A Primer for Handling Anxiety Attacks

As part of my unfortunate, perpetually-undiagnosed "female complaint", each month at PMS time I do what I call "reaching into the grab bag". The "grab bag" is a hypothetical place filled with the entire list of possible PMS symptoms, which can be found on just about any medical website. I "reach into the grab bag" and I pull out three symptoms more or less at random. Those are the ones I have to deal with for that given month. The symptoms are discarded within a day or two of actual onset of menstruation, and next month I reach in for another three, at random.

This month, I happen to have picked out "anxiety attacks".

Now this is not terribly new for me. I have been officially diagnosed with "Generalized Anxiety Disorder", which basically means that I may get anxiety attacks sometimes for no particular reason. Oh, we are sure that there is a reason. Perhaps there is a hormone drop, or surge, or a neurotransmitter glitch. The problem with finding an intermittent error in any system, as I'm finding with a really bizarre personal computer problem involving a disappearing hard drive, is that if you don't catch the problem in the middle of happening, the diagnostics all check out as normal. Suffice to say that I have identified a few triggers, but have no hopes of catching all of them.

So I have decided to take a moment and create a primer, for family, friends, and whoever might benefit from the information, on how to identify and treat an anxiety attack from the perspective of the sufferer's family member, friend, or whoever happens to be accompanying her when it happens. I am doubly encouraged by a scene the Disney movie Frozen. Anxiety sufferers cringe at the reprise to "For the First Time In Forever", in which Elsa very clearly displays every sign of a physical anxiety attack, and Anna does everything wrong in trying, with an open heart and honest desire to help, to make things better. I know you guys want to help your friend. I'm going to help you figure out how.

Step 1: Identifying an anxiety attack

Anxiety attacks often start with a surge of panic. At this point, I know the feeling well enough that I don't actually feel "afraid", so I could dispassionately describe it as an adrenaline surge. It's the same feeling you get when you are driving down a snowy road, you turn the wheel, and nothing happens. In fact, the entire anxiety attack pretty much follows your physical symptoms after you do something like that. The person may start trembling, sweating, or shivering, may rest her hand near her neck to feel her heart pounding, may blink rapidly, and her breathing will change. If she's a pro at dealing with the attacks, her breathing may become deeper, slower, and more deliberate. If she doesn't have a handle on it, her breathing may become shorter, faster, and shallower. If the attack is severe or she doesn't know how to identify or manage it, she might even start to cry.

There may be no obvious trigger, and anxiety often builds to an attack (secretly and in the background) rather than hitting the rapid onset that you would feel if you had just entered a genuinely dangerous situation. She may have been mall-walking for an hour and a half and suddenly get hit with a full-fledged attack while doing nothing in particular. Even when you have been having anxiety attacks for years and are pretty well used to them, the opening surge still blindsides you.

Step 2: Shift your focus

In the scene from Frozen, the first mistake Anna makes is to assume that Elsa is "afraid", and that figuring out what is frightening her and easing her fears will make her reaction go away. This is actually 100% wrong. Whether the trigger is emotional or physical, the anxiety attack response is utterly and fully physical, and "solving the problem" will do absolutely nothing for the symptoms. In fact, attempting to "solve the problem" will be useless on two fronts: you are repeatedly applying a potential (probably a likely) trigger for the attack, and she is not going to be able to deal with any underlying emotional state in a reasonable manner. If she had an attack of leg cramps, you wouldn't push her to keep jogging while telling her that she can 'get through this'. You'd let her stop until the cramps ease and help her work them out of her leg. You need to do the same thing here.

So the wrong thing to say is, "Are you scared?" or "What are you afraid of?" or "How are things going at home?" The right thing to say is, "Are you having an anxiety attack?"

Now that isn't to say that being a counselor is the wrong thing to do overall. There is obviously an underlying stressor causing the problem, and you might want to talk to her later on and find out if it's emotional. Never do it during the attack, or even in the immediate aftermath. You want to be in "nurse mode" with your friend right now, not "counselor/psychologist mode".

