How do I help my friend who has panic attacks?
May 7, 2011 5:16 PM   Subscribe

My friend constantly has panic attacks. Is there any coping mechanisms that I can suggest or anything I can do or say as a friend to help him calm down?

It sucks because what will happen is, I'll make plans with this friend a week in advance to do something fun. The entire week leading up to the plan, he's all "hell yeah, can't wait till friday night!" Then come Friday at 8pm he'll call me and tell me he's either running late or decided not to come because he's "having a panic attack". This has happened probably 7 or 8 times now in the past year.

I'm not quite sure what this means, I've been with him when he has had said panic attacks before and it doesn't LOOK like he's having an "attack", he just gets very quiet and doesn't make a lot of eye contact and appears to be in deep concentration (he's otherwise very outgoing), though he can still talk and converse and function and says things like "hold on, I'm just having a panic attack". I'll ask what's wrong, if there's anything I can do, if I can get him some water, and he just says that it's nothing that is specifically bothering him, that he just gets these panic attacks and he always has and he just needs to let them pass. They usually pass in 20 minutes or an hour or so.

Like I mentioned, he is very outgoing and loves to go out and talk to people, but he seems to always have these panic attacks on weekends when we're either about to head on a big night out or even worse already out at a bar or party or concert. He refuses to see a therapist* but is on meds. I've known him for the better half of his life and while he has been stressed out about things before (school/career) he's never faced serious trauma or anything. My questions are:

- Is there anything I can do at the moment he has a panic attack? Do I rub his back and tell him he'll be okay? Do I try to change the subject and get him talking about something else so he can get his mind off of it? People who have panic attacks, how do you cope? What would you like your friends to do?

- How do I proceed with making plans with a friend who has panic attacks 25 percent of the time? He loves going out, he's the one who invites me most of the time, but - and yeah I'm probably going to hell for saying this - it just sucks getting my plans blown for this all the time.

People who have chronic panic attacks, please help me understand what my friend is going through.

*I anticipate someone answering with "your friend needs to see a therapist". Let me just say this now for the sake of getting it out of the way: Yes, I know.
posted by anonymous to Human Relations (17 answers total) 7 users marked this as a favorite
For one, don't touch him (i.e. rubbing his back or offering a hug). A lot of people with panic attacks will just get even more stressed by touch. They may just be really focusing on trying to pull things back together. If he's open to it, you can suggest breathing in very slowly and then breathing out very slowly at least up to five times.

If you're tired of having your plans get wrecked, maybe you need to find a time that's not right before the weekend to just sit down over coffee and talk about the situation and how it's affecting you. You can't force him to see a therapist, but you can say that you're going to have to start making weekend plans on your own if it's too much for him to handle. He may just figure that you're OK with this if you haven't said anything to him.
posted by Wuggie Norple at 5:28 PM on May 7, 2011 [1 favorite]

It sounds like he's already found his coping mechanism. When he's withdrawn and in deep concentration he's probably unconsciously using CBT techniques to talk himself out of the panic attack.

Back when I used to get them I would have to concentrate very hard and continually tell myself that it was just a panic attack and that I was not dying, there was nothing wrong with me, that it would all pass, etc. Eventually I learned to talk myself out of them before I even had one, and I haven't even been close to a panic attack in 8 years or so.

My panic attacks would start with a weird mental feeling that I would then fixate on, and my pulse rate would rise, it would feel like my heart was beating out of my chest, and then I would panic and fixate on my heart rate, which drove it higher and it was this huge ridiculous panic spiral.

Sitting still and concentrating on calming myself down instead of on the panicky feeling is what brought me back. And that might be what your friend is doing.

It was embarrassing when it happened around other people I didn't know well, which could be why he's avoiding going out - maybe coupled with some social anxiety (you can be outgoing and still have social anxiety). But at the same time, being around safe people was comforting, because I was TERRIFIED of having a heart attack and dying alone.

I did NOT want special attention or really, even any attention at all. Knowing someone was there with me was enough. Drawing attention to it heightened the embarrassment.

So if you're with your friend and he's having a panic attack, just tell him you're there for him, ask him if you can do anything for him, and then leave him be. He's dealing with it as best he can.
posted by elsietheeel at 5:29 PM on May 7, 2011 [7 favorites]

I think the best thing you can do is ask him (when he's not having a panic attack) if there is anything you can do for him when he is having one that would help lessen the effects or help the attack pass. Not everyone reacts to panic attacks the same way, so the advice you get here might be off base. I, for one, generally feel a need to get outside when I'm having a panic attack, and will go out for a brisk walk. Other people need to be still. I don't like being touched at all if I am having a panic attack; it just makes me feel closed in and more panicky.
posted by Felicity Rilke at 5:35 PM on May 7, 2011 [2 favorites]

Knowing someone was there with me was enough. Drawing attention to it heightened the embarrassment.

