These are some suggestions on how to cope with Anxiety and Panic and how you can help

prevent and alleviate the symptoms.

The Power of Positive Thinking

One way of tackling panic attacks is to look at the way you talk to yourself, especially during
times of stress and pressure. Panic attacks often begin or escalate when you tell yourself scary
things, like "I feel light-headed . . . I'm about to faint!" or "I'm trapped in this traffic jam and
something terrible is gonna happen!" or "If I go outside, I'll freak out." These are called
"negative predictions" and they have a strong influence on the way your body feels. If you're
mentally predicting a disaster, your body's alarm response goes off and the "fight-flight
response" kicks in.

To combat this, try to focus on calming, positive thoughts, like "I'm learning to deal with panicky
feelings and I know that people overcome panic all the time" or "This will pass quickly, and I
can help myself by concentrating on my breathing and imagining a relaxing place" or "These
feelings are uncomfortable, but they won't last forever."

Sometimes it's helpful to remind yourself of these FACTS about panic attacks:

 A panic attack cannot cause heart failure or a heart attack.

If it's too hard for you to think calming thoughts or to concentrate on relaxation strategies when
you're having a panic attack, find ways to distract yourself from the negative thoughts and
feelings. Some people do this by talking to other people when they feel the panic coming on.
Others prefer to exercise or work on a detailed project or hobby. Changing scenery can
sometimes be helpful, too, but it's important not to get into a pattern of avoiding necessary daily
tasks. If you notice that you're regularly avoiding things like driving, going shopping, going to
work, or taking public transport, it's probably time to get some professional help.

Put a stop to the thoughts that lead to anxiety, and to replace those thoughts with realistic,
rational thoughts. Then, when these self-statements are practiced and learned, your brain takes
over automatically. This is a form of conditioning, meaning that your brain chemistry
(neurotransmission) actually changes as a result of your new thinking habits.

First, use thought stoppage. Be gentle but firm about it.

"STOP! These thoughts are not good for me. They are not healthy or helpful thoughts, and I
have decided to move in a better direction and learn to think differently." (You are reminding
and reinforcing your brain each and every time you make this rational and realistic statement.)
Then, pick two or three statements from the list below that seem to help you, and repeat them to
yourself OUT LOUD each day. (You don't have to believe them fully yet - that will happen
later).

When Anxiety is Near: General Statements

1. I'm going to be all right. My feelings are not always rational. I'm just going to relax, calm
down, and everything will be all right.

2. Anxiety is not dangerous -- it's just uncomfortable. I am fine; I'll just continue with what I'm
doing or find something more active to do.

3. Right now I have some feelings I don't like. They are really just phantoms, however, because
they are disappearing. I will be fine.

4. Right now I have feelings I don't like. They will be over with soon and I'll be fine. For now, I
am going to focus on doing something else around me.

5. That picture (image) in my head is not a healthy or rational picture. Instead, I'm going to focus
on something healthy like ____.

6. I've stopped my negative thoughts before and I'm going to do it again now. I am becoming
better and better at deflecting these automatic negative thoughts (ANTs) and that makes me
happy.

7. So I feel a little anxiety now, SO WHAT? It's not like it's the first time. I am going to take
some nice deep breaths and keep on going. This will help me continue to get better.

Statements to use when Preparing for a Stressful Situation

1. I've done this before so I know I can do it again.

2. When this is over, I'll be glad that I did it.

3. The feeling I have about this trip doesn't make much sense. This anxiety is like a mirage in the
desert. I'll just continue to "walk" forward until I pass right through it.

4. This may seem hard now, but it will become easier and easier over time.

5. I think I have more control over these thoughts and feelings than I once imagined. I am very
gently going to turn away from my old feelings and move in a new, better direction.

Statements to use when I feel overwhelmed

1. I can be anxious and still focus on the task at hand. As I focus on the task, my anxiety will go
down. 
2. Anxiety is a old habit pattern that my body responds to. I am going to calmly and nicely
change this old habit. I feel a little bit of peace, despite my anxiety, and this peace is going to
grow and grow. As my peace and security grow, then anxiety and panic will have to shrink.

3. At first, my anxiety was powerful and scary, but as time goes by it doesn't have the hold on me
that I once thought it had. I am moving forward gently and nicely all the time.

4. I don't need to fight my feelings. I realize that these feelings won't be allowed to stay around
very much longer. I just accept my new feelings of peace, contentment, security, and confidence.

