Anxiety or nervousness is a natural response to dangerous or risky situations.
However, anxiety becomes problematic when a person experiences moderate or severe anxiety or panic when there is in fact no immediate danger or threat. A panic disorder is the experience of anxiety that is inappropriate; that is, the anxiety is in the form of intense fear or terror that is not in response to any apparent risk or dangerous situation.
People who have a panic disorder have recurrent, unexpected panic attacks. One of the criteria for a diagnosis of a panic disorder is worrying a great deal about having more panic attacks. The person will often do things to try and prevent more panic attacks from happening, or avoid situations that may be difficult to leave if they were to experience a panic attack.
For example, they may avoid driving, being a passenger in a car, or going to movie theatres and places with crowds of people. When someone has panic attacks or a panic disorder, it can have a profound impact on the entire family.
If you are a family caregiver for someone who experiences panic attacks, you are well aware of this impact!
How to recognize a panic attack
Panic attacks are sudden and typically reach a peak within approximately 10 minutes. Those 10 minutes can be the longest 10 minutes imaginable for a person experiencing intense fear or terror and distressing physical symptoms that can be compared to those of a heart attack.
Specifically, a panic attack is when any four (or more than four) of the following symptoms suddenly develop and appear to reach their highest intensity within 10 minutes:
- Intense fear that is not appropriate for the given circumstances
- Noticeably accelerated heart rate or heart palpitations
- Trembling or uncontrollable shaking
- Excessive sweating
- Sensation of choking
- Feeling nauseous or abdominal discomfort
- Heaviness or discomfort in the chest
- Dizziness or feeling light-headed, faint, or unsteady
- Feeling detached from self, from the surroundings, or from reality
- Fear of going crazy or losing self-control
- Fear of dying
- Feeling numb or experiencing tingling sensations
- Feeling chilled or experiencing “hot flashes”
For family caregivers, a 10-minute panic attack can be very distressing. Being able to recognize when someone may be having a panic attack and knowing exactly what to do can be quite empowering.
Become a Mental Health “First Aider”
You can learn “Crisis First Aid” for panic attacks. Mental Health First Aid is a program of the Mental Health Commission of Canada and can be applied to help someone who appears to be having a panic attack. During this pandemic, courses are postponed and will be rescheduled post-pandemic. Until then, here are steps to take if someone you care for is experiencing panic attacks.
As a Mental Health “First Aider,” if someone appears to be having a panic attack, you first call 9-1-1.
In truth, you are unable to know whether the person is having a panic attack or a heart attack. This is because many of the signs and symptoms of a panic attack are the same as for a heart attack. It is important to err on the side of caution even if the person has a history of panic attacks.
Panic attack – what to do
If you suspect that someone you are caring for is experiencing a panic attack, and while you are waiting for medical help to arrive, you can do the following:
- Move the person to a quiet, private location if possible and have them sit down. Alternatively, remove the trigger is possible (such as bright lights than can be turned off).
- Encourage slow breathing (in through the nose and out through the mouth). If you think it would be helpful to use words, you can tell the person to:
– “Smell the roses” (breathe in through the nose)
– And then “blow out the candles” (breathe out through the mouth)
With or without words, it would be most helpful to model this breathing, which will in turn help to keep you calm!
- Listen without judging. The person’s fears may seem unrealistic to you but they are being experienced as real and threatening by the person having the panic attack.
- Explain that it could be a panic attack they are experiencing and not something life threatening. Further, reassure them that if it is a panic attack, it will soon stop and they will fully recover.
- Stay with the person until medical help arrives or the panic attack is over.
Panic attack treatment
Beyond Mental Health First Aid, there are several avenues for treatment of panic attacks and/or a panic disorder. As always, it is best to have a full assessment completed by a health care professional. You can gently and kindly suggest this to the person.
As with depression and other types of anxiety, there are a variety of pharmacologic and non-pharmacologic interventions. The message you want to convey is that there are effective treatments for the management of panic attacks and/or a panic disorder. Self-help workbooks can also be a good starting point. They can be especially helpful for people who refuse to seek out (or allow you to help find) professional help.
The following books on overcoming a panic attack have been recommended by mental health experts:
- Antony, M.M., and McCabe, R.E. (2004). 10 simple solutions to panic: How to overcome panic attacks, calm physical symptoms, and reclaim your life.
- Barlow, D.H., and Craske, M.G. (2007). Mastery of your anxiety and panic, 4th edition.
- Wilson, R. (2009). Don’t Panic: taking control of anxiety attacks, 3rd edition.
As a family caregiver, you can develop your own mastery in being an effective “Mental Health First Aider.” It can be profoundly satisfying to be able to help someone who is literally scared to death.
You might also find it helpful to read “Caring for Someone Who Has Anxiety.”
Have you ever had to help someone having a panic attack? What was that experience like?