Very true. I get them. And I'm very outgoing - I'm a bartender. I never get them at work, but I get them at other bars. It's embarrassing, it's frustrating, it's the second most awful feeling in the world - the first most awful is knowing how "irrational" it all is.

I used to back out on plans all the time. Now I just don't make them. I love my friends dearly, but I'm very clear that I don't like making plans in advance. Perhaps this has limited the number of people I can be friends with, but those that i've got are incredible. We hang out on a moments notice, and we do it for however long we feel like.
posted by special agent conrad uno at 5:36 PM on May 7, 2011

Usually when I have a panic attack I feel like I can't breathe. My heart starts racing and I get dizzy, sometimes nauseated. To a casual observer it might just look like I've lost my train of thought, or stumble a little when I walk. If it's really bad I might need to sit down until it passes, I've even blacked out a few times.

There are some things that I know are attack triggers. Other times the attacks come on for absolutely no reason. It can be scary to be in a new environment where I don't know what will be happening or where I know there may be triggers.

After the panic attack has passed I feel completely exhausted. The same kind of exhaustion I get when I'm getting over the flu, not the good kind of exhaustion like you'd get from exercise. If I've had an especially bad panic attack it can take days to recover.

I'm with special agent conrad uno, plans in advance usually don't work out. Don't get me wrong, I like making plans. I'm a planner-type person by nature. The problem with plans in advance is that the more time I have to think about it, the more time I have to work my self up for no reason.

If you want to go out with your friend on Friday at 8, don't call him until Friday at 7:30.
posted by TooFewShoes at 5:46 PM on May 7, 2011 [2 favorites]

When you make going-out plans with your friend, include the possibility of an easy way out/home for you two or just him in the plan. "Hey friend, we're going to the club on 25th street on Sat. 9pm. Wanna come? Also, there's a subway station right across from the pub should you decide you want to leave or you want to go do something else. It's no problem and I won't give you a hard time about it if you feel like bailing."

When I used to get panic attacks regularly, I sometimes bailed on outings because A) there's nothing worse than having a panic attack and being sick and shaky in a hip, public place, far from home and no way to get there for hours; not to mention all the drunken "Noooo, don't leave, you should stay and PARRRRTTTTYYYY!!!!!", and B) the thought/reality of all that would trigger a panic attack.
posted by iamkimiam at 6:17 PM on May 7, 2011

Having a panic attack when you're home is awful, having one away from home is about a bazillion time worse :( I hate that shit. For me, and I think many, each attack is not triggered by a specific thing that I could point to, although over time you get used to trends in how they are triggered. It sounds like your friend is getting them frequently, it's probably really interfering with his life. Your patience with his bailing on plans might go a long way in helping him not feel pressured about going out.

I agree that drawing attention to it in the moment is anti-helpful, at least beyond "can I get you anything/do anything for you?" Having someone get me some water was often helpful. I don't get panic attacks very often anymore, but when I got them all.the.time, diversion was almost always the key to get me out of them more quickly, getting my mind OFF how awful I was feeling. I also agree with others that the longer range the plans, the more likely I was to, at some point, have to back out, while last minute plans more often worked out fine.
posted by upatree at 6:44 PM on May 7, 2011

This sounds EXACTLY like my panic attacks. I've been told I look like a deer in headlights. I don't move a lot, I'm quiet, etc.

It's possible that the medication he's on is not enough or not the right kind. Talk therapy honestly did not do anything for my panic attacks except convince me to go on medication. Is he on something that he takes every day at the same time, or does he have something that he can take as needed (i.e., klonopin, xanax, etc.)? Some people do develop a dependency on benzodiazopenes, but I only take them when I really need to, and they work very well. It calms me down just enough so I can get out the door. Once I'm at the party/whatever, I'm generally OK. Mindfulness meditation and deep breathing techniques have also helped me a lot.

Ask him what's likely to trigger an attack. Some triggers for me: feeling like I'm going to make someone else late or cause some serious consequence by being late (e.g. missing a plane). Feeling trapped (e.g. seated in the middle of the row at the symphony). Feeling like the center of attention or put on the spot.

You can't necessarily do anything about his triggers, but just being aware of them can help you identify when he's having an attack. Maybe he can use a codeword, if you're out with other people, so he doesn't have to explain himself to the whole group. When he's not having an attack, sit him down and ask him what he needs from you when he does. From my husband, I want a hug. Anyone else needs to leave me alone or distract me with unimportant conversation. Just tell me a story that I don't have to respond to in any way or even really listen to - like a sporting event you watched. When I snap out of it, I'll respond and then you'll know I'm OK. But don't take it personally if my eyes glaze over, because I'm focusing on calming down.

