panic is injurious to health

1. PANIC CONTROL
MANAGEMENT
NISAR AHMED KHAN

4. OVERVIEW
• A panic attack is a sudden episode of intense fear that triggers
severe physical reactions when there is no real danger or
apparent cause. Panic attacks can be very frightening. When
panic attacks occur, you might think you're losing control,
having a heart attack or even dying.

5. OVERVIEW
• Many people have just one or two panic attacks in their lifetimes,
and the problem goes away, perhaps when a stressful situation
ends. But if you've had recurrent, unexpected panic attacks and
spent long periods in constant fear of another attack, you may have
a condition called panic disorder.
• Although panic attacks themselves aren't life-threatening, they
can be frightening and significantly affect your quality of life. But
treatment can be very effective.

9. SYMPTOMS
• Panic attacks typically begin suddenly, without warning. They
can strike at any time — when you're driving a car, at the mall,
sound asleep or in the middle of a business meeting. You may
have occasional panic attacks, or they may occur frequently.
• Panic attacks have many variations, but symptoms usually
peak within minutes. You may feel fatigued and worn out after
a panic attack subsides.

10. SYMPTOMS
Panic attacks typically include some of these signs or symptoms:
 Sense of impending doom or danger
 Fear of loss of control or death
 Rapid, pounding heart rate
 Sweating
 Trembling or shaking
 Shortness of breath or tightness in your throat
 Chills

11. SYMPTOMS
One of the worst things about panic attacks is the intense fear that you'll have another one. You may fear
having panic attacks so much that you avoid certain situations where they may occur.
 Hot flashes
 Nausea
 Abdominal cramping
 Chest pain
 Headache
 Dizziness, lightheadedness or faintness
 Numbness or tingling sensation
 Feeling of unreality or detachment

12. CAUSES
It's not known what causes panic attacks or panic disorder, but these factors may
play a role:
• Genetics
• Major stress
• Temperament that is more sensitive to stress or prone to negative emotions
• Certain changes in the way parts of your brain function

13. CAUSES
Panic attacks may come on suddenly and without warning at first, but over time,
they're usually triggered by certain situations.
Some research suggests that your body's natural fight-or-flight response to danger
is involved in panic attacks. For example, if a grizzly bear came after you, your body
would react instinctively. Your heart rate and breathing would speed up as your
body prepared for a life-threatening situation. Many of the same reactions occur in
a panic attack. But it's unknown why a panic attack occurs when there's no obvious
danger present.

14. RISK FACTORS
Symptoms of panic disorder often start in the late teens or early adulthood and affect
more women than men.
Factors that may increase the risk of developing panic attacks or panic disorder include:
• Family history of panic attacks or panic disorder
• Major life stress, such as the death or serious illness of a loved one
• A traumatic event, such as sexual assault or a serious accident
• Major changes in your life, such as a divorce or the addition of a baby
• Smoking or excessive caffeine intake
• History of childhood physical or sexual abuse

15. COMPLICATIONS
Left untreated, panic attacks and panic disorder can affect almost every
area of your life. You may be so afraid of having more panic attacks that
you live in a constant state of fear, ruining your quality of life.
For some people, panic disorder may include agoraphobia — avoiding
places or situations that cause you anxiety because you fear being
unable to escape or get help if you have a panic attack. Or you may
become reliant on others to be with you in order to leave your home.

16. COMPLICATIONS
Complications that panic attacks may cause or be linked to include:
• Development of specific phobias, such as fear of driving or leaving your home
• Frequent medical care for health concerns and other medical conditions
• Avoidance of social situations
• Problems at work or school
• Depression, anxiety disorders and other psychiatric disorders
• Increased risk of suicide or suicidal thoughts
• Alcohol or other substance misuse
• Financial problems

17. PREVENTION
There's no sure way to prevent panic attacks or panic disorder.
However, these recommendations may help.
• Get treatment for panic attacks as soon as possible to help stop
them from getting worse or becoming more frequent.
• Stick with your treatment plan to help prevent relapses or
worsening of panic attack symptoms.
• Get regular physical activity, which may play a role in protecting
against anxiety.

