How do you power through an anxiety attack and improve your mood?
October 1, 2016 2:20 PM   Subscribe

What do you do when you are having an extremely inopportune anxiety attack and you need to plow through a horrible mood urgently without benefit of medication? Do you have a strategy for a quick turnaround, a hard restart?

I am in treatment and on medication and restarting therapy. Assume for this question that you are out of saving throws, no pills, and no escape from a social situation. My meds help to generally attenuate some of my anxiety, but I really get crushed by situational and unforeseen anxiety attacks. I am ULTRA tired of turning good nights unpleasant, leaving events suddenly, stressing out my partner and embarrassing myself.

If your body is in full revolt, cortisol apocalypse, impossible to smile or laugh, and you can't escape a social situation and you need to turn things around on the spot and climb back up into the world and maybe even resume smiling and enjoying yourself, do you have methods or techniques to do this on the spot and under pressure?

Doubly interested if you have been extremely emotionally sensitive your entire life, always the kid leaving things crying, and still kind of feel that way as an adult.
posted by My Famous Mistake to Human Relations (16 answers total) 41 users marked this as a favorite
I'm so sorry that you're having to deal with this. It can be SO hard to focus and function when your anxiety is 10/10!

Is the treatment you're starting cognitive behavioral therapy? That's the absolute best bet for panic attacks. I'm really sorry to say this, but fast-acting medication--or really, any other method that people will recommend to settle yourself down in the moment--is actually counterindicated for people with panic attacks except in the very short term (i.e., until they can get into exposure therapy) because it worsens the attacks in the long run. Your therapist should work with you to make a list of every possible situation that would trigger an attack, rate them in terms of how distressing they are, and then support you as you intentionally seek out these triggers from easiest to hardest. The key here is to stay in the situations long enough for your anxiety to go down by at least half- which I PROMISE it will. Your therapist will teach you how to rate your anxiety from 0-100 every few minutes while you're staying in the situation so you know when it's time to leave. If your therapy is not focused on these things, it's not the gold standard treatment for panic attacks and I would strongly recommend finding a cognitive behavioral therapist instead.

In the meantime, you can do some of your own prep work. Write down some of the more common anxious thoughts that you're having, with a focus on the anxious thoughts that make you want to leave different situations- like "I can't handle this," "other people think I'm weak," etc. Then, make a list of the evidence for and against those thoughts. Limit the evidence to things that are objectively true and would stand up in a court of law- if others would debate its truth, it doesn't go on the list. Then, think about the absolute worst case scenario you can imagine- everyone you've ever met thinks you're weak, you have a full on mental breakdown and never recover, etc. Consider how likely each of those are- rate them on a 0-100 scale in terms of likelihood. Finally, list different ways that you would cope if those things were to actually happen. Make yourself a cheat sheet with the most helpful information you've come up with on it that you can keep on your phone or in your wallet and glance at when you're mid anxiety attack. There are more strategies you can use to pick apart your thoughts in this worksheet.

I like to think of anxiety as a bully that sometimes shows up and stands there criticizing you. You could punch it in the face (take Xanax or another fast-acting med), but it'll come back with its bully friends. The way to get a bully to go away is to show it that it can get under your skin, so you have to show this bully that it can't hurt you by ignoring what it's telling you to do (i.e., leave the situation), and eventually your anxiety bully will get sick of harassing you and leave you alone. To withstand a bully mentally until he/she leaves for good, it's helpful to really believe for yourself that what the bully's saying is wrong. You can work on this going through the prep work I described, although you'll start to believe that your anxiety bully is wrong as you do the exposure part. It takes practice, but you can do it! You have the strength in you, even if you haven't convinced yourself of that yet.

