16 Steps to Stop Panic Attacks
1. If you haven't already done so, see your physician to make sure there are no physical
Many who are reading this have already had at least one ER visit.
Panics often mimic heart attacks. It is essential to rule out cardiac and other
physical ailments. Many have had numerous and repeated cardiac tests, yet
continue to feel that they are having a heart attacks while they are experiencing
symptoms. Others may feel there is a physical problem that makes them feel
like they are choking. Many ask how they can tell if it is a panic and NOT a heart
attack? Heart attacks don't go away with deep breathing or taking a Xanax.
2. Decrease caffeine intake immediately. Aim to end all caffeine, at least until you stop
the panic attacks.
Panics occur when one enters the “fight or flight” response, which releases
Adrenalin. The body is over-stimulated. Some report drinