment Options for Your Clients
- Grounding Techniques & Breathing Exercises
- Using Meditation for Panic Attack Management
- What Can Clients Do During an Attack?
- Top 3 Exercises for Relieving Anxiety
- Assessing Panic Attacks: 3 Tests & Questionnaires
- 6 Helpful Tips & Apps
- PositivePsychology.com’s Helpful Tools
- A Take-Home Message
What Triggers a Panic Attack?
Regardless of who they happen to or how they manifest, panic attacks do not happen in a vacuum. Although panic attacks are often unpredictable and seem spontaneous, there are nevertheless risk factors that act as potential panic attack triggers.
Negative mood is a situational factor that contributes to the increased likelihood of experiencing a panic attack. In contrast, an individual’s general level of anxiety is a less specific factor that can work in the background and increase the likelihood of panic attacks regardless of situational factors.
In other words, it can be useful to think of anything that causes negative mood as a trigger (e.g., upsetting events, stress, drugs with a depressant effect), while general levels of anxiety can be thought as a magnifying lens that turn seemingly innocuous events into potential triggers.
These general triggers are useful for understanding the psychological origin of a panic attack. However, they may miss some of the spontaneity and confusion of how panic attacks manifest in day-to-day life, where triggers may be harder to identify and the timeline of a panic attack does not necessarily follow a neat beginning, middle, and end.
An individual interviewed by Woodgate, Tennent, Barriage, and Legras (2020) described the onset of their panic attack:
“I was just walking down the street and then these guys walked past me and they’re like ‘What’s up?’ and I started panicking.”
Panic attacks have defined triggers, but the approach to identifying and understanding these triggers should be flexible and open to the particular characteristics and experiences of your client.
Treatment Options for Your Clients
Treatment options are suitable for clients who are experiencing panic attacks because of a clinically significant mental health condition such as panic disorder.
The first port of call for such clients should be Cognitive-Behavioral Therapy (CBT). CBT is a diverse therapy that can involve any combination of a suite of therapeutic interventions, unified by the goal of helping your client reevaluate their beliefs and ‘reprogram’ the habitual links between their beliefs and behaviors.
As the name suggests, the mental health interventions involved in CBT can be categorized as either cognitive or behavioral.
Cognitive therapies involve identifying and disrupting beliefs that cause the negative mood or anxiety that trigger panic attacks and educating patients to understand their panic attacks and put psychological distance between themselves and their experiences.
Behavioral therapies can involve relaxation techniques, practicing how to navigate potentially triggering situations, and exposure therapy, in which a client is safely guided through a direct or visualized experience of a potentially triggering situation.
Whatever combination of interventions works best for your client, CBT has been shown to be a successful therapy in most cases and is well suited to managing panic attacks, where controlling those triggering links between beliefs (e.g., negative mood) and behaviors (e.g., the psychosomatic panic response) is crucial.
Some clients, for example those with panic attack triggers linked to social anxiety or agoraphobia, might consider online-administered CBT.
This form of therapy is largely self-driven, with education and self-administered exercises taking the forefront, although this blended care approach is facilitated by regular contact with a therapist. While not as tried-and-tested as regular CBT, there is promising evidence supporting the success of this treatment (Carlbring, Ekselius, & Andersson, 2003).
Grounding Techniques & Breathing Exercises
Grounding techniques are tools your client can use to take control of their thoughts when they feel the spiral of a panic attack beginning and put psychological distance between themselves and what they’re experiencing.
Grounding is simply the action of positively affirming what is known, constant, and real about a situation, drawing a clear line in the sand around what is unknown, transient, and imagined. This mental boundary stops the individual from becoming overwhelmed and effectively contains the influence of a panic attack to within that boundary.
Grounding techniques can be sensory, physical, cognitive, or emotional. Sensory grounding techniques involve the client asking themselves what they know for certain from their senses; for example, naming what they can see, what they can touch, what they can taste or smell, and so on.
Cognitive grounding techniques similarly involve identifying what information is known for certain, such as naming the date, time, or location or affirming that they’re in a safe and controlled environment.
Emotional grounding techniques are sometimes referred to as ‘emotional labeling’ and involve the client taking a detached perspective to their emotions, describing to themselves exactly how they’re feeling in the same way they might describe what the weather is like.
