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WHEN SOMEONE says they’re having a panic attack, a bystander’s first response must be to believe them —that they are not feeling anxious in ways a typical person can relate to, but in serious trouble and in need of the right help.
Most important for the bystander: remain low-key and don’t go away, because most panic attacks ease up in 20 to 30 minutes. Says DC school aide and artist A.M. “You feel so vulnerable and so embarrassed that you don’t want to be around other people, but it’s not good to be alone either.”
During a panic attack, the body “prepares for the pseudo-emergency…eyes may dilate to improve vision, heart rate quickens to circulate blood faster to vital organs, breathing increases to get more oxygen to the circulating blood, and your muscles tense in case you have to move quickly.” Hyperventilating can lead to dizziness and heart palpitations, which in turn cause some to panic more.
What’s known as “5-4-3-2-1” is a tool that bystanders can use to ratchet down the panic, a series of prompts for the sufferer to focus on and name out loud nearby sensory stimuli: 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and one thing you can taste. “These five steps are a way to ground yourself in the NOW…take you out of your head.”
Use specific examples: 5 things you see might include something blue, or something huge; for things you can touch, try your feet in your shoes or the ring on your finger, according to The Independent, which calls the sequence a “mindfulness hack [that] helps bring us back to the present.” The thing you taste can be your tongue.
For A.M., 5-4-3-2-1 required “lots of practice— for months to be able to step out of my body.” When practicing, she went first to touch, such as rough surfaces, and then smell. But in real situations, she likes to start with sight, especially numbers, like apartment numbers, or letters. Touch is still #2, and then hearing: “because everything is super loud: breath, heartbeat…”
The right help for sufferers does not include rational explanations for their feelings of fear: in their minds, they are threatened, and sometimes they are dying. Also unhelpful: telling them to “calm down.” Both responses invalidate the experience, said A.M. And suggesting calm breathing is usually a bad idea, “because panic attacks mean you are struggling to breathe at all.”
You’re stuck in your head, as A.M. describes it, so what helps is connecting to reality, or at least being distracted. After 5-4-3-2-1, talk about anything that might interest the sufferer, like a TV show they’re watching.
For her boyfriend, O.D., who also has panic attacks, meditation—focusing on breath, sound and then touch—works well. “It’s important not to move, just sit there,” he says. For those who prefer this option, practice is also advised—daily for 10 minutes or so—both to help reduce frequency of panic attacks and make them easier to conquer.
A.M. compares her panic attacks to being on a roller coaster: you can see you’re heading for the top, but when you get there you stop. You’re stuck. For her, the anticipation is terrible—”feeling the dread of it coming—even if the waiting only lasts 30 seconds: I can’t talk, I feel like I’m drowning.” She worries about going to the Giant—and used to avoid taking subways—fearing a panic attack would start and she wouldn’t be able to get out in time.
Fear induced by phobias is similar to that with panic attacks; the difference is those with phobias can see their specific trigger (spiders, vomit, open spaces or airplanes, for example), while people who have panic attacks cannot. Although both groups live with ongoing anxiety about having the next attack, those with phobias are on the lookout for their triggers. For panic attack sufferers, symptoms can spring up with no warning and sometimes no apparent reason.
Both groups, however, can find relief in having another person present to help with grounding and distraction, to accompany them through 5-4-3-2-1 when it helps, and to wait with them until symptoms subside.
—Mary Carpenter
Every Tuesday in this space, well-being editor Mary Carpenter fills us in on health news we can use.