5. All these things that are happening to me seem overwhelming. But I've caught myself this
time and I refuse to focus on these things. Instead, I'm going to talk slowly to myself, focus away
from my problem, and continue with what I have to do. In thisway, my anxiety will have to
shrink away and disappear.

Abdominal Breathing

One of the most important things that will help you during a Panic Attack is to control your
breathing. Although it is the last thing on your mind, and very hard to control, it is very
important as it will calm you down. Panic Attack sufferers will almost inevitably suffer from
hyperventilation and must learn abdominal breathing.

Slow, abdominal breathing alone has been shown to abort panic attacks and prevent them. But
for a person with panic disorder, learning slow abdominal breathing can be quite difficult. People
with panic disorder are almost always chest breathers. The worst thing you can tell a person
during a panic attack is to breathe deeply. It takes a lot of practice to breathe with the diaphragm
without a great deal of training, but if you can learn to breathe slowly with your diaphragm, you
will not panic!

You must practice abdominal breathing so that when you have a Panic Attack you can put it into
action.

Here are some tips on learning diaphragmatic breathing. Start while lying on your back. Place
one hand on your chest and one hand on your belly (between navel and ribs). Focus on allowing
the belly to rise easily when inhaling and fall when exhaling. HOLD THE CHEST STILL with
your hand on your chest. The objective is to breathe all the time with the belly (diaphragm) and
not the chest. You are aiming at about 6 breaths per minute. This is a slow relaxed process. There
should be no sense of effort.

If the belly won't move and the chest continues to move, put a weight on the belly between the
navel and ribs (where the hand was). A heavy book will do, but something that is not painful and
weighs 3 - 5 pounds is best. Focus on allowing the weight to rise on inhale and sink on exhale.
Again - no effort!

If still no success, kneel on all fours, i.e., assume a position of a four-legged animal. In this
position, the chest tends to be locked in place, forcing the diaphragm to take over the breathing
task. Slow and easy, no effort. Once you learn to breathe with your belly, you must practice,
practice, practice.

The first week, you should practice for only a few breaths at a time while lying on your back.
Then gradually extend the practice time to 15 minutes. When this can be done comfortably, you
should start to practice while sitting. Then standing. Then walking.

After you can breathe with the belly in all positions, you should practice in different situations.
Start with easy situations like sitting in a car. Then sitting in a restaurant. Progress until you can
breathe with the belly in situations that previously felt un-natural and uncomfortable.

IMPORTANT: If at any time during the breathing training, you feel dizzy or light-headed, then
stop the exercise, rest, and try again in a few minutes. The breathing training is not about being
tough or facing your fear. It is about learning to breathe to normalize the bodily functions.

You may find it helpful to have someone doing this breathing exercise with you as they 'take
control' and get you to breathe on their command.

Ok, so these techniques may not be very sophisticated but they work and may help you:

Distraction

If you think about what is happening to you in a Panic Attack, you actually get worse, so you
need something to distract you from the feelings and make you concentrate on something else.

Talk! talk! talk!

One of the best coping techniques is to keep talking. Whilst you are talking, about anything and
everything, you will be distracted from the feelings of panic. Do not talk about how ill you feel
but get someone just to chat generally with you about a subject you are interested in so you need
to concentrate on the conversation. It will help if you can smile, laugh or run around! Do
anything but sit down and wallow in the feelings - tell yourself that they will soon pass and just
for the time being you need to 'waffle' to someone about anything at all.

I have actually done this in a supermarket when I was feeling panicky and I have started chatting
to the person in the queue behind me just to take my mind off things. Try it - it may work! If it
doesn't then say "ok" and try another coping technique.

Whilst Driving:

You must distract your mind from feeling Panicky and frightened whilst driving as you may feel
even more frightened as you're in control of a potentially dangerous piece of machinery. Here are
a few coping techniques (believe me they work, no matter how mad they sound):

1) Add up number plates - look at the car in front and add up any numbers on the number plate,
try to see what car number plate gives the highest score.
2) Select a colour and start counting the number of cars you can see in that colour.

3) Select a make of care and start counting how many cars of that make pass you.

4) Take the letters in a car number plate and work out an amusing phrase for it.

5) Sing! - put some music on and sing along. If you start singing you will automatically start to
breathe correctly and it will also take your mind off the problem. This recently worked for me on
a long drive and I started to feel panicky. I turned the music up and sang away - it worked!

6) Talk positively to yourself - e.g. "I've only driven shorter distances recently so it's Ok to feel
nervous about this journey. I know I will be fine as I always am fine and the feelings of
nervousness cannot harm me and always pass. I know I am a good, safe driver and will in time
get to enjoy this journey. If I should feel faint, I know that these sensations will pass and that the
sooner I relax , the sooner the faint feeling will pass."

7) Distract yourself and start planning a birthday party for XXXX , now who shall we invite,
where shall we go, what games shall we play etc.

8) Plan what to spend a windfall on, DIY projects are all useful too. Ensure you need to think
about the details of whatever you think about.

9) Talking books are great especially if you have a favourite subject/ author.

You may need to start this thought replacement long before your journey and may need to try
several distraction options out before you find the one that works for you.

Cut down on Stimulants

The last thing a panic attack needs is more fuel to 'feed' it. Certain stimulants are known to
aggravate and even bring on Panic and Anxiety:

Alcohol

Some people see Alcohol as a relaxant and start drinking to try and deal with the devastating
effects of an anxiety disorder. This of course is no solution. How do you know the difference
between a hang-over and anxiety symptoms? The alcohol withdrawal or hangover tends to
reinforce the physical symptoms which people interpret as increasing anxiety levels. This only
keeps the cycle of anxiety and panic going. Alcohol will also not help you sleep - yes it may
make you fall asleep but the sleep will be disturbed, intermittent and you still wake up feeling
even worse!

The process of metabolizing alcohol can use up all the body's B vitamins.

If you are using alcohol on a daily basis as a way to 'relax', you should contact either your doctor
or your drug/alcohol unit or Alcoholics Anonymous (AA) in your city/town.
Caffeine

Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic (it increases urine
production). Recreationally, it is used to provide a "boost of energy" or a feeling of heightened
alertness. It's often used to stay awake longer - college students and drivers use it to stay awake
late into the night. Many people feel as though they "cannot function" in the morning without a
cup of coffee to provide caffeine and the boost it gives them.

Caffeine is an addictive drug. Among its many actions, it operates using the same mechanisms
that amphetamines, cocaine and heroin use to stimulate the brain. On a spectrum, caffeine's
effects are more mild than amphetamines, cocaine and heroin, but it is manipulating the same
channels and that is one of the things that gives caffeine its addictive qualities. If you feel like
you cannot function without it and must consume it every day, then you are addicted to caffeine.

Panic sufferers are usually advised to cut out caffeine because of the stimulant effects it has on
the brain and body.

Caffeine is commonly found in coffee, tea, chocolate, cocoa and don't forget that some soft
drinks contain caffeine as well : Coca-Cola, Pepsi-Cola, Dr Pepper, RedBull and fizzy Lucozade
to name just 5!

I stopped drinking tea, coffee and any soft drinks containing caffeine in September 2000 and it
has had a dramatic effects on my Panic attacks. If I now drink a soft drink containing caffeine
then I end up shaking and feeling quite ill! For the first few months I really missed a cup of tea in
the morning but it was worth the sacrifice for my health. I now drink water instead so I get more
than my recommended 8 glasses a day. If you really can't face a day with tea or coffee then use
the decaffeinated varieties - they aren't that bad!

Smoking

Nicotine is passed into the blood stream and is circulated to the brain. It then triggers a variety of
responses in the nervous system. It can affect the cardiovascular system, causing rapid heartbeat
and elevates the blood pressure.

Daily smoking is associated with an elevated risk of new onset of panic attack, according to
study results published in theDecember issue of Archives of General Psychiatry.

Although there is no real evidence to suggest that smoking can cause panic and Anxiety, its use
does aggravate the condition.

Try cutting down or giving up and see for yourself what difference it makes.

Exercise
A minimum of three to five times a week of some form of exercise is recommended. This should
include a cardiovascular workout as well. Exercise uses up excess adrenaline as well as
producing relaxing endorphins.

Although you may not feel like exercising, you can make significant progress with Panic and
Anxiety once you start a regular exercise program.

I was not originally a believer in this but decided to go on a diet and thought that exercise was
probably going to help as well. So, I embarked on a daily exercise program. I do either an hour's
aerobic workout video or go swimming for 30 - 40 minutes every day.

