The dos and don'ts of intense anxiety and panic
When mindfulness is not enough
Anxiety is one of the most common issues bringing people to see me in the therapy room.
It has also been an old and faithful friend throughout my life. Mostly, it has lived in the background, but every now and then it has hijacked centre stage.
People often offer very generic advice about anxiety management, such as telling you to practice mindfulness or deep breathing. This advice is well-intentioned, but while many of these tools can be great for mild to moderate anxiety, intense anxiety or panic is a somewhat different beast and often requires a different approach. Tools that can work with mild anxiety, like noticing body sensation, or counting your breath, may send you into a spiral of struggle and hypervigilance, and exacerbate panic.
You would need to be something of a Zen master to sit through a panic attack on a meditation cushion - trust me, I tried it.
I was mid-20s, mid-exams, and stress was mounting like the inside of a pressure cooker. Everyone seemed to be saying that meditation was good for stress, so I took myself to a lunchtime drop-in class at the London Buddhist Centre to try out meditation for the very first time. Seated on my cushion in a room full of strangers, guided to focus on my breath and body, with no escape, no distraction, nowhere to wriggle or move the mounting restless energy, and minimal guidance from the teacher, proved to be half an hour of sheer, unadulterated hell. Heart racing, sweating, nauseous, and desperate to run from the room before I completely humiliated myself, I white-knuckled it through the class. It was another decade before I seriously attempted meditation again.
Meditation has since become an important part of my life and self-care, but I generally don’t recommend it to someone who is in the midst of extreme anxiety, unless they are a very seasoned meditator. It can be a profoundly helpful practice once we've built the muscle, but beginning in the midst of panic is probably not wise. This is where generic advice about practicing mindfulness and breathing can often miss the spot.
When it comes to intense anxiety or panic, it’s helpful to remember that the fight/flight response in the body is preparing us for speed, strength, and movement. We need to work with what’s naturally happening. Movement can be a useful and necessary way to discharge this response and move the energy through the body, allowing the natural stress response cycle to complete itself. Seated on a cushion, there is nowhere for the energy to go.
We need to understand how our nervous system works, to understand what it needs.
Here are my dos and don'ts for intense anxiety and panic
Do move your body - power walk up a hill, shake, dance, do some mini cardio to move the energy. Walking is especially helpful due to its left-right rhythm, which balances the hemispheres of the brain.
Do put a cold pack over your eyes - fridge temperature is good - it helps trigger the dive reflex1, which will slow your heart rate and metabolism (and of course, some people swear by cold water plunging for the same reason).
Don’t try to force deep breaths – it tends to create struggle and a feeling of being unable to breathe.
Do focus on breathing out. We are usually over-breathing or breath-holding in these moments. Emphasising the exhale helps release both.
Don't believe all the thoughts and stories in your mind that say you can't bear this, it will never end, you will die.
Do trust that you will survive this, and the moment will eventually pass.
Do look for the people who can stay calm and steady in the face of your panic.
Do place your hand somewhere on your body, perhaps your heart, and receive the warmth and contact of this touch.
Do wrap yourself in a heavy blanket, find some weight, and contact (hugging a pillow or yoga bolster can help).
Do connect with your surroundings and your five senses- the things you can see, hear, smell, taste, and touch.
Do connect with nature if you can – lean your back against a tree trunk, find a view of the horizon or water. Feel your bare feet on grass, or your hands in the earth.
Do validate yourself - this is hard, it’s intense, it is downright f-ing awful. It’s not helpful to add shame, judgement, and self-hatred to your load.
Don't get too caught in the thoughts and stories spinning in your mind about your life. Know that you will access different stories when your state shifts.
Do remember this is human. Many of us will experience moments like this at some point in our lives.
Do build your toolbox of strategies for these moments, but don’t hold them too tightly. Some days nothing seems to work, and we need to ride the storm until it passes.
Do remember, it always passes.
And if intense anxiety or panic are happening frequently, do consult a therapist. There are reasons why it is surfacing now, and sometimes it helps to dig a little deeper. Anxiety can show up when we're avoiding feeling something significant, (like grief or anger), when we've experienced trauma in our history and the nervous system is stuck in a historic survival mode, when we're exhausted and depleted but running on adrenaline to keep going, or when our intuition is trying to tell us something is seriously out of kilter in our lives. It can be exacerbated by hormonal imbalances, sleep deprivation, and caffeine, alcohol, or mood-altering drugs. There are ways to work with each of these types of scenarios, and a good therapist can help you figure out the particular roots and patterns that are showing up for you.
It helps enormously to be companioned on that journey by someone steady. We are wired to co-regulate our nervous system with the people we’re in close contact with. Finding the solid, calm presence of another helps us to first experience, and later internalise, that capacity for soothing and grounding.
Thank you for reading. Do pass on this post to others who may find it helpful. And I’d love to hear your own experiences and what you have found helpful (or not) in moments of extreme anxiety or panic.
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Disclaimer - Content is intended for educational and entertainment purposes only, and is not a substitute for individualised mental health treatment or advice.
The dive reflex is triggered in the body when we suddenly plunge into ice-cold water. For survival purposes, your metabolism will shift, slowing your breathing and heart rate and sending blood flow towards your core (i.e., it triggers the opposite physiological response to intense anxiety).
I'm a sucker for anxiety articles. They are mostly fluffy and repeat what's easily found on the internet, but this one was different (expected nothing less from you, of course). It's amazing how much a panic attack convinces someone they are dying. I used to get them at the start of perimenopause (back then I had no tips as it was all new to me), but now I know better and your tips are spot on.
Great advice, Vicki - and I love the tone of voice here as well.