18. DIAGNOSIS
Your primary care provider will determine if you have
panic attacks, panic disorder or another condition, such
as heart or thyroid problems, with symptoms that
resemble panic attacks.
You may fill out a psychological self-assessment or
questionnaire. You also may be asked about alcohol or
other substance use.

19. DIAGNOSIS
To help pinpoint a diagnosis, you may have:
• A complete physical exam
• Blood tests to check your thyroid and other possible
conditions and tests on your heart, such as an
electrocardiogram (ECG or EKG)
• A psychological evaluation to talk about your symptoms,
fears or concerns, stressful situations, relationship problems,
situations you may be avoiding, and family history

20. CRITERIA FOR DIAGNOSIS OF PANIC
DISORDER
Not everyone who has panic attacks has panic disorder. For a diagnosis
of panic disorder, the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), published by the American Psychiatric Association,
lists these points:
• You have frequent, unexpected panic attacks.
• Your panic attacks aren't caused by drugs or other substance use, a
medical condition, or another mental health condition, such as social
phobia or obsessive-compulsive disorder.

21. CRITERIA FOR DIAGNOSIS OF PANIC
DISORDER
• At least one of your attacks has been followed by one month or
more of ongoing worry about having another attack; continued fear of
the consequences of an attack, such as losing control, having a heart
attack or "going crazy"; or significant changes in your behavior, such as
avoiding situations that you think may trigger a panic attack.
If you have panic attacks but not a diagnosed panic disorder, you can still
benefit from treatment. If panic attacks aren't treated, they can get
worse and develop into panic disorder or phobias.

22. TREATMENT
Treatment can help reduce the intensity and frequency of your
panic attacks and improve your function in daily life. The main
treatment options are psychotherapy and medications. One or
both types of treatment may be recommended, depending on
your preference, your history, the severity of your panic disorder
and whether you have access to therapists who have special
training in treating panic disorders.

23. PSYCHOTHERAPY
Psychotherapy, also called talk therapy, is considered an effective first choice treatment for
panic attacks and panic disorder. Psychotherapy can help you understand panic attacks and
panic disorder and learn how to cope with them.
A form of psychotherapy called cognitive behavioral therapy can help you learn, through your
own experience, that panic symptoms are not dangerous. Your therapist will help you
gradually re-create the symptoms of a panic attack in a safe, repetitive manner. Once the
physical sensations of panic no longer feel threatening, the attacks begin to resolve.
Successful treatment can also help you overcome fears of situations that you've avoided
because of panic attacks.
Seeing results from treatment can take time and effort. You may start to see panic attack
symptoms reduce within several weeks, and often symptoms decrease significantly or go
away within several months. You may schedule occasional maintenance visits to help ensure
that your panic attacks remain under control or to treat recurrences.

24. MEDICATIONS
Medications can help reduce symptoms associated with panic attacks as well as depression if that's
an issue for you. Several types of medication have been shown to be effective in managing symptoms
of panic attacks, including:
• Selective serotonin reuptake inhibitors (SSRIs). Generally safe with a low risk of serious side
effects, SSRI antidepressants are typically recommended as the first choice of medications to treat
panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic
disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class
of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic
disorder.
• Benzodiazepines. These sedatives are central nervous system depressants. Benzodiazepines
approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam
(Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-
forming, causing mental or physical dependence. These medications are not a good choice if you've
had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous
side effects.

25. Craig N. Sawchuk, Ph.D., L.P.
1. Psychologist
2. Rochester, MN
AREAS OF FOCUS:
Cognitive behavioral therapy, Psychotherapy, Somatic
symptom disorder, Phobias, Generalized anxiety disorder,
Panic attacks, Anxiety disorder, Hoarding disorder,
Insomnia, Trichotillomania, Social anxiety disorder,
Adjustment disorder, Depression, Obsessive compulsive
disorder, Mood disorder, Seasonal affective disorder,
Impulse control disorders, Tic disorders, Agoraphobia,
Illness anxiety disorder.