You may have noticed by now that I keep using the phrase "anxiety attack" instead of "panic attack". I almost wish I could invent another word for it. When I have an attack, I am not "panicking". In fact, I'm probably completely calm to all outward appearances. I am having a physical reaction, like cramps or hives. (I am not entirely typical. Usually the person having an anxiety attack will have an emotional reaction as well. In that case... it is still merely a physical, chemical reaction and ought to be treated as one.)

Step 3: Managing an attack

Now that you know that you're dealing with a physical/medical event, you will find it much easier to learn how to treat the attack. The first and best thing to do, especially with someone who has a history of anxiety attacks, is to ask, "What can I do?" and "What do you need?" Then listen. That seems obvious, but in that Frozen scene, it is one thing that Anna does not do. Her sister puts out very clear "back away" signals and even states clearly that she is making it worse, but she just keeps persisting, certain that the Power of Friendship will solve the issue. Some people may feel better if you hold hands, or give a hug, but some will not, and it is neither your fault nor a rejection of you as a friend.

Because I am sensitive in a number of ways I don't understand, I perceive people as if they have 'zones of influence' or 'zones of personality' (commonly called 'auras', mostly in spiritual circles to which I do not belong) extending for a short distance around them. When I am dealing with an anxiety attack, I am managing my own 'aura', doing a balancing act. I do not need your 'aura' getting into my zone and throwing off all my readings. Now that's my personal experience. Frequent sufferers generally already know what works and can tell you what you can do, or just communicate whether they need closeness or space. If you are going to hug or hold hands, for heaven's sake keep yourself calm, because they might be feeding off your mood in hopes of stabilizing theirs.

There are several medical/physical steps that can shorten an anxiety attack. Forcing yourself to breathe deeply and slowly will slow the heartbeat and help kick the body off of its adrenaline surge. Massaging the vagus nerves (roughly where the jawbone meets the ear and just behind it) will also help. You could give your friend a drink and encourage her to sip it slowly once the initial surge starts to recede. Do not give her anything with caffeine in it. She should probably avoid caffeine completely for the rest of the day. Visualization also helps, but it has to be a place that she finds relaxing, not a place that you find relaxing. Though the two may coincide, don't depend on it!

If your friend has a chronic problem, she may have been prescribed medication. Alprazolam (Xanax) is a fairly common "take-as-needed" medication for anxiety attacks. Check the bottle and do her a favor - offer to drive home. Most anti-anxiety medications cause mild or marked drowsiness.

Anxiety attacks typically peak within the first ten minutes and take about a half hour to really resolve. Serious problems like allergic reactions and cardiac difficulties (she might mistake an anxiety attack for either of these, and might even be convincing to bystanders and helpful medical staff) will continue or get worse.

Step 4: Aftermath

Anxiety attacks are like earthquakes. They tire people out, and the larger ones commonly have 'aftershocks'. Your friend might need to cut your trip/visit short, eliminate an event from her schedule, or simply needs to go right home as soon as the symptoms subside. If she decides to power through the rest of the day (whether she powers through or goes home, she is just as frustrated with cutting it short as you are), just keep an eye out and be aware that the attack will have sapped her energy and lowered her ability to cope with stress triggers. If you leave the mall to find that your planned dinner spot is crammed full of noise and bright light, feel free to suggest a different spot!

Basically, just be aware that it is possible to have multiple anxiety attacks in a day, and each one weakens her resistance to the next. If the attack was severe, she might need a couple of days to fully recover.

When the physical effects of the attack have faded away, it may be a good time to encourage your friend to check on her stressors and triggers. Now is the time to find out if she has been facing a bad situation at work, or whether she is just at a bad point in her hormonal cycle. Dealing with the triggers ahead of time will prevent or at least lessen future attacks.

Be patient... anxiety disorders often require lifelong management, like diabetes or Crohn's, and it may be decades in the future (or longer!) before we can even identify the underlying problem, never mind finding a full-out cure. A person with an anxiety disorder can still lead a perfectly fine, happy, fun, fulfilling life, as long as her family and friends can patiently deal with the attacks and move on to the good stuff.