Anxiety and Panic Attacks

How to help a someone who is already having a panic attack

Here is a short video which describes what a panic attack looks and feels like and how you might help someone experiencing an attack

How to help your friend during a panic attack - BBC

• Call for support from an adult and stay with the student until help arrives. A panic attack might last for 20 minutes so it is important you get help.
• DO NOT leave the person alone.  Imagine feeling like you are having a heart attack and you are just left to deal with it alone. 
• Use the words “you are having a panic attack.  It will be over soon.  Someone will stay with you until it passes, ”  A panic attack can feel like a heart attack and people really do feel they might die during a panic attack, so reassurance is important. 
• Usually a panic attack is associated with hyperventilating or overbreathing which impacts on the bodies CO2 and O2 balance.  Historically the advice was to breathe into a paper bag to re balance CO2 and O2 by re breathing more CO2 from the bag.  The advice is now not to use a bag as it might develop a dependency on the bag and cause more anxiety if one is not available.  
• Try to lock into the rhythm of the student’s breathing and use one hand to move up and down with their breath. 
• Ask them to follow your hand with their breath as you move it up and down, gradually getting slower and slower.
• The aim is to gradually slow the pace of breathing while trying to extend the outbreath in relation to the in breath.
• Initially just slowing the pace is enough but after a while ask them to breath from the diaphragm rather than the chest and shoulder, and through the nose rather than the mouth. 
• Don’t try to get them back in to the classroom too quickly.  If they have had a full panic attack they might need a few minutes to rest and recover. 
• Perhaps the most important thing is to try to check in with the young person later on or the next day. Remind them of how brave and amazing they are.   This is about reinforcing to students that their wellbeing is our priority, anxiety is not a personality flaw, they are not alone and we are here for them.

What to say to a friend:  Normalising

Explain to the young person that the physical sensations associated with anxiety are actually there to make us the best versions of ourselves.  Increased heart rate, breathing rate, adrenaline etc are all getting us ready to protect ourselves from a perceived danger.  The trouble is there is often no actual danger so we need to learn to self regulate.  

It is also important to reassure the young person that what they are feeling is quite normal and doesn’t mean they “have” anxiety.  Instead they might be “experiencing a period of stress or anxiety” which is common and many people experience it. 

Ways to reduce your own anxiety 

Breathing Practice

The most effective strategy to combat anxiety in the moment is controlling the breath but regular breath practice can also reduce your baseline anxiety and make it less likely to become overwhelming. 

The following video shows James Nestor who is the author of the book Breath: The New Science of a Lost Art  5 Ways To Improve Your Breathing with James Nestor

For a more in depth understanding of breath and how it can affect anxiety and loads of other areas of our lives here is a great podcast of James Nestor discussing many of the topics in the book.     This DAILY BREATHING TECHNIQUE Will Transform Your Body & Mind TODAY! | James Nestor

Here is a short video to help understand what belly or diaphragmatic breathing is. If teaching to a young person you would skip the lying down part unless they were practising at home. 

How to Practice Belly Breathing - Nemours Children's Health System

How to breathe to combat anxiety

• From the diaphragm rather than from the chest and shoulders.  The opposite of how you breathe when anxious.
• Through the nose not the mouth.
• Slow the breath by extending the exhale. 
• Breath deep but quiet.  The exhale should be silent and extended.  Imagine making a candle flicker without being blown out. 
• Concentrate on the moment the inhale turns into the exhale and vice versa.

5 Finger Breathing

A simple technique that can be used in class without anyone realising or before an exam to calm the body and mind. Five Finger Breathing | a simple guided breathing exercise for kids

The Physiological Sigh

Watch Neuroscientist  Andrew Huberman describe what he calls the Physiological Sigh to relieve anxiety and describe some of the other benefits of controlling your breath on stress and anxiety. 

Breathing Techniques to Reduce Stress and Anxiety | Dr. Andrew Huberman on the Physiological Sigh

Safe Space Visualisation

This is a technique that needs practice when the young person is feeling calm but will help during periods of anxiety.ANXIETY HACK | safe space visualisation - a simple strategy to help manage anxiety

3 more techniques to try:

Write It and Rip It: 5,4,3,2,1: Box Breathing

3 ways to calm things down - practical ideas for managing anger & anxiety

Our thoughts are not always correct or helpful.

The videos below show a couple of ways of being  aware of our thoughts and beliefs (catch it) fact check them (check it) and then potentially change the thought or belief to a more realistic or helpful one.

Taking your thought to court  Taking your thoughts to court

Catch it Check it Change it  Reframe Unhelpful Thoughts

Realistic Thinking V Catastrophising

Here is a 7 minute video describing some common thinking errors (cognitive distortions)CBT Cognitive Distortions Animation

What is catastrophising?  This is a form of distorted thinking where a person imagines the worst case scenario as an outcome to a situation they are anxious about.  E.g. “I’m going to fail”.  What is causing the anxiety is often that they have over emphasised the possibility of this outcome.  

Best case/worst case/realistic outcome:  Imagine the worst case scenario.  You might need help with this but often it is what you have in the back of your minds. Next do the same but for the best case scenario.    Lastly, ask yourself what the most realistic outcome will be.  You will invariably say somewhere in the middle.  

One key phrase to remember is that of realistic thinking.  It is a useful thing to be able to repeat as a way of focusing  once you have gone through the process a few times.  By repeating the phrase realistic thinking you are encouraging yourself to focus on a far less anxiety inducing future.  This doesn’t mean settling for half best but just not focusing on the worst case scenario.

The 5 Step Anxiety Release

This set of questions is excellent for reducing anxious thoughts.  You can ask these verbally but getting the young person to write them down is usually better as they can refer back to it if the thoughts reoccur. 

• Write down the thing you are anxious about.

• What’s one practical thing you can do to prevent it or prepare for it?

• What’s one reason its probably not going to be as bad as you fear?

• What’s one reason you know you can handle it?

• Name one upside of the situation? (we call this a reframe)