I wish you all the very best.
posted by quiet coyote at 2:52 PM on October 1, 2016 [9 favorites]

Okay so this is definitely a thing for me (and I am indeed very emotionally sensitive as well), and if i'm in a can't-escape public situation, I do a few techniques:

* Place your hand on a wall and lean into it, then just focus on the pressure on your hand. You can also do this by focusing on the feeling of your feet on the floor
* List off five things that you can see, four that you can hear, three that you can feel, two that you can smell, one that you can taste. This is a good one for when you're in an overwhelming environment but can't shut out the overwhelming stuff - you can try to turn it to your advantage instead
* I carry around a scent or scented oil that I use as a signal to my brain that i'm in a safe place. Every night i use the scent/oil before I go to bed when i'm all cozy, then I carry another tube around so I have a "good" scent that I can use to calm myself. My favourite is Neal's Yard Rose Facial Oil as I read somewhere that rose oil could help reduce adrenaline, but really any scent would do (I also use Caudalie's beauty elixir)
* One time on a plane i got into a horrible panic attack situation like this and ended up using ice to re-set myself -- i put it all over my face, under my feet, in my bra, and the shock of the cold seemed to distract my body enough that I could get a bit of control. I've also heard about people biting into lemons but haven't tried that one yet.
* My number one thing is to do belly breathing when I'm in that terrible wild-eyed mode. I breathe in to inflate my stomach, then breathe out for the same amount of time. There are lots of good apps on your phone that will just play two sounds to help you count, and they're perfect for just grabbing a private moment in the bathroom for a few minutes. Even 2 minutes of this can really help me recover myself. If you haven't ever tried yoga, I can heartily recommend it -- some of the slower vinyasa styles will basically teach you to get yourself into stressful physical situations then learn to breathe to calm yourself down. I've found it sooooo useful for panic attacks.

I'm really sorry that you're having to go through this - sometimes, despite everything, you just need to go home and take care of yourself too, and that's okay.
posted by ukdanae at 3:02 PM on October 1, 2016 [22 favorites]

I recommend a course in Dialectical Behavior Therapy to go along with your one-on-one counseling. That's the longer term solution.

In the immediate situation, I find that the mammalian diving reflex works wonders as a reset. They recommend making sure a doctor thinks your body is fit to do it.

But OH my goodness does it work.

I'm sorry things are crap on your end.
posted by Stewriffic at 3:05 PM on October 1, 2016 [7 favorites]

For the panic attacks that I would have at the mall or other place where I wasn't fit to drive, I would go to the bathroom and very slowly, very gingerly place water on my face. I would do it in a calm, loving way. Usually I was shaking so bad I had to go slowly. Then I smiled at myself in the mirror. Don't judge, accept. This is you! (I used to get so angry with myself for being anxious that I would cry.)

Then I would go in a stall, sit down, and do Thich Nhat Hahn's focus on the breath: slowly breathing in and saying to self or out loud, "I am breathing in." And then slowly, "I am breathing out." I would do this until my heart rate slowed and the shaking stopped.
You could certainly do this discreetly around others, I do it all the time at loud events. I read about it in either Hahn's Peace is Every Step or Everyday Mindfulness.

These days, I carry a grounding stone. Anything that you can put in your pocket or a bracelet to wear that you can rub or touch to ground yourself. Google grounding techniques if you're interested. Sorry you're having a tough time. Hope things get better for you.
posted by It'sANewDawn at 5:15 PM on October 1, 2016 [2 favorites]

For panic attacks I generally remind myself it will end soon and try to focus on something else. I am claustrophobic so by definition most of my attacks happen when I can't go anywhere, often when the subway is crowded and stopped between stations. If I am with people I can talk to, I find that helps distract me but when not, doing something like looking for things that start with every letter of the alphabet or other tasks of that level help me wait the adrenaline out. But remember. This has happened before. You are still alive. You can make it. At least one person (me) knows you can.
posted by dame at 5:53 PM on October 1, 2016 [1 favorite]

Mammalian diving reflex always works for me. If dunking your face in freezing water isn't an option, then splash your face, or get a towel wet and press it under your eyes. Or take a cold can of soda and press it against your face. Even some kind of wet wipe will help, if you are a purse-carrying individual. You want to target this area right here.
posted by AFABulous at 5:56 PM on October 1, 2016 [1 favorite]

I also came here to say mammalian diving reflex. I find the fastest thing to be sticking my head near a tap and letting the water run over everything between my eyebrows and nostrils.
posted by delezzo at 6:41 PM on October 1, 2016 [1 favorite]

Searching for DBT TIP Skills might give you other ideas to try, too.
posted by lazuli at 7:17 PM on October 1, 2016

Try "7-11 breathing"--breath in for seven counts, out for 11. This encourages the activity of the parasympathetic nervous system ("rest and digest").
posted by praemunire at 7:50 PM on October 1, 2016 [1 favorite]

Walk. Your body is in fight or flight mode, so give it an illusion of flight by moving. Your anxiety will fight you on this - it will be all, curl into a ball now - but don't let it. Open your chest, throw your shoulders back, open your arms, move. Drink water. You're In a battle and walking and walking and water are your allies.

