5 Ways to Get Through a Public Panic Attack
Our columnist shares his best hard-won advice for dealing with anxiety attacks in public so you can, too.by Eddie McNamara Health Writer
Panic attacks are no one’s idea of a good time ever. But having one in a public place—around strangers you're convinced are judging you—can make you feel even more vulnerable and afraid. The additional fear of having a panic attack “that people see” can be so upsetting that it eventually becomes its own problem, driving you to avoid possible triggers like crowds, streets, or public places. Let’s not let that happen.
I’m not a doctor or therapist. I’m just a guy who has had thousands of panic attacks since being diagnosed with post-traumatic stress disorder (PTSD) and panic disorder 17 years ago. I can’t teach you how to cure them, but I can tell you the next best thing: how to make sure they don’t stop you from doing what you want.
When I’m in the midst of a full-blown panic attack, these strategies help me get through. The more you practice them, the more comfortable you’ll get with experiencing unpleasant feelings. You might still get panic attacks, but they won’t have the power they once did. Choose a few techniques to try, and memorize your favorite one for when you need it most.
Stop Resisting. The worst thing you can do in the throes of panic is fight against it or pretend it’s not happening. It’s like throwing another log on the fire—it only increases the intensity. Instead, accept that you can’t avoid the feeling of doom, the racing heart, or the shakiness, however scary they may feel. They’re going to be there whether you fight it or not. If you’ve had a panic attack before, you already know that it will soon pass. There are zero documented cases of panic that have lasted forever, and you’re not going to be the first one it happens to. A panic attack can’t kill you or “drive you crazy,” either. It feels terrifying now, but remember that no matter how unpleasant it is, it will be over in a few minutes.
Don’t "Just" Breathe. The most annoying thing in the world is someone telling you to breathe. I’m not saying that. Instead, I’m telling you to breathe mindfully. One of the scariest things about a panic attack is the sensation that you can’t get enough air, which can cause you to hyperventilate. In fact, getting more oxygen is a good way to defuse a panic response quickly—but you have to do it in a slow, deliberate way. There are a million different exercises, but I like this one to reset my rapid breathing: It’s called Relaxing Breath, from Dr. Andrew Weil, and it’s helped me get through some situations.
Here’s how to do it: Exhale by sighing through your mouth. Close your mouth and inhale through your nose for a count of four. Hold your breath for a count of seven. Then exhale through your mouth for a count of eight. That’s one round. Repeat that four times or until your normal full breathing resumes.
Study Your Symptoms. Your heart’s pounding like you had six espressos, you’re light-headed, your face feels flushed, your mouth is dry, and your stomach feels like you’re riding the Coney Island Cyclone. Instead of distracting yourself from your symptoms, be brave and turn towards them. Direct your attention to the physical sensations you feel, moment by moment, without judgement, and without trying to change them. Get curious and notice how they move and change. If your hands and feet feel numb, acknowledge the sensation without attaching a story to it. If you feel the kind of fear you would if a pack of hungry lions were chasing you, give it a nod, then recognize that you’re not in any real danger. If it helps, tell yourself (silently), “It’s just a feeling.” Eventually, you’ll notice your thoughts slowing down, your symptoms lessening and lifting from your body. You might even feel proud for looking fear in the eyes.
Tap into the Power of Your Senses. In therapy, I learned to turn around feelings of fear and unreality by using my five senses. The doctor called it “grounding,” a common technique that reduces symptoms by keeping you in the present. Here goes:
Name five things you can see. Look around. Maybe it’s a computer screen, a water bottle, the color of a wall, a crack in the sidewalk. Silently list them in your mind.
Do the same with four things you can touch. Maybe it’s your cell phone, a ring on your finger, the seat next to you.
Follow that up with three things you can hear. Maybe it’s an annoying pop song on the radio, a bird chirping, a siren in the background.
Next, list two things you can smell. This might seem difficult depending on where you are, but I’ve got faith in you. The perfume on your wrist, a coworker’s cup of coffee. If you smell nothing, acknowledge that.
Finally, use your sense of taste. Maybe it’s a mint or gum in your mouth, maybe it’s the garlic from the pizza you had for lunch.
Identifying your sensations forces your brain to recognize where you are and what’s actually happening vs. the perceived crisis your body thinks is happening.
Do a Mini Meditation. Everybody talks about the three F’s of panic: fight, flight, and freeze. I’ve got an extra one for you—F this. If you’re totally overwhelmed, just bail out on life for about five minutes. I’ll dip into someplace quiet (the library, a coffee shop, a bathroom stall), pop in my earbuds, and fire up a short guided meditation on my phone. Download a few to have on hand for emergencies. I like Mindfulness of Body and Breath with Mark Williams on the free Insight Timer app. After a few minutes, your anxiety levels will drop, and you’ll be in a much better state of mind for re-entering the world.