In contrast, breathing exercises are a tool your client can use to control their mental state by controlling their physical state.
Breathing is one of the most fundamental behaviors we engage in. It’s an influential form of feedback from the body to the brain that helps determine how we should be feeling or acting in a given moment.
As an exercise for managing panic attacks, the idea is to use this link between the brain and the body for therapeutic benefit. By deliberately engaging patterns of breathing that mimic states of relaxation and rest, we use our body to communicate that our mind should enter a similarly restful state.
Even if we’re in a situation that we experience as stressful, we can exploit the fact that there are parts of our brain that don’t know the difference and will become relaxed if we feed them the correct information.
There are many breathing exercises your client can consider. Controlled breathing generally involves taking fewer than 10 breaths per minute, with most exercises involving slowing breathing down to 5 breaths per minute, with a deliberate inhalation through the nose and exhalation through the mouth.
Some more extreme controlled breathing exercises involve breathing as little as twice per minute, but these are not something your client should attempt independently. These breathing exercises are all largely the same in therapeutic effect, and the focus should be on finding one that your client finds comfortable and that achieves the desired feeling of deliberate relaxation.
These exercises are tools to be used whenever your client feels the need, whether that is during the onset, experience, or aftermath of a panic attack, or when they feel their anxiety levels rising and want to calm themselves down and reduce the likelihood of a panic attack being triggered.
Using Meditation for Panic Attack Management
A more advanced exercise your clients can practice is meditation.
Like the other exercises described in this article, meditation comes in different varieties. Each variety has its own particular procedure and way of describing the process, which may be more or less accessible to your client depending on the goals for their therapy and their personal or spiritual beliefs.
These differences should be considered carefully, but all forms of meditation share the same basic function as a system of relaxation through ‘embodied thought.’
‘Embodied thought’ is a concept we haven’t yet mentioned explicitly, but it’s really a combination of the exercises already described above. It takes the ideas behind controlled breathing and the different types of grounding and applies them in a single exercise.
In meditation, your client adopts a comfortable seated position and then typically begins by closing their eyes and engaging controlled breathing. This brings on a state of relaxation, but importantly, it also brings on a state of focus through sensory grounding, as your client deliberately pays attention to the rhythm and sensation of their breathing.
This state is maintained for a period, often around 15 minutes, and when your client comes out of the meditative state, they should feel more relaxed and in control of their mind. This should directly benefit their therapeutic efforts to lower the background levels of negative mood and anxiety that may predispose them to panic attacks.
However, juggling the several exercises involved in meditation isn’t easy, and doing even one of these exercises successfully is something your client should feel proud of. Meditation should only be something they attempt if they feel comfortable using these exercises and want to supplement the everyday exercises they use for managing their anxiety with the more focused mental ‘workout’ that meditation provides.
What Can Clients Do During an Attack?
The exercises described above are essential tools for reducing the likelihood of a panic attack occurring, recovering from the aftermath, and fostering better psychological wellbeing. However, they can also be used during a panic attack to reduce its severity and duration.
As soon as your client feels the onset of a panic attack, they should begin by grounding themselves, affirming that they are experiencing a panic attack, immediately creating some psychological distance, and identifying a panic attack as something that is happening to them. Once they have done this, their focus should be on managing the intense physical pain and anxiety they will be experiencing.
This is a Herculean task, and your client should realize that success is not making the panic attack disappear, but just making it a little more controlled.
They should use their controlled breathing exercises to soothe the brain, soften the alarm signals being sent by the body, and reduce the spiraling sensation of a panic attack. They should affirm that they are safe and that the panic attack will pass, labeling their emotions as calmly as possible to increase the psychological distance they created initially.
Top 3 Exercises for Relieving Anxiety
The exercises discussed above are useful tools your client can use to prevent and control a panic attack.
They might also find it useful to know techniques for managing generalized anxiety that might exist in the broader context of their panic attacks.
As you learned above, anxiety can act as a sensitizing factor, making it more likely for a panic attack to occur. In a more general sense, your client may find it easier to engage with their therapy and maintain a positive attitude if they feel confident controlling their everyday mental health.
First and foremost, when your client thinks about relieving anxiety, they should think of the acronym HEPAS: healthy eating, physical activity, and sleep.
The cornerstones of relieving anxiety are removing the negative physiological states that can cause it, such as fatigue, hunger, and lack of nutrition, and embracing positive physiological states that improve our mood, such as the warm glow following exercise and fresh air and the feeling of improving our physical health.
2. Guided imagery
Another simple exercise is visualization or guided imagery. In this exercise, your client actively imagines a relaxing environment, distracting themselves from anxious thoughts arising from their present situation and replacing them with pleasant thoughts arising from the imagined environment.
The goal here is not escapism or denial. Instead, the goal is for your client to turn away from anxious thoughts when they feel them developing and instead take their mind in a more positive and relaxing direction.
3. Progressive muscle relaxation
Last, your client can also try using progressive muscle relaxation, in which they distract themselves from anxious thoughts by directing their focus deliberately toward their body. This exercise is a fusion of the ideas behind the grounding and breathing exercises described earlier in this article, using the body as a focus to distract and calm the mind.
In progressive muscle relaxation, your client assumes a comfortable position in which their body is not engaged in any physical strain and all their muscle groups are at rest. They then systematically tense and relax the muscles in their body, step by step, starting at the feet and extending upward to the face and head, before passing down through the arms to the fingertips.
Each body part should be tensed and held for a short duration, typically around 10 seconds, and then relaxed, before moving on and repeating the process for the next body part.
Assessing Panic Attacks: 3 Tests & Questionnaires
Here are a few tools your client can use to examine their panic attacks and the relevant aspects of their mental health:
- The Panic Attack Questionnaire is the most widely used clinical tool for assessing the severity and characteristics of panic attacks and can help you and your client better understand their unique experience.
- The Generalized Anxiety Disorder Questionnaire is used as part of a diagnosis of a variety of anxiety disorders, including panic disorder, and might be useful for examining whether your client’s panic attacks are isolated or part of a broader mental health issue.
- The British National Health Service hosts a depression and anxiety self-assessment quiz that may be a useful tool for clients of any nationality to examine their general mental health, which may provide useful insight into the general triggers of their panic attacks.
6 Helpful Tips & Apps
- Remember the HEPAS acronym: healthy eating, physical activity, and sleep? This doesn’t mean your client should overhaul their diet or take up marathon running; rather, it’s about emphasizing that their psychological wellbeing begins with taking care of their body.
- When practicing grounding or guided imagery, it’s useful to have an automatic reference that your client uses each time. For example, they might focus on how their feet are touching the ground or have a specific place or situation that they visualize.
- Panic attacks are by definition very difficult to control and rationalize. Your client isn’t superhuman, and they shouldn’t feel like they’re failing if these exercises don’t make their panic attacks disappear. Instead, they should feel successful if they can gain just a little more calm and control each time.
- For help with breathing exercises, check out the Stress & Anxiety Companion from the British National Health Service.
- For help with meditation, check out popular guided meditation apps like Headspace or Calm.
- For help with grounding, check out journaling apps like Daylio, which will help your client practice taking a detached and introspective approach to their emotions.
PositivePsychology.com’s Helpful Tools
PositivePsychology.com has a suite of helpful tools that can help you apply the exercises and techniques described in this article.
Here are just a few to get you started:
- For an example of a grounding technique, check out the 5-4-3-2-1 Stress Reduction Technique.
- For an example of a breathing technique, check out the Three Minute Breathing Space Exercise.
- To get started with a simple meditation technique, check out the Sitting Meditation exercise.
A Take-Home Message
A panic attack can be an intensely painful and frightening experience for your client, but treating them shouldn’t be intimidating.
With the help of some basic relaxation techniques, your client can lower their anxiety and increase their sense of self-control.
In doing so, their panic attacks will become less frequent, less frightening, and ultimately treatable.
We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.
- Carlbring, P., Ekselius, L., & Andersson, G. (2003). Treatment of panic disorder via the Internet: A randomized trial of CBT vs. applied relaxation. Journal of Behavior Therapy and Experimental Psychiatry, 34(2), 129–140.
- Woodgate, R. L., Tennent, P., Barriage, S., & Legras, N. (2020). The lived experience of anxiety and the many facets of pain: A qualitative, arts-based approach. Canadian Journal of Pain, 4(3), 6–18.