Acknowledge your panic. Remind yourself that nobody has 30 heart attacks a week and lives. Use ice cold logic: hello, I recognize this, it's a panic attack, chances are I am not actually dying and also, nobody else can tell I'm having one if I just keep smiling. Remind yourself that this a thing that happens, it has a beginning, a middle and an end. You will come to the end. Count. Do the multiplication tables. Recite poetry in your head.

You can get to a point where you can sense one beginning. That's your best place to stop it. Drink a big glass of water, breathe slowly, keep moving, smile, remember that you are not actually dying and, 1/2 of an excruciating hour later, you may well be able to think again. You WILL be okay. Keep telling yourself that and keep going.

30 years of panic attacks now and I have them mostly moved to a minor inconvenience. It isn't fun. But if you frame it like a battle in your head - "hello, panic. I know you. We are going to walk this through. You are just panic and I am me" (or the Bene Gesserit litany against fear helps too) - you can get through them and out the other side.

Also, klonopin. You don't have to take it - I hardly ever take mine - but knowing you have it nearby if you need it is magical.
posted by mygothlaundry at 9:02 PM on October 1, 2016

This is of course very dependent on who you're with, but I have found relief in briefly blithering on about it. As one might about a sharp headache suddenly coming on. It is, for me, a relaxation technique to simply tell somebody I am in a panic. Depending on their experience with it you might get empathy, you might get a blank look (often the former; loads of people grok anxiety) -- but it doesn't really matter; the important part here is to just offload that bit of information. Then I feel relieved that I no longer have to worry about not acting like a weirdo, because everybody has just been informed that I am indeed feeling weird -- and the pressure's off, and the anxiety abates because of that.

You need a lot of self-confidence, I think, to pull this off effectively -- the delivery should be eloquent and amusing; maybe you can have some go-to quips about how absurd it is that this never happens when you are in a nice hot bath or in the middle of an exercise class or somewhere else thought to help with panic, har har, thanks, panic! Unfortunately even in 2016 plenty of people are skittish about mental illness and rather uninformed and cannot parse it as akin to a headache problem.

But that (unless it is a formal dinner with your partner's boss or some such) is their problem (you will tell yourself) -- you are of course advanced enough to see it as a medical bother and it is no less embarrassing to excuse yourself for a breath of fresh air and a walk around the block (or a quick shot of J├Ąger at the bar, who knows) as one might take to try to offset the threat of a looming headache.

I figured this out after (1) figuring out it was a tremendous relief to tell a friend 'Crap, I seem to have a sort of panic/anxiety thing descending; not sure why, but, just a heads-up in case I seem a bit out of it' and (2) living in a small town where everybody recognises you and it is imperative to be full of small talk at all times, and there are a lot of seniors here so small talk about health woes is very common. "How are you?" "Oh, good, same old! But right now I've got a bit of an anxiety thing going. Heh, maybe I can use it to get something done really really fast! Ha ha."

It's a thing a lot of people experience but not enough people talk about. Tell yourself you are doing the planet a favour by bringing it out in to the open. I have a FB friend, a very smart and accomplished and witty person, who periodically posts updates about her struggles with anxiety. I think this is terrific and told her as much -- that being open about it was a relief for me and undoubtedly many others dealing with the same hassles. The reply was roughly 'thank god, that's so nice to hear, I was afraid I was being a self-obsessed bore.' But in my view it certainly beat updates with photos of expensive food for a good use of social media. You are not alone is a great message.

The advice given for "bad trips" for drug enthusiasts can be useful -- reminding oneself that you are experiencing the effects of panic (where it says "the drug" in those sorts of write-ups) and not reality can be helpful.

