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«Controlling Panic Recognising changes in your breathing & Face the fear Giving up ‘Safety Behaviours’ Sponsored by Charlie Waller Institute from ...»

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Workbook for session 2

Controlling your body, actions & panic.

Session 2 teaches you these new skills and is in 2 main


Controlling Panic

Recognising changes in your breathing


Face the fear

Giving up ‘Safety Behaviours’

Sponsored by Charlie Waller Institute from a donation made by the

James Wentworth Stanley Memorial Foundation

© Dr Jim White 2007


Controlling your panic

Panic attacks are common in stress. For some, panics may be the worst part of stress. This section teaches you ways to get on top of panic. It will also teach you ways to prevent panic.

Even if you have not had a panic, you will find the skills taught in this session will help with your stress.

This section is in two parts:

PART 1: Finding out about panic  What is a panic attack?

 Types of panic  Who gets panic?

 Thoughts, Actions, Body  Breathing © Dr Jim White 2007

-1- www.talkingtherpaies.berkshire.nhs.uk PART 2: Fighting panic  Work out the problem  Control your breathing  Control your thoughts  Control your actions  Reduce the risks  What to do in a panic © Dr Jim White 2007

-2- www.talkingtherpaies.berkshire.nhs.uk

1. What is a panic attack?

The word 'panic' comes from the Greek God Pan. Pan would lie in wait for people in remote mountain passes. He would jump out at them and frighten them to death. Hence ‘panic’ means being in a state of terror.

Though they cause great stress, panics are not dangerous.

When you have your first few panics, you may fear you are going mad. You may call out your GP. You may rush to hospital as you fear you are having, e.g. a heart attack or stroke. Panics can last from a few seconds to a few hours and may leave you feeling shaken, tense and tired out. You may find your life revolves around trying to stop the next panic.

We can look at the way panic affects many people


You will feel a rush of fear and feel that you are losing control. You will feel that something awful is about to happen to you even though you may not be able to say what that thing is.


You may avoid going places where you think will bring on a panic. You may avoid doing things for the same reason.


The body reacts in much the same way as to stress. But the symptoms will be much stronger.

Your heart rate can almost double in a few minutes in panic. That has such a strong effect on the rest of the body, it is no wonder that it can fill you with terror.

-3Panics you can predict You may think that if you have had a panic in a busy pub, you will panic if you go back to that or any other pub. You may think that if you get angry or exert yourself you will upset your body and you will panic.

You must face these fears if you are to get better. Think of using the skills about controlling thoughts and actions to cope with this.

Panics you can’t predict Most panics seem to happen out the blue. You may feel OK. Then, for no reason you can see, you can be in a state of panic. This may lead to great fear as you feel you have no control. As you can't predict when a panic attack could hit you, you don't know how to prevent the next one.

Sometimes the fear of having a panic is as bad as having it.

Night time panics You can wake from sleep in a panic attack. These 'nocturnal panics' are common in the first few hours of sleep. The most common signs are shortness of breath, racing heart, hot and cold flushes, choking feeling, trembling and a fear of dying. You may fear going to sleep due to your fear of having such a panic. You may sleep with the window open as you think there is not enough air in the room.

-4© Dr Jim White 2007 www.talkingtherpaies.berkshire.nhs.uk

3. Who gets panic?

About one in three people in Britain has at least one panic each year. So they are common. It may be that some of us are more prone to panic due to our basic nature. But those whose lives

are most affected by panic often have:

 Anxiety Depression  Phobias  Alcohol problems  These may go together. If you get tense at the thought of meeting others, you might drink too much as a way of coping. This may make you more stressed and more prone to panic. This may lead to depression.....and so on as a vicious circle builds up.

4. Thoughts, Actions and Body The following pages look at some of the ways in which panic affects your thoughts, actions and body - TAB.

-5© Dr Jim White 2007 www.talkingtherpaies.berkshire.nhs.uk Though it may feel like it, panic does not come out of the blue. Panic is a reaction. Once you learn about the things that trigger panic, you can take your first step in controlling it. TAB feeds

itself. Let us look at how this works with panic:

The role of thoughts As the panic may seem to come out of the blue and as it hits you with such strength, you may

think, e.g.:

–  –  –

If you believe these thoughts, they must cause you to feel more stress. The more stress you

feel, you more it affects your thoughts. Add to this:

The role of actions Panic will affect your actions and this will feed back into your thoughts Look at the state of me - I’m acting like an idiot. They are all looking at me. I’ve got to get out of here" If you are avoiding going places or doing things for fear of having a panic, you are aware that you are restricting your life out of fear. This will affect your self-confidence.

The role of the body Panic makes you tune into your body. This is no surprise given the very unpleasant ways your

body may react to panic. So your thoughts are made worse by this:

"I'm so dizzy. I'm going to pass out" “My stomach is heaving - I'm going to throw up"

-9When you breathe out, you breathe out CARBON DIOXIDE (CO2).

OXYGEN is taken to your lungs and is then carried round your body in the blood stream. It feeds all the cells in your body. Once this is done, what is left - the waste product - has turned into CARBON DIOXIDE (CO2). This is sent back to your lungs via your blood stream and breathed out.

When you are calm, there is a balance between the oxygen going in and the CO 2 going out.

This balance is kept by your breathing. Think of a car - the faster the car goes, the more fuel is used. If the car goes slower, it burns less fuel. Your breathing works in the same way with oxygen acting as your fuel. If you are playing football, running for a bus, digging the garden, then your body need more fuel. So you breathe in more oxygen. When, a few hours later, you sit at home in front of the TV, you breathe much more slowly as you do not need the same energy. In both cases, the balance will stay in place.

