A Therapist’s Top 3 Tools for Managing Panic Attacks

How to deal with panic attacks

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What to do when your anxiety threatens to get the best of you.

Anxiety is a familiar emotion — one we may experience more often than we care to admit — and in most cases, we view it as a bad thing. But according to Dr. Kevin Chapman, the founder and director of the Kentucky Center for Anxiety and Related Disorders, your anxiety can actually be a useful tool.

“We call anxiety ‘preparatory coping’ because it’s trying to prepare us to deal with a future threat,” Chapman explained.

Just like sadness, fear, disgust, or anger, your personal relationship with anxiety is less about the fact that you’re experiencing it at all and more about how you manage it.

“The issue isn’t the emotion itself,” Chapman said. “The issue is that many people experience negative emotions frequently and intensively. We call that neuroticism. But at the core, anxiety is rarely a problem unless it’s chronic anxiety.”

Anxiety-prone people are familiar with another alarming emotion: panic. Being in an uncomfortable situation feels even worse when that frenzied sense of dread creeps in. But panic is actually a by-product of anxiety, Chapman explained. “It’s what you do in response to anxiety, to try to feel better, which backfires and makes you feel worse.”

Lucky for all of us, a spell of panic doesn’t last forever — and there are proven strategies for coping with it, and for getting more comfortable in circumstances that set it off. We asked Dr. Chapman to walk us through a few tools that can get you back to a calm sense of comfort in no time.

Push yourself to stay in environments that make you feel anxious. 

First things first: When you’re feeling uncomfortable in any given situation, Chapman says the most helpful thing you can do is will yourself to stay put, instead of making a quick exit.

“One of the worst things I can do when I’m having a panic attack, or any sort of anxiety, is escape,” Chapman said. “If I leave a situation, that’s going to reinforce to my brain that anytime I experience strong arousal, I have to avoid it.”

In moments of panic, Chapman instructs his patients to “ride the wave,” which means allowing yourself to experience the anxiety and wait until it abates — which it will

“Panic tends to peak at 10 to 15 minutes,” Chapman said. “The reason we call it a peak is that it can’t go higher than that. So it’s about knowing that this isn’t dangerous, though it is uncomfortable — and knowing that there’s a difference between something being intolerable and being uncomfortable.”

That said, Chapman encourages clients to be honest with themselves about what they can handle. So if you are in a situation that’s intolerable and you must get away, it’s important not to let that prevent you from exposing yourself to that situation again.

“If someone builds a strong urge to leave — which will happen if people are prone to these symptoms — it’s always essential for them to return to that situation as soon as they can,” he said. 

Shift your attention to the external. 

In moments of panic, our focus shifts inward. We’re thinking deeply about ourselves and the stressful feelings that overcome us. But one of Chapman’s tools to get out from under that panic is to redirect your attention to things outside yourself, which will distance you from your problematic emotions. If you’ve ever heard the term “mindfulness,” this is exactly what that means, Chapman explained — being “mindfully aware” of what’s stimulating your senses.

“It’s about shifting attention to the five senses in the present moment, whether that’s how my body feels on this seat, what’s happening on this screen, the sound of the subway train, or this person who just walked in ordering a pumpkin spice latte,” he said. “It’s literally shifting our attention to anything external.”

To accomplish this, take an inventory of what other stimuli you’re experiencing beyond your panic. Ask yourself questions like: What sounds am I hearing? What am I smelling? What physical sensations am I feeling? This exercise takes you out of your own head and connects you with the present moment, which will help you see past your internal stress.

You can take this a step further by using some of Chapman’s favorite “portable tools” for dealing with panic, breathing exercises. “That combination of breathing and attention-shifting is really powerful because it gives you that physiological relief to give you the ability to think clearly,” he said. 

Chapman also recommends this strategy for people who experience social anxiety. 

“The problem with social anxiety is that my attention shifting internally prevents me from saying the right thing to someone,” Chapman explained. “So if I shift my attention externally to focus on the conversation or to something outside of my body, that allows me to be able to retrieve the information [that I want to communicate].” 

Replace negative thoughts with “flexible” ones.

“Most people who struggle with strong symptoms of anxiety tend to judge the symptoms,” Chapman said. “They say, ‘Why do I always have to feel this way? I shouldn’t be feeling this.’ Well, you are feeling that, and there’s a reason. So number one, not judging that you’re having the symptoms is key.”

Negative thoughts (like that judgement of your own feelings) are harmful because they train our brains on the worst parts of what we’re experiencing. It’s essential to stay open to the possibility that things may not be as bad as you fear. “It’s not about being positive,” Chapman said, “it’s about being flexible.” 

So, for example, if you’re heading to a job interview, you may be worried that you’ll say the wrong thing, or you won’t know the right answer to a question, or you’ll forget an important point you want to make. These negative thoughts can worsen your anxiety. 

To embrace flexible thoughts, as Chapman recommends, focus instead on different possible outcomes that wouldn’t leave you feeling so upset. Maybe your interviewer will be friendly and approachable rather than intimidating. Or perhaps, if you do make a mistake, you’ll notice it right away and correct yourself, showing that you’re paying close attention. You won’t know what happens until you get there, but thinking about the ways in which you could get through the interview without succumbing to panic will put you into a better headspace to deal with any potential curveballs.  

“Generating flexible thoughts in advance, before I go into that situation, is major for regulating emotions,” Chapman said.

It’s also important to separate the truth of your circumstances from your worries about what might happen, which often have no basis in reality.

“It’s kind of like a person who has a phobia of flying,” Chapman said. “Knowing how engines operate and the statistics on flying actually will help them remain in those situations. So having facts versus feelings is very important.”  

The best path to using Chapman’s coping strategies successfully, he said, is learning not only what they are but why they work. 

“My motto with every client, literally, is that I’m teaching you to become your own psychologist,” he said. “Psycho-education is essential. We’re trying to make this last long-term, so you don’t need me later.”