31. LIFESTYLE AND HOME REMEDIES
While panic attacks and panic disorder benefit from professional treatment, these self-care steps can
help you manage symptoms:
• Stick to your treatment plan. Facing your fears can be difficult, but treatment can help you feel
like you're not a hostage in your own home.
• Join a support group. Joining a group for people with panic attacks or anxiety disorders can
connect you with others facing the same problems.
• Avoid caffeine, alcohol, smoking and recreational drugs. All of these can trigger or worsen panic
attacks.
• Practice stress management and relaxation techniques. For example, yoga, deep breathing and
progressive muscle relaxation — tensing one muscle at a time, and then completely releasing the
tension until every muscle in the body is relaxed — also may be helpful.
• Get physically active. Aerobic activity may have a calming effect on your mood.
• Get sufficient sleep. Get enough sleep so that you don't feel drowsy during the day.

33. USE DEEP BREATHING
While hyperventilating is a symptom of panic attacks that can increase fear, deep
breathing can reduce symptoms of panic during an attack.
In one studyTrusted Source, published in 2017, 40 people joined either a therapy
group that involved deep or diaphragmatic breathing or a control group. After 20
intensive training sessions, those who practiced deep breathing saw improvements
in their attention levels and emotional well-being.
Blood tests also showed lower cortisol levels in this group, suggesting lower levels
of stress. The participants did not have panic disorder, but the strategies could help
people who have panic attacks.
Another group of scientistsTrusted Source found that slow breathing could have
similar effects. They suggested it could also improve feelings of relaxation, comfort,
and alertness and reduce symptoms of arousal anxiety, depression, anger, and
confusion.

34. IF YOU’RE ABLE TO CONTROL
YOUR BREATHING, YOU’RE LESS
LIKELY TO EXPERIENCE THE
HYPERVENTILATING THAT CAN
MAKE OTHER SYMPTOMS —
AND THE PANIC ATTACK ITSELF
— WORSE.
FOCUS ON TAKING DEEP
BREATHS IN AND OUT
THROUGH YOUR MOUTH,
FEELING THE AIR SLOWLY FILL
YOUR CHEST AND BELLY AND
THEN SLOWLY LEAVE THEM
AGAIN. BREATHE IN FOR A
COUNT OF FOUR, HOLD FOR A
SECOND, AND THEN BREATHE
OUT FOR A COUNT OF FOUR:

35. RECOGNIZE THAT YOU’RE HAVING
A PANIC ATTACK
By recognizing that you’re having a panic attack instead of a heart
attack, you can remind yourself that this is temporary, it will pass, and
that you’re OK.
Take away the fear that you may be dying or that impending doom is
looming, both symptoms of panic attacks. This can allow you to focus
on other techniques to reduce your symptoms.
It is not always possible to avoid triggers for a panic attack, but if you
know what triggers it, this can help you understand that it is a panic
attack and not something else.

36. CLOSE YOUR EYES
Some panic attacks come from triggers that overwhelm you. If
you’re in a fast-paced environment with a lot of stimuli, this can
feed your panic attack.
To reduce the stimuli, close your eyes during your panic attack.
This can block out any extra stimuli and make it easier to focus
on your breathing.

37. PRACTICE MINDFULNESS
Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of
detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening.
Mindfulness involves:
• focusing your attention on the present
• recognizing the emotional state you’re in
• meditating to reduce stress and help you relax
Focus on the physical sensations you are familiar with, like digging your feet into the ground or feeling the texture of
your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to
focus on.
Experts say that mindfulness strategies, such as meditation, can help manage anxiety symptoms, although it’s not
clear they can treat an underlying anxiety disorder.
American Family Physician recommended mindfulness as a strategy for dealing with panic and anxiety in 2015,
saying it can be as helpful for reducing stress as CBT and other behavioral therapies.
Some researchTrusted Source has suggested that mindfulness-based cognitive therapy could help people with
anxiety disorders who are receiving medical treatment but haven’t found drug treatment helpful.