IANAD, obviously, but you do sound like a good candidate for a person with a little pill-box with a fast-acting, short-lived benzodiazepine. As mygothlaundry mentions, simply knowing it is there is helpful. I have a prescription for 1mg Ativan tablets. At one point the pharmacy bollocksed up my Rx and gave me half the quantity of it in 2mg tablets, which happened to be almost identical to a muscle relaxant I occasionally take. These sat in my purse for ages and eventually I figured out that I had on several occasions snapped a muscle relaxant in two and put that under my tongue and... It worked. The muscle relaxant in question normally has no mental side effects; I'd done quite well with a placebo. Yikes. Obviously I couldn't go back to not realizing I was taking the wrong drug, but it did teach me that I could take a small part of the 1mg pills and that would still be effective. (If 20 min or so go by and I am still in a bad place, I take more -- not wholly unlike dieting, I suppose.)
posted by kmennie at 1:25 AM on October 2, 2016

From living with someone who has moments like these, a few quick-and-dirty things that have worked sometimes: A cold shower or face-wash sometimes triggers a "morning, new day" reaction that can reset things. A favorite candy saved for emergencies: the familiar taste can trigger a change. Danae's scented oil idea, or a scented talisman (sandalwood works wonders) helps sometimes, especially if you find spa sessions soothing. Violent exercise (jumping jacks, situps, pushups, run around the block) triggers some sort of physiological change sometimes.

Experimenting is good, too, so one of the best things to do is to keep a tiny journal of what works, when. You may find patterns based on the time of day or circumstances that will help you design the perfect antidotes for future attacks.
posted by rokusan at 4:10 AM on October 2, 2016

Best answer: I am the kid who left things crying. I am the adult who used to flip-out and leave things because I suddenly could not deal. I am not that adult anymore. I sympathize.

I try to take a short walk and have a pep talk with myself about WHY these things ALWAYS happen at EXACTLY the time I CAN'T do anything ABOUT them... and then sort of realize that a lot of the thing I think are hard and fast inescapable truths about the world do actually have some wiggle room in them.

So like if I got some sort of puking norovirus like thing, I could leave the party. And this may not be like that but maybe it is. The fallout from having to leave isn't great, but it's also not world-ending bad. So I try to think a little (in a sort of picking at a scab way) WHY I think that I have no options? I am a grown woman, I run my own life and things mostly go my way. Sometimes I feel hemmed in by manners, for example, and I convince myself that being rude to strangers is worse than me having a panic attack. That's dumb. But in the past it made perfect sense. That, to me, is also actually a sign that my meds aren't working or that I'm not taking them properly.

So usually I make deals with myself. "I am going to go into the bathroom and read Twitter and splash water on my face and set my timer for 15 minutes on my phone and then go back out and fake it and if by the time the alarm goes off I am still losing it I will make my goodbyes and leave" because, honestly, I usually think there are more social "rules" that bound my behavior than there actually are.

And it's worth, at a quieter time, talking to your partner about this and trying to figure out of part of this is because TEAM US is not quite on board with some of the things you need in social situations. My partner is very helpful for me when I just need to get the fuck out. It doesn't happen all the time but because my contribution is trying to manage my feelings so that freakouts are rare, his contribution is smoothing the way for me when I'm like "um really I have to leave NOW" and it's the same for me with him where maybe he's had too much to drink. It doesn't happen often but if he does I can be supportive and not grumpy because I know he's usually trying and everyone makes mistakes.
posted by jessamyn at 2:51 PM on October 2, 2016 [2 favorites]

I find the RAIN meditation to be the most helpful in times of crisis:
Recognise the feelings and sensations you are having
Allow them
Investigate what it feels like
Non-identify - you are experiencing the panic, you are not the panic.
posted by daybeforetheday at 1:02 AM on October 3, 2016 [1 favorite]

I have found that if I can make a change in the immediate scene - go from an indoor room to an outdoor space, for example - I can cope best. But if not, I try to look for one visually comforting thing. Even if it is a pleasant wall color, someone's bright clothing, a curved dish or pot - then I can go on, as long as I keep breathing. In places like giant box stores where it's impossible to find even one restful thing to focus on, I usually admit defeat and leave.
posted by tizzie at 8:40 PM on October 6, 2016

Exercise and meditation.

More specifically: weights/cardio. MBSR/Headspace.
posted by talldean at 9:45 PM on October 6, 2016

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