Wow - the difference this had made to my Anxiety and Panic. I had no episodes of Panic again
until a death in the family brought them back to a small extent, but I generally feel so much
better for it. I never believed that it would ever help but the results are amazing and I now wish I
had done at least some exercise years ago.

Please give it a go and see how you get on - I wish I had taken my own advice years ago !

Mind-body workout

Explore the possibilities of meditation, hypnotherapy and other forms of healing such as Reiki
(laying-on-of-hands) and yoga. I have tried both of these so click on the links to read about my
experiences.

Nutrition

This is the cornerstone of good health. Cut out fats and processed foods and eat fresh greens and
white meats instead. It's easier than you think - two weeks is all it takes to recondition your taste
buds for a lifetime of benefits and well being.

Take your vitamins

The B vitamins are stress relievers, so start on a course of Vitamin B complex. Other vitamin
supplements you could incorporate in your diet that have been found to be helpful are
calcium/magnesium (for palpitations) and omega-3 fatty acids.

Did you ever wish that you could take a vitamin for depression? Well, for some of you it may be
just that simple. There are a variety of vitamin deficiencies that can lead to depression
symptoms.

The B-Complex Vitamins

The B-complex vitamins are essential to mental and emotional well-being. They cannot be stored
in our bodies, so we depend entirely on our daily diet to supply them. B vitamins are destroyed
by alcohol, refined sugars, nicotine, and caffeine so it is no surprise that many people may be
deficient in these.
Here's a rundown of recent finding about the relationship of B-complex vitamins to depression:

 Vitamin B1 (thiamine): The brain uses this vitamin to help convert glucose, or blood
sugar, into fuel, and without it the brain rapidly runs out of energy. This can lead to
fatigue, depression, irritability, anxiety, and even thoughts of suicide. Deficiencies can
also cause memory problems, loss of appetite, insomnia, and gastrointestinal disorders.
The consumption of refined carbohydrates, such as simple sugars, drains the body's B1
supply.
 Vitamin B3 (niacin): Pellagra-which produces psychosis and dementia, among other
symptoms-was eventually found to be caused by niacin deficiency. Many commercial
food products now contain niacin, and pellagra has virtually disappeared. However,
subclinical deficiencies of vitamin B3 can produce agitation and anxiety, as well as
mental and physical slowness.
 Vitamin B5 (pantothenic acid): Symptoms of deficiency are fatigue, chronic stress, and
depression. Vitamin B5 is needed for hormone formation and the uptake of amino acids
and the brain chemical acetylcholine, which combine to prevent certain types of
depression.
 Vitamin B6 (pyridoxine): This vitamin aids in the processing of amino acids, which are
the building blocks of all proteins and some hormones. It is needed in the manufacture of
serotonin, melatonin and dopamine. Vitamin B6 deficiencies, although very rare, cause
impaired immunity, skin lesions, and mental confusion. A marginal deficiency sometimes
occurs in alcoholics, patients with kidney failure, and women using oral contraceptives.
MAOIs, ironically, may also lead to a shortage of this vitamin. Many nutritionally
oriented doctors believe that most diets do not provide optimal amounts of this vitamin.
 Vitamin B12: Because vitamin B12 is important to red blood cell formation, deficiency
leads to an oxygen-transport problem known as pernicious anemia. This disorder can
cause mood swings, paranoia, irritability, confusion, dementia, hallucinations, or mania,
eventually followed by appetite loss, dizziness, weakness, shortage of breath, heart
palpitations, diarrhea, and tingling sensations in the extremities. Deficiencies take a long
time to develop, since the body stores a three- to five-year supply in the liver. When
shortages do occur, they are often due to a lack of intrinsic factor, an enzyme that allows
vitamin B12 to be absorbed in the intestinal tract. Since intrinsic factor diminishes with
age, older people are more prone to B12 deficiencies.
 Folic acid: This B vitamin is needed for DNA synthesis. It is also necessary for the
production of SAM (S-adenosyl methionine). Poor dietary habits contribute to folic acid
deficiencies, as do illness, alcoholism, and various drugs, including aspirin, birth control
pills, barbiturates, and anticonvulsants. It is usually administered along with vitamin B12,
since a B12 deficiency can mask a folic acid deficiency. Pregnant women are often
advised to take this vitamin to prevent neural tube defects in the developing fetus.