38. FIND A FOCUS OBJECT
Some people find it helpful to find something to focus all their
attention on during a panic attack. Pick one object in clear sight
and consciously note everything about it possible.
For example, you may notice how the hand on the clock jerks
when it ticks, and that it’s slightly lopsided. Describe the
patterns, color, shapes, and size of the object to yourself. Focus
all your energy on this object, and your panic symptoms may
subside.

39. USE MUSCLE RELAXATION
TECHNIQUES
Muscle tension is a symptom of anxiety, and muscle relaxation techniques can help reduce tension and promote
relaxation during an attack. Progressive muscle relaxation aims to release tension in one group of muscles at a time
to relax the whole body.
Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling
your body’s response as much as possible.
If you attend muscle relaxation therapy, your therapist might take you through the following stepsTrusted Source:
• First, you may learn how to tense the muscles before releasing the tension.
• Then, you will learn how to relax the muscles without tensing them first.
• You may also learn how to relax specific sets of muscles, for example, in the shoulders, for practical use in
everyday situations.
• Finally, you may learn how to practice rapid relaxation, when you can identify any areas of tension and release it
as needed.
To start relaxing your muscles at home, consciously relax one muscle at a time, starting with something simple like
the fingers in your hand, and move your way up through your body.
Muscle relaxation techniques will be most effective when you’ve practiced them beforehand.

40. PICTURE YOUR HAPPY PLACE
Guided imagery techniques can help reduce stress and anxiety.
ResearchTrusted Source suggests that both spending time in nature
and visualizing nature can help treat and manage anxiety.
What’s the most relaxing place in the world that you can think of? A
sunny beach with gently rolling waves? A cabin in the mountains?
Picture yourself there and try to focus on the details as much as
possible. Imagine digging your toes into the warm sand, or smelling
the sharp scent of pine trees.
This place should be quiet, calm, and relaxing — no streets of New
York or Hong Kong, no matter how much you love the cities in real life.

41. ENGAGE IN LIGHT EXERCISE
Research shows that regular exercise can not only keep the body healthy but boost
mental well-being, too.
Experts have found that exercising at 60 to 90 percent of your maximum heart rate
for 20 minutes three times per week can help reduce anxiety.
If you are not used to exercising, talk with your doctor before starting. There is
some evidenceTrusted Source that starting aerobic exercise anew can trigger
additional anxiety in people with an anxiety disorder. Building up gradually can
help your body adjust and avoid breathing problems. Aerobic exercise includes
activities such as running on a treadmill.
If you feel stressed or you’re hyperventilating or struggling to breathe, stop and
take a rest or choose a more moderate option, such as walking, swimming, or yoga.

42. KEEP LAVENDER ON HAND
Lavender is a traditional remedy that many people use to reduce stress and help them relax.
ResearchTrusted Source suggests it has a calming effect but doesn’t lead to dependence or cause withdrawal
symptoms. Using products that contain diluted lavender oil may help reduce or manage symptoms of anxiety.
However, the Food and Drug Administration (FDA) does not regulate essential oils, and strengths and ingredients
vary widely.
If you use lavender essential oil, make sure you:
• get your oil from a reputable source, such as a pharmacy
• follow the instructions for use
• avoid applying concentrated oil directly to the skin
• avoid using lavender with benzodiazepines because the combination can cause intense drowsiness
While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of
essential oils. It’s important to talk with a healthcare professional before you begin using essential oils and be sure
to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.

43. REPEAT A MANTRA INTERNALLY
Repeating a mantra internally can be relaxing and reassuring,
and it can give you something to grasp onto during a panic
attack.
Whether it’s simply “This too shall pass,” or a mantra that
speaks to you personally, repeat it on loop in your head until you
feel the panic attack start to subside.