What To Do When You Feel A Panic Attack Coming Part 2: The Shields

The Shields (i.e. Coping Techiqnues):

Benzodiazepines (ie Xanax, Ativan, Klonopin, Valium): These are usually the most immediately powerful of all of the coping techniques. It usually takes about 20 minutes for benzodiazepines to kick in, and they strong enough to stop and even full blown panic attack. The main drawbacks of these medications are that if you take too much, they can make you tired, and if you take them everyday, you might get used to them after 1-3 months (i.e. they might stop working). In addition, people with a history of addiction problems can get addicted to these medications (although in general, they produce a pretty weak high, so it’s exceedingly rare for a non-addict to become addicted to these drugs). I prescribe benzodiazepines to my patients while they are learning the other coping techniques and starting the exposures. I typically recommend using benzodiazepines on an emergency basis to stop panic attacks, and occasionally I even recommend using benzodiazepines on a regular daily basis for people who are in a chronic state of panic / high anxiety. Although benzodiazepines will not cure panic disorder, they can provide relief while you are engaged in a more definitive treatment (such as Cognitive Behavioral Therapy) to help you gain complete mastery over panic.

Leaving the Situation: This is one of the strongest coping techniques, but also can eventually lead to problems. Leaving a crowd, pulling over on the side of the road while driving, or avoiding vigorous exercise are examples of leaving the situation. These are effective coping techniques because they can frequently avert a panic attack. However, these techniques have the obvious drawback of encouraging agoraphobia (i.e. the avoidance of activities because of a fear of panic). I would say that leaving a situation is useful, but only if you are also engaging in a definitive treatment to help you gain mastery over panic disorder.

Relaxation Techniques: It’s hard to stop thinking about something “cold turkey.” It’s easier to stop thinking about something if you replace your thoughts with something else. Relaxation and meditation techniques aim at getting you to stop thinking by giving you an effective distraction to replace your thoughts with. For example, many Buddhist forms of meditation replace your thoughts with a focus on repeated sounds and/or breathing. In addition, various visualization exercises replace your thoughts with vivid imagery. The relaxation techniques I have found to be most effective for panic attacks are 11-muscle relaxation with Abdominal Breathing, Sensation Focusing, and Permission Breath Counting, which are all cognitive-behavioral techniques. I never teach patients just one coping technique because different techniques seem to work for different people. Relaxation techniques initially may not be strong enough to stop a panic attack, but they become much more effective once you have started doing exposures.

Thought Restructuring: This coping technique teaches you ways to stop your anxiety by talking back to it. Thought restructuring is a type of journaling done on paper for 10 minutes a day for 1-2 weeks. After 1-2 weeks, I usually encourage my patients to stop talking back to their thoughts on paper and start doing it in their heads. Much like relaxation techniques, this is a cognitive behavioral therapy technique, it gets better with practice, and it becomes much more effective once you have started exposures.

Thoughts restructuring along with Relaxation Techniques eventually form the two most healthy and permanent parts of your “shield” because they can be used extensively without having the drawbacks of avoiding situations or relying on medications. However, these “shield” techniques are usually not strong enough alone to gain complete mastery over panic disorder, most patient need to do exposures.