-10© Dr Jim White 2007 www.talkingtherpaies.berkshire.nhs.uk Hyperventilation (HV) HYPER (too much) VENTILATION (breathing) means you are breathing too fast for your needs.

Once your fight / flight reaction kicks in, your body is filled with energy to fight a threat. This is fine if you have to run from danger - you will use up the extra energy. One of the problems in panic is that the threats you worry about are not those that you can fight or run from. So you are left filled with this energy in the shape of oxygen that you can’t burn up. It is like breathing fast enough to let you play a hard game of football when all you are doing is sitting in front of the TV  As you are not burning up the oxygen, it lies in your blood stream longer as your cells do not need to use it up. But as you have to breathe out each time you breathe in, you lose CO 2. At this point, you have lost the balance - you have too much oxygen and too little CO 2 in your

blood. This causes three things to happen:

1. CO2 levels in your blood drop

2. there is a drop in the amount of acid in your blood and it becomes more alkaline

3. some blood vessels in your body narrow for a short time These three changes cause many of the body signs of panic. The blood stream hangs on to the oxygen for longer. So even though you are taking in a lot more oxygen, it ‘sticks’ more to your blood.

This means less blood gets into the brain. This may cause you to feel:

 dizzy  faint  confused  ‘unreal’  breathless, choking  You may also have blurred vision

-11© Dr Jim White 2007 www.talkingtherpaies.berkshire.nhs.uk

It also means less blood gets to parts of the body. This may cause:

 raised heart rate (as it works harder to pump blood around the body)  numbness or tingling in fingers, feet, mouth  stiff muscles  clammy, cold hands

Your body is now working hard. This may cause you to feel:

 hot, flushed and sweaty  tired out  aches and pains in your chest as if you have a tight belt around your ribs (breathing from the diaphragm will ease this a lot)  you may yawn or sigh a lot. This a sign of HV.

Note that all these symptoms are caused by HV and not by stress. Yet they very similar to the how people say they feel in a panic attack. So if you control the HV, you will control the

symptoms. This will then help you control (or prevent) panic. Bear in mind:

–  –  –

If you hyperventilate quickly - say thirty breaths a minute - these symptoms can come on in seconds (e.g. if you get a sudden shock). More common is to increase your breathing from, say, fourteen times up to fifteen times a minute. No big deal yet with every minute that passes, you have one extra breath of oxygen lying and one less amount of CO 2 in your blood stream.

© Dr Jim White 2007 -12www.talkingtherpaies.berkshire.nhs.uk After one hour, you have sixty extra breaths and have lost sixty amounts of CO2. The balance is slowly changing. In this case, the body tries to deal with the slow change and you may not get any signs of the HV. But you will get to the point of no return when the symptoms appear without any warning. This is when your CO2 drops below a certain level. This could happen even with a yawn (you lose a lot of CO2 when you breathe out of a yawn).

It's like the straw that breaks the camel's back. It seems to come out of the blue. As you don’t see why the symptoms have hit you, they cause you to think that something awful is about to

happen to you. And this leads you to panic. Here is the vicious circle that is involved:

–  –  –

This vicious circle is the same as exists for people who don't panic with one important exception

- the panic/stress. If anyone hyperventilates, they will get the same symptoms - it is normal to do so. They do not cause you to panic. It is the way you interpret the symptoms that causes you to panic.

–  –  –

around the mouth and nose and/or in your fingers and toes If you answer ‘YES’ to any of these signs, then HV may be a factor in your case. You will learn what to do about this in the next part.

-15© Dr Jim White 2007 www.talkingtherpaies.berkshire.nhs.uk (1) Work out the problem Find out as much as you can about how panic affects you. You will find Panic Diaries at the back of this booklet. Fill these in every time you have a panic. Do this as soon as you can after

the panic. There are six questions:

–  –  –

Keeping this diary may show you that panic is more common in certain places or at certain times. If so, try to work out why this is. Then try to work out a way to tackle this problem. This part will teach you skills you can use to fight the panic.

–  –  –

Look at what may happen to your BEHAVIOUR and AVOIDANCE Behaviour

Do you:

Try to fill your lungs with air if you HV? You now know that you need less air not more and you know how to do this. So make sure you do it as soon as you can.

Pace up and down the room, try to read, watch TV - anything to try not to think about how you feel. Don't try to run from the panic. Face it and fight back using the skills you have been learning.


Do you:

Avoid going to certain places because you think you will panic there? Go there, face it and do not run away. Work out how to handle it and prepare well. Don't give in to it.

Avoid becoming emotional - feeling angry, feeling excited in case it provokes panic? Allow all these normal emotions to come out. In the long run, the restrictions on your life are adding strength to the panic. Don't give in to it.

Do things to try to stop panic - carry a diazepam, make sure there is someone at home with you. These make you worse not better. Plan ways of getting rid of them.

Whatever the Action problems are, try hard to change the way you react to panic or to the fear of it. By doing so you will show yourself that you can get a grip on this problem.

–  –  –

www.talkingtherpaies.berkshire.nhs.uk (5) Reducing the risk of panic So far we have looked at ways of hitting panic head on. Now let us look at some of the risk factors. Knowing what they are helps you plan ways to prevent panic.

1) Rapid postural change Don't change your position too fast. So, if you have been sitting down for a while, get out the chair slowly. Don't jump out of bed first thing. You may get a swimming feeling in your head if you do. This can lead to panic in some people.

2) Tiredness Make sure you get enough rest as both panic and stress are made worse by fatigue.

3) Low normal blood sugar This is nothing to do with diabetes. You keep your blood sugar level up when you eat every few hours. If you don’t eat, the level drops and makes you more prone to panic. Though it slows down while you sleep, you need to eat something first thing to raise your sugar level - a piece of toast should be enough. Don't skip meals or go on crash diets. As a rough rule of thumb - eat something every three hours.

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