Tactics for acute anxiety attack

October 31, 2019 8:21 AM

Last night, while I was feeling very anxious, my husband helped me by asking me to go through the “evidence for the counterfactuals” (ie take my anxious thoughts, think of the opposite thing, and then find evidence for this opposite thing). It was very effective at breaking the cycle in the moment. Do you have other short-term tactics like that? Please note: I am not looking for long term tactics as anxiety happens to me more like a coughing fit than a chronic cough.
posted by CMcG to Health & Fitness (12 answers total)

Cold water on the face activates the diving reflex, and is a good way to manage a panic attack. There is no adverse effect of a very cold wet washcloth on the face.
Stimulating the vagus nerve seems to affect anxiety and possibly inflammation, research is ongoing. Use caution with some forms of vagal stimulation, as it could make you dizzy if you overdo it.
posted by theora55 at 9:15 AM on October 31, 2019 [6 favorites]

Once when I was driving home from a stressful thing I had a major panic attack and I kept repeating to myself ‘Breathe in breathe out’ and reminding myself that it was a panic attack and I would survive it. I recited physical things and told myself aloud they were all related to the current panic attack, ie racing heart, shortness of breath, sweaty/clammy hands etc. The attack didn’t magically end but I was able to continue driving safely home.
posted by RichardHenryYarbo at 10:13 AM on October 31, 2019 [2 favorites]

4-7-8 breathing was really useful to me for disrupting panic attacks when I was having a lot of them, years ago. You've described a more cognitive thing but you might find this helpful just the same.
posted by less of course at 10:31 AM on October 31, 2019 [2 favorites]

I’ve seen 54321 grounding work really well.
posted by jameaterblues at 10:48 AM on October 31, 2019 [6 favorites]

"and then what?"

If I don't finish this report my boss will be mad. And then what? I'll get written up. And then what? I'll have to be put on a performance improvement plan. And then what? I might get fired. And then what? I'll have to find a new job. And then what? My new job might suck more than this one does. And then what? I guess I'll just learn to live with that or I'll find a different job. And then what?

This works for me to run things to their worst possible scenario (which is my natural tendency). Ultimately I realize that the worst possible outcome isn't as bad as I imagined it, and likely won't happen anyway. But it's helpful for me to know just how bad it could possibly be.

My anxiety attacks aren't sudden like what you're describing, so I don't know if you could do this in time, but I find it helpful.
posted by spikeleemajortomdickandharryconnickjrmints at 11:25 AM on October 31, 2019 [2 favorites]

In a similar vein to jumping jacks: my therapist said that panic attacks are because our flight-or-fight mechanism springs into action, and we get a lot of adrenaline pumping through our veins, but it has no where to go. She suggested clenching and unclenching my fists and other muscles to use up that adrenaline. I imagine that's why the jumping jacks work, too.

So you might try something physical and vigorous.
posted by bluedaisy at 11:29 AM on October 31, 2019 [1 favorite]

Best answer: I created an infographic for prompting questions to deal with anxiety along the lines of what your husband was doing that might be helpful.

Also, PSA: grounding and diving reflex strategies are fine for really rare anxiety attacks or when it's dangerous to have a panic attack or flashback (e.g., when driving), but aren't meant to be used as a go-to strategy for PTSD flashbacks or panic disorder. In general, strategies like these that aim to distract you from pathological anxiety in the moment tend to maintain the anxiety over time. It's preferable to either let the anxiety come down naturally on its own or face the anxiety directly via the kinds of prompting questions in the infographic I linked to. I think these kinds of strategies entered the public consciousness via DBT but DBT's pretty clear that you're supposed to use them basically when you don't have another option.
posted by quiet coyote at 2:23 PM on October 31, 2019 [7 favorites]

The classic move for grounding yourself is to find 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and one thing you can taste. For some reason I hate this but my version is noticing everything red around me, then everything orange, then everything yellow, etc. I think this has a dual benefit in that it makes you focus on your surroundings instead of your thoughts and it also takes you through the spectrum into "calmer" colors.
posted by babelfish at 4:53 PM on October 31, 2019 [4 favorites]

Nthing 54321. Contrary to quiet coyote, I did use it as a go to strategy in the worst of my PTSD times. It was taught to me by my psychologist. It did help ground me so that I could go on with what I was doing. It made me focus on the literal world rather than what was going on in my head. It worked a crap ton better than the Xanax my psychiatrist gave me for panic attacks. This was in the context of intense therapy, so YMMV.
posted by kathrynm at 7:01 AM on November 1, 2019

I cannot verify if this is medically accurate, but a therapist told me one time that it's impossible to have a panic attack while you're doing jumping jacks.

It is not medically accurate. The only times I have had such an attack, I was in the middle of running on a treadmill and was forced to stop because you can't keep running if you're suddenly having trouble breathing.

I think this kind of instruction is given out in the hope that it works if you believe it, but unfortunately if you do believe it and then do have a panic attack mid-exertion you are much more likely to panic even more and conclude (logically! not from panic!) that you must be having a genuine stroke or heart attack since it's 'impossible' for it to be only what it feels like.

This is not to say that taking a fast walk in the outdoors is not a useful calming method and distraction, it definitely is.
posted by queenofbithynia at 2:38 PM on November 1, 2019

quiet coyote's strategy reminds me of a CBT technique called a thought record

I do mindfulness meditations regularly, and find that doing a progressive muscle relaxation or body scan really calms me down.
posted by radioamy at 9:44 PM on November 2, 2019

Nthing 54321. Contrary to quiet coyote, I did use it as a go to strategy in the worst of my PTSD times.

Yes, these strategies work well in the short term, but can maintain PTSD/anxiety when used as a go-to strategy over time (this is also true of Xanax). A lot of well-meaning therapists don't realize this.
posted by quiet coyote at 3:20 PM on November 4, 2019