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Panic Self Help

Panic disorder is an anxiety disorder where individuals experience repeated panic attacks. The
normal physical sensations of anxiety are experienced as "dangerous" to the individual who
then believes the symptoms mean they are going to die (heart attack, will suffocate etc).

Naturally, no-one wants these panic attacks, so we may start to avoid situations where they
might occur, and "fear the fear" - we are scared about experiencing the panic attack.
Avoidance can lead to Agoraphobia (from the latin for fear of open spaces), where we avoid
certain places because of the fear of a panic attack and of not being able to escape, which
eventually may keep us from going out at all.

Example of a vicious cycle of Panic

Self Help for Panic Disorder

Cognitive Behaviour Therapy focuses on learning to challenge the unhelpful thoughts and
beliefs, and gradually making changes in our behaviour so that we learn that the feared
consequences do not happen, and that it is anxiety that makes us feel the way we do.

[Link]/[Link] © Carol Vivyan 2015. Permission to use for therapy purposes. [Link]
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In order to break the vicious cycle of repeated panic attacks and/or agoraphobia, we need to
change the way we think, and change what we do. Firstly, we can learn about how any anxiety
affects our body. This is the body's normal response to danger (or believing we're in danger):

 Read Alarming Adrenaline

The main problem with panic disorder is that when those adrenaline feelings really kick in, they
feel like we are really suddenly seriously ill. It can feel like we're choking, suffocating, having a
heart attack. It really feels like we could be dying, right now! Terrifying.

In fact, these physical feelings of adrenaline are normal - it is simply the body's alarm system
being activated in order to help us escape from a dangerous situation. So it feels dangerous,
even if it really isn't.

We add meaning to the thoughts and feelings - we believe the thoughts, and we think the
feelings mean we could be dying.

The feelings will pass. If we could just notice the thoughts and feelings, and not react to them
by believing them to be dangerous in themselves, if we could breathe deeply and focus on our
breathing and allow the thoughts and feelings to come, and go, then the adrenaline will calm
down within a few minutes.

The most effective technique for stopping a panic attack - even before it starts - is to:

 Use STOPP skill

 Focus on deep and slow belly Breathing,
 Let other thoughts and feelings come and go as they will.
 Just notice the thoughts and feelings, then think about your breathing again.
 Once the worst of the feelings have passed, then choose what to do now - where to
focus. Either carry on what you were doing, or do something else - with your full
attention.

THINKING DIFFERENTLY: Challenging Thoughts

If we can change the way we think about a situation or about the normal anxiety feelings, then
we will not feel so panicky. We can learn to challenge those anxiety-provoking
thoughts. Thoughts are not statements of fact. Don't believe everything you think!

 Learn more About Automatic Thoughts

 Learn Fact or Opinion skill
 Learn about The Mind Bully

Thoughts are just thoughts. We look at life, and situations through distorted lenses. Just
because we think we're going to die, or have another panic attack, doesn't mean that is how it
really is! We are looking at the physical sensations of adrenaline or going out or to certain
places or situations, through those very distorted lenses.

 Read: Different Perspectives

Learn to challenge the unhelpful and distorted thinking:

 Use the Vicious Cycle & Alternatives to map out your own thoughts, feeling and
behaviours, and generate some healthier alternative thoughts and behaviours.
 Use this Panic Thought Record Sheet to help learn to challenge the thoughts
 Practise STOPP skill
 Learn to use Positive Coping Statements

[Link]/[Link] © Carol Vivyan 2015. Permission to use for therapy purposes. [Link]
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THINKING DIFFERENTLY: Re-Focus

When we think about being in a situation or when we start to feel anxious, our focus of
attention gets totally caught up in our own thoughts and feelings. The physical feelings of
anxiety just makes it worse, as we start to believe we could be dying. It can be a horrible
experience which leaves us feeling battered and exhausted - we just want to escape that
situation to stop the feelings - and avoid repeating them!

It is very helpful to learn how to change our focus of attention and take more control over how
we react to thoughts. We can learn to just notice the thoughts and physical sensations of
anxiety, acknowledge them, then let them pass. Notice the Mind Bully and let it go - turn your
focus of attention to something else. First of all, you might learn to focus on your breathing.

 Practise Mindful Breathing

Then you might learn and practise Mindfulness skills and Mindful Activity. It's important to
practise these skills frequently, every day, so that when you NEED them, you'll be able to use
them effectively.

NOW
Notice: Where my attention is

Observe: What I’m doing. Think: “I am walking”, “I am sitting",

“I am breathing”, then notice those sensations in your body

Wise Mind: What now? How shall I continue? Doing or Being?

NOW: Mindfulness for Busy People leaflet

MINDFULNESS FOR BUSY PEOPLE

 Choose an activity to do mindfully throughout the day, for one, two or five minutes. For
example: Drink a cup of tea. Walk. Wash the dishes.
 Whatever you are doing, be in that moment, right now. See, hear, smell, touch, feel,
breathe.
 Simply notice whenever other thoughts and sensations come to mind, then re-focus on
your chosen mindful activity.
 Be patient and compassionate with yourself.
 Describe… rather than judge good or bad, pleasant or unpleasant.
 It is as it is.

Everything Flows. Nothing is fixed. Heraclitus

NOW: Mindfulness for Busy People leaflet

See the mindfulness handout for more examples

[Link]/[Link] © Carol Vivyan 2015. Permission to use for therapy purposes. [Link]
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Doing Differently

Our usual strategy for dealing with social anxiety, is to avoid social situations. However, that
just serves to keep the anxiety and panic going because we never find out that things will be
ok.

Use the Avoidance worksheet to gradually face your fears

Slowly, we can change what we do. Use the Avoidance worksheet to identify what you don't
do or where you don't go, then start by gradually exposing yourself to the least feared situation
in the list, using healthy coping strategies in those situations.

It's important that you see the situations through - stick with the anxiety - it will pass.

Use STOPP skill to incorporate all these strategies

STOP - just pause for a moment

Take a breath - one slow deep breath
Observe - there's the mind bully again. My body and mind is reacting to the thoughts and
anxiety feelings.
Pull back - this is just the anxiety talking. Don't believe everything you think! Let's stick with
the facts - these thoughts are just opinions (Fact or Opinion). These feelings are normal - it's
just the body's alarm system doing its job, when it doesn't need to. These feelings will pass.
Practise / Proceed - What can I do right now? I can use these strategies:
 Mindful Breathing
 Panic Thought Record Sheet
 Avoidance Worksheet
 Positive Coping Statements
 NOW: Mindfulness for Busy People
Where can I put my focus of attention right now? (Mindfulness & mindful activity). What
else can I do that would help me tolerate these thoughts and feelings without reacting to them?

Complete your own STOPP Worksheet

[Link]/[Link] © Carol Vivyan 2015. Permission to use for therapy purposes. [Link]