Panic Attacks: Tips to Manage & Mitigate the Effects

Interview Dr.Colleen Cira

How common are panic attacks?

According to the National Institute of Mental Health, approximately 4.7% of the adult population in the U.S. experience panic disorder at some time in their lives.  Panic Disorder is different than simply having a panic attack.

Panic attacks on their own are not diagnosable according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) but are included as the main symptom of Panic Disorder, which is diagnosable.  Therefore we don’t have prevalence rates on panic attacks as stand-alone experiences; however, if 4.7% of the US population experiences full-blown panic disorder (which is the combination of experiencing panic attacks and then developing a fear about having a panic attack that you begin to change your behavior in order to avoid the perception of triggering them), then I think it’s fair to assume that more than 4.7% of the population has experienced at least one panic attack in their lifetime.

How long does a panic attack usually take to pass?  Or does that vary for the individual?

According to the DSM-V, severe anxiety that results in panic symptoms peak after about 10 minutes.  This is not to say that you feel 100% after that amount of time, but the intensity fades after about 10 minutes.  That being said, some attacks occur in succession, making it difficult to determine when one ends and another begins.  

What exactly is happening in the body when you experience a panic attack?  Does understanding what is happening in your body help you to overcome the attack?

When you are having a panic attack, your sympathetic nervous system has kicked into overdrive and all sorts of chemicals (cortisol, adrenaline) that would help prepare you for a threat are coursing through your blood.  The problem is that most of the time that people are having a panic attack, there is no threat. Part of the symptom cluster of a panic attack is that they often “come out of the blue”, which means your nervous system was triggered for reasons we can’t pinpoint.  But yes, by knowing what’s going on – by knowing that this is not a heart attack, you’re not “losing your mind” or “going crazy”, by knowing that you’re not going to pass out – just by knowing that this is simply a panic attack, that awareness and the self-talk that can happen from a place of awareness and acceptance, absolutely can help.

Is removing yourself always the best option?  

If you’re at your desk, it may be easy to step away and head to a bathroom or go outside for some fresh air, but not so easy when you’re in a meeting in a boardroom or when you’re in a conference or a situation where people would notice that you’ve left the room.

You are the best bet for when you cannot leave is to practice these techniques so much and become so familiar with yourself that you can spot a panic attack a mile away.  Once you’re in full blown panic, riding it out while focusing on your breathing and engaging in self-talk is your best bet, all of which can be difficult to do when you’re in a group of people and feeling under a microscope.  Just like a toddler who is kicking and screaming on the floor, there’s not a whole lot of effective strategies to calm that kid down at that moment. You just have to wait for the storm to pass. But you CAN help prevent panic attacks, which is the most effective way to deal with them in the first place.  If you must stay where you are, you can try to ride it out by simply focusing on your breath and engaging in helpful self-talk (I know what this is and how to manage it, I just need to accept that this is happening, focus on my breath and this will go away all on its own, etc). But if that becomes too difficult, which it might, your best bet is to leave the room and then do damage control with your boss later.

Panic attacks aren’t easy to hide.

They come with physical symptoms sometimes – sweating, shaking maybe an upset stomach. When a panic attack comes on at work, people can be embarrassed.  Is there anything you can do to help decrease the severity of your physical symptoms during a panic attack?

The physical symptoms are all happening as a result of your sympathetic nervous system being activated.  So anything you can do to activate your parasympathetic nervous system – the side of your nervous system that is responsible for bringing your body back to the status quo – is going to be helpful.  As I mentioned before, slow, deep, belly breathing is one way to activate your parasympathetic nervous system. This is hard to do at the moment but is helpful for putting the breaks on. The other thing that you can take advantage of is how our bodies respond to the cold.  When we are cold, our heart rate slows because it’s trying to conserve energy. And when you’re having a panic attack, having your heart rate decrease is very helpful! So wash your face with really cold water, go to the kitchen and hold onto a couple of ice cubes for as long as you can (not pleasant, but effective), let a very cold water run over your hands for as long as you can stand it, if it’s cold outside, go stand out in the cold or take the ice pack from your lunch and put it on the back of your neck.  Anything you can do to decrease your body temperature will help slow your heart which will help activate your parasympathetic response.

The importance of breathing.

 There are plenty of apps that deliver breathing and mindfulness exercises. The app “Calm” is excellent for someone trying to do breath work who is a meditation newbie.  Calm is very simple, has tons of guided meditation options and you can choose to do it for as little as 2 minutes, which is helpful for someone who is really upset and/or new to the practice.  They also offer a free version and it’s available for download on both iPhone and Android phones. If someone is averse to anything that looks or feels like meditation, even guided meditation, Breathe2Relax is a great app for just focusing on the breath.  In the app, you can choose how relaxed or stressed you feel in the moment and then you’ll hear a voice that will walk you through a breathing exercise where the pace of the breath-work is based on how relaxed or stressed you reported that you’re feeling. This is also a free app and has the ability to link to your Apple Watch.

Should you tell someone else in the office that you are prone to panic attacks?  Or should you tell them during that you are having an attack?

Sometimes speaking about panic attacks is difficult as the person may fear the repercussions—people thinking they are weak, or that they can’t handle the stressful demands of the job, etc. If you have someone at work who you really trust, then yes, I think it’s incredibly helpful to tell someone.  There is certain vulnerability whenever we reveal a part of ourselves to someone else, especially if we don’t feel great about what we’re disclosing.  But if there’s someone who you trust, who you know cares about you and wants what’s best for you, then that person’s support is a great thing to have. Research is clear that even when we simply know that we have support – even if no one is actually helping us at that moment – it makes us more resilient and better able to deal with adversity.

If you know you’re prone to having attacks, what are some things you can do to help prevent panic attacks?

This is the most important part of managing panic!  There are so many things that you can do to help prevent and manage panic attacks and most of these include making changes in your day-to-day life.  Just a few of these include: A regular practice of deep relaxation (meditation, mindfulness, breath-work, etc), regular activity/exercise, a decrease or elimination of stimulants (caffeine, sugar and nicotine) from your diet, learning to acknowledge and express your feelings, especially anger and sadness, and changing the way you talk to yourself (The Anxiety and Phobia Workbook, Edmond J. Bourne, Ph.D.).  There are lots of simple changes you can make on your own that will help with this, but sometimes it’s simply not enough or you can’t find the motivation or follow through to act on these things…and there’s no shame in that. At some point, we all have to decide when we can do something on our own and when we need help. If trying to manage your anxiety and panic is feeling too overwhelming or hopeless on your own, that’s often a sign that you need some support.  To find the right therapist who specializes in anxiety and panic and they can walk alongside you on your journey.


Available for Interviews: Dr. Colleen Cira

Dr. Colleen D. Cira, Psy.D. received both her Masters and Doctorate from the Illinois School of Professional Psychology and has been practicing in the field since 2001. Dr. Cira is a Licensed Clinical Psychologist and the Founder and Executive Director of Cira Center for Behavioral Health, PC a boutique group practice with locations in Chicago and Oak Park that specializes in Women’s Issues/Health and Trauma. Dr. Cira is a trauma and anxiety expert, clinical supervisor, writer, speaker, consultant, activist, wife, and Mommy to two little ones.

Jo Allison
Success In Media, Inc.

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