I feel an overwhelming need to get to a "safe place," which can vary depending on the circumstances, but everyone and everything seems like an obstacle when I'm having an attack. The best thing you can do is stay out of the way. Don't touch, don't suggest, don't rush. I know what I need to do to calm myself down.

I am certain that he feels really badly for bailing on you and I'm sure he wishes he could come out more. Gently suggest that he talk to his doctor about different medication, and tell him to tell the doctor that the attacks are impeding his ability to live his life. Tell your friend that you understand it's difficult for him, and try not to pressure him about being late. Make plans that don't require you to be there at an exact time - dinner, museums, parties, etc. Make plans with a group, so if he doesn't show, you're not going alone.

Read the Anxiety and Phobia Workbook, which explains what causes anxiety and how to treat it. Then give it to him. Tell him that you know he doesn't want to go to therapy, and that's cool, but that desjardins said this book would really help him.
posted by desjardins at 7:11 PM on May 7, 2011

Nthing that it does, in fact, sound as though he's having panic attacks. When I have them in front of other people, I also get very quiet, my eyes probably widen (because closing them makes me dizzy), and I have to concentrate very hard on making myself feel better. When I'm around friends or other people I trust, I can tell them what's happening, and they respond by telling me everything is going to be okay and not to worry, even if they or I don't precisely know what's wrong. My partner hugging me tight or holding my hand also helps, but I don't think I could handle that from a friend. When I'm around people I don't know, the panic is magnified because I have to concentrate on looking or seeming normal rather than doing the mental steps that calm me down.

Social situations that bring me to places I don't know, and/or surround me with strangers tend to be triggers, especially if I'm experiencing some sort of upheaval or big change in my personal life, even though I'm very outgoing. Other triggers are pot and bad hangovers (so I no longer smoke pot or drink very much). You might want to ask your friend what situations cause him to feel anxiety and adjust your time together accordingly. (However, tread carefully--sometimes discussing my triggers or describing my panic attacks will cause me to have one. If he wants to stop talking about it abruptly, don't take it personally.)

I think you're being a good, understanding friend to even ask this. I hope you guys can figure it out and remain buddies.

(Also, thank you for asking this question and helping me realize just how normal my panic attacks are--although they still suck.)
posted by swingbraid at 8:39 PM on May 7, 2011

I recommend your friend see a doctor for med checkup; Prozac caused panic attacks for me. Appropriate medication is critical. I had a panic attack in a therapist's office. That was really helpful because she gave me some useful tips. Xanax is often recommended for panic attacks; it can be taken under the tongue for faster delivery. Another help is a cold wet washcloth on the face; it triggers physiological changes that really help. Relaxation techniques and meditation can help, too.
posted by theora55 at 9:20 PM on May 7, 2011 [1 favorite]

I asked a question about my own panic attacks a while back. Some of the advice there may help by proxy.

I also will not make eye contact while having a panic attack. Unlike some of the suggestions, if someone I know well and trust offers a hug I will cling to them like a son of a bitch. I just warn them that I'm going to cry like a baby and embarrass the crap out of myself in the process; luckily I have great friends and they don't seem to care. (If they do, they keep their traps shut.)

Panic attacks can come in all kinds of forms, and for the weirdest reasons, and the solutions are just as varied. I nth the suggestions that you could ask him (perhaps when he's not having a panic attack) if there's anything you can do to help in those instances. Whether that's get him a drink of water or fend off anyone trying to be SuperBuddiestm with him, he'll probably be super appreciative just for the asking.
posted by Heretical at 11:01 PM on May 7, 2011

He sounds like he's coping as best as he can - I'm not sure there's much more you can do other than to be patient and understanding.

Touching is never a good idea nor is making a big fuss over it. Even asking if someone's okay can prolong it. It's usually best to ignore it and be understanding. It just is what it is.

If his big issue is planned events, do less planned activities.

And while it might be irritating to you that he bails, just think of the torture he's going through.

You say, though, that you've known him most of your life but that he's bailed on 7-8 occasions in a year. If that's a sudden increase from usual, something has happened - not necessarily anything traumatic - but he might be going through a rough time. Socially-induced panic attacks are often related to a loss/lack of self worth (perceived or actual) in some capacity - the big ones are job/career, marriage, middle-age. He could just be more sensitive to how he is 'seen' by others and that's why his nervous system is freaking out on him.
posted by mleigh at 12:49 AM on May 8, 2011

I have canceled many plans and lost most of my previous jobs because of panic attacks. As far as what works for getting out of them, it's different for everyone. In my case, distraction tends to help -- either getting into a completely unrelated conversation (which doesn't always work, because communicating can cause more panic, oftentimes) or watching certain movies or TV shows (True Stories or The Muppet Movie can usually pull me out). But, for the most part, there really isn't anything anyone else can do. Water is nice. Usually touching isn't very helpful.

