It’s a much mis-used description – panic attack. Sometimes people claim to have them when they simply feel a bit nervous or rushed but anyone who has ever experienced one will know what the feeling really means. Panic attacks can be extremely frightening. They can make you feel out of control, struggling for breath, nauseous, sweaty and terrified that you are having a heart attack or breakdown. At the worst extreme, they can create a sense of detachment, almost as if you are having an out-of-body experience. They can last a few minutes, or half an hour, can strike anywhere at any time whether you are alone or on a crowded train. In rare cases panic attacks can escalate into panic disorder, where the feeling of being overwhelmed lasts for days, weeks or months.

One Therapy therapist Simone Actilio explains that panic attacks are actually very common – one in three of us will experience them – yet often sufferers may not discuss them because they fear it carries some sort of stigma.

Panic attacks are frightening but they always pass.

But the reassuring truth is that a panic attack is not physically dangerous, rather it is your body’s normal physiological response to anxiety, to any form of stress, fear or excitement – but magnified.

Simone says, ‘A panic attack is a physical manifestation of an unconscious conflict that is often rooted in the person’s early emotional experience.’ 

It stems from our primitive ‘fight or flight’ response (the usual comparison is to a cave man escaping a sabre-toothed tiger): the adrenaline hormone surges causes breathing to become faster and shallower to drive more oxygen to the muscles; the muscles tense and the heart beats faster to pump more blood to them. Your blood supply diverts to your limbs so your skin looks paler and you sweat to stay cool. To allow the body to focus on ‘fight or flight’, less important  functions shut down: for example, your salivary glands stop secreting which results in that unpleasant dry mouth. As you hyperventilate, you exhale increased levels of carbon monoxide which changes the acidity levels in your blood which in turn may cause cramping or dizziness. So try to hold on to the fact that this is all a natural but exaggerated response.

However, the problem with panic attacks is the unpredictability of how, where and why they happen. Sometimes life throws up stressful situations: relationship problems, redundancy, money worries or even supposedly happy events that nevertheless cause stress: a wedding or important presentation at work. But sometimes the cause may be much harder to fathom and can be rooted in your past experiences. For example, children who have suffered physical or emotional abuse or separation anxiety are more likely to suffer panic attacks in later life. And people who are harshly critical of themselves may find that their internal negative voice expresses itself in physical symptoms.

‘It’s not a simple linear cause and effect’, explains Simone ‘but it is possible, through exploration of your past experiences, that you may discover the source.’

And with a cruel twist, the fear of having a panic attack, especially in public, can actually be the trigger to spark an attack. 

What can I do when a panic attack attacks?

Once you can reassure yourself that the physical symptoms are not harmful and that they will pass you can try various techniques to help and ultimately ward off the experience.

BREATHING Breath control is one of the most effective methods for coping. At the first sense of an attack – when your chest tightens or you feel you are losing control – you can slow your breathing down. Inhale from your abdomen; you should see your tummy swell in and out. Breathe out slowly, for longer than you inhale – try counting up to five. Remember the carbon dioxide balance is changing which is why breathing in and out of a paper bag, breathing back in your own carbon dioxide, can help keep your acid levels stable. Even cupping your hands over your mouth as you breathe will help. 

DIARY Keeping a diary over several months will help to identify events, places or times that may trigger attacks. It might not be obvious but sometimes you can spot a pattern, however unlikely, that might link to moments of high anxiety or fear.

CHECK-UP It’s always worth seeing your doctor to check that there are no underlying health conditions contributing towards the problem. (Although for some people just seeing a doctor can cause a rise in stress levels so be aware of this if you do suffer from ‘white coat syndrome’). Alcohol, too much caffeine and smoking can contribute towards panic attacks. A doctor may prescribe an anti-depressant which, used in conjunction with therapy, can be effective.

EXERCISE Regular exercise raises your level of endorphins, the ‘feel-good’ chemicals that can offset the feelings of being overwhelmed by depression or  anxiety. 

MEDITATION As well as helping you to control the jumble of thoughts that cascade into your mind as an attack threatens, meditation has been proven to help lower your heart rate and blood pressure. It takes some practice to access a state of meditation but there are many apps and online guides as well as classes. And once you are able to master it you can practice it anywhere – on a train journey, in an office, a restaurant – and no-one will notice. It’s not all about sitting cross-legged and chanting!

THERAPY Often, as we described above, the causes of panic attacks lie deep within and sometimes you may be unable or reluctant to investigate what these reasons are. Simone Actilio says ‘a qualified therapist may be able to help you to make sense of this unsettling, and often, terrifying experience, to identify  thought patterns or reactions.’ 

Does counselling for panic attacks work?

Yes. Many people come to us for anxiety-related issues.

Some forms of therapy, such as CBT (Cognitive Behaviour Therapy) can help you moderate your responses to situations so that when you find yourself in a triggering environment you can control how you react. Some other types of therapy, such as psychodynamic psychotherapy, aims at exploring the conscious and unconscious meaning of the panic attack, how its triggers can represent intense early life wishes and fears. Whichever sort of therapy is right for you, it can help to identify why the panic attacks happen, to break the cycle and allow you to accept that if they happen, you have the tools to deal with them.

One Therapy London has qualified therapists who can help with panic attacks so please contact us if you would like help.  

Many of us may be surprised by the intensity of emotion we are feeling after the recent death of the Queen – a woman we probably never met and certainly never knew. Yet somehow it feels like a personal loss we were unprepared for. Death at 96 is not surprising – but with the Queen’s death there may also be an odd sense of shock, and a conflicting combination of emotions that can be disorientating. We may even feel confused or guilty about crying or mourning for a stranger when we have experienced the death of those close to us more calmly.

But, as One Therapy London therapist Ceri Hiles explains, a public outpouring of grief may bring back unexpressed personal experiences of death within one’s own the family, either recent or from many years ago. ‘Long-buried feelings of loss and sadness resurface, can be powerful and sometimes that response includes unresolved grievances, or things left unsaid from the past. A flashback to a previous death can be very vivid and real. You may have been encouraged to be ‘strong’ or so overwhelmed by practical matters or supporting others that you didn’t fully accept your grief at the time.’ Ceri adds, ‘In some cases a deceased person held together certain family relationships and fractures can occur when that bond is lost which can be difficult to resolve.’ Seeing a bereavement played out before the nation can force us to confront these emotions.

One Therapy London therapist Tom Deitch sees many people who lost family or friends during the pandemic. ‘They may have been unable to say goodbye in person and been allowed only a brief, limited funeral, depriving them of the rituals that can help us accept death: seeing friends from across the country, sharing memories, music, photographs. Very public grieving, as with the death of the Queen, can bring back this sadness and an earlier grief somehow put on hold.’

After the death of his wife, the author C S Lewis wrote, ‘No-one ever told me that grief felt so like fear.’ Feeling frightened and anxious is a perfectly understandable reaction when something that has been a constant in life for so long, like the presence of Queen Elizabeth, changes suddenly, and at a time when we may already be feeling insecure about the future (for many other reasons at the moment like the uncertainties created by the Covid pandemic, Brexit and the current economic challenges facing the country). This change may make us feel out of control, as if the structure of our life is crumbling. It isn’t so much that the Queen’s death changes our future, more a reminder that life is ephemeral. Tom Deitch says, ‘When we realise that nothing is permanent, that being eternal is an illusion, it reminds us of our own mortality.’

But an outpouring of communal, collective grief can also help to connect us with other people when we might be feeling sad, lonely or isolated. It gives us all a powerful sense of belonging to a community, that our feelings are mirrored by others and therefore they are valid and real, however personal or individual. It may be brief, but it forms a bridge between people who may not otherwise communicate or share experiences and can actually open up conversations or new relationships.

Sometimes this can feel like a pressure to conform in the way we grieve (should we not go to a planned concert out of respect, or should we pretend we think the whole thing is overblown?) – but everyone is different and it’s important not to feel judged by how we can best express ourselves.

At a time of collective grieving, like when the country is mourning the death of the Queen, we might find ourselves looking for some direction from leaders of the country or the church, people who can take responsibility for guiding us through what feels like a tidal wave of unfamiliar confusion. That can be helpful – although nothing is a rule to be followed. Rituals, such as queuing to pay respects, observing a minute’s silence or simply observing public ceremonies give shape and resolution to emotions that are often difficult to articulate.

So when we are experiencing sadness, fear, anxiety or guilt, it’s helpful to remember that there is no right or wrong way to feel. Grief is often stifled or repressed, especially when we are young, because family members or colleagues want to make us feel ‘better’ or want us to ‘move on’. The traditional British stiff upper lip (as often embodied by the Queen herself) isn’t always helpful. We need to take time to think about what we have lost and our emotional responses to change and accept them for what they are – a part of what makes us an equal member of a community.

One Therapy has experienced grief and bereavement therapists if you would like to talk to someone.