I have a very close friend, let's call her K, who is also prone to panic attacks. What we do is this: whenever we make plans, we make them with the understanding that either of us can bail on the other, either beforehand or during, for any reason whatsoever, with or without a phone call. Also, we tailor our meetings to our situation: if we're planning on going somewhere, it'll either be a place where either of us can be comfortable without the other person, or we'll meet up at one of our houses first. Furthermore, whomever of us is doing alright will call the other person before heading out -- if there's no answer, we assume the other person is not okay and the plans are off. So, if K is supposed to come by my house so we can head out and get coffee, and she doesn't show up, I know that she's not coming, and that's okay. If K is doing alright and I'm not, she'll give me a call before heading over to my house, I won't answer the phone, and she'll know that I'm having a panic attack.

What is important to understand is that, through no fault of his own, your friend cannot be completely reliable in this way. Do your best to avoid putting too much pressure on him -- it's very easy for a panic attack to worsen by panicking about having a poorly-timed panic attack.
posted by The Great Big Mulp at 1:02 PM on May 8, 2011

And as for you, it's perfectly fine to make backup plans with other people just in case he can't go through with meeting up. Most likely, he knows that panic attacks can make him unreliable, and, judging from experience, he probably feels awful about that. So, yeah, to reiterate: do your best to keep the pressure off him, and make sure he doesn't feel like he's letting you down by not being able to show up.
posted by The Great Big Mulp at 1:17 PM on May 8, 2011

I also get very quiet and appear to zone out during panic attacks. If I try to keep talking to people during them, I find myself seeming utterly spacey and stumbling over words, saying "uh" a lot, or just trailing off in the middle of sentences. My solution is to hide for a while, if I can. Ideally get home, take off my clothes, and curl up in bed with my eyes closed until I feel better. Distractions just confuse me more and make it worse. I'm highly introverted, though, so that sort of reaction is not uncommon for me when I've had too much social interaction between rest periods anyway.

I find I'm having pretty good luck of late with herbs. My anxiety is WAY up right now because I am coming off of Effexor, so I'm taking 2 or 3 kava pills when I take my medicine in the morning to mitigate the nigh-inevitable anxiety bump from that. If it gets bad later on during the day, I might take more kava, but it usually takes that a while to kick in for me, and it's a relatively mild calming effect. So my Big Guns right now are valerian pills. They smell like stinky feet, but they're very effective (and they also work well for insomnia). I almost always only need one to quell my anxiety. If that doesn't work, another one will knock it out. It sounds like when your friend gets his attacks in public, he manages to get past them pretty quickly, so the valerian might not be useful for those. But when I really REALLY don't feel like meeting a social obligation, one of those half an hour in advance, when I realize it's not going to go away on its own, often does the trick. YMMV, and herbs might sound a bit too dirty-hippy for your friend (especially when he smells the valerian-- ugh). But I decided I would rather go with that than get hooked on benzodiazepines, and so far it's working for me.
posted by Because at 3:03 AM on May 10, 2011

My ex-boyfriend used to have crazy panic attacks often, and would often call me. My therapist father educated me in breathing techniques to pass along. my current boyfriend also has a rare panic attack every few months or so...i think knowing that i'm there, that I understand, and that i'm not freaked out about it reassures him. if your friend has these panic attacks around you, it might be good to somehow let him know that you understand what is happening and that you understand and are not judging him. just ride it out, don't make a big deal of it (no "ARE YOU OKAY?"s). stay very calm, ride it out. don't coddle him, don't rush him, just be calm and be a good friend. this is after you educate yourself on what they are and what they feel like.
posted by custard heart at 7:10 PM on June 2, 2011

also, glass of water is a good idea. and if it's in public, just steer him to a secluded place and stay with him. you don't need to be constantly talking, just reassure the person that you are not in any hurry.

for me personally, when I am going into crazy mode (even if it's just my monthly PMS depression) it helps to be reminded of that. the boyfriend agrees -- sometimes it feels like THE WORLD IS FALLING DOWN, and it helps to be reminded "you are having a panic attack". it puts it in perspective. for me, as soon as i realize "you are having pms depression" it's like, oh yeah, my life doesn't suck, my world isn't falling apart, this is just a biological thing and it will pass".
posted by custard heart at 7:14 PM on June 2, 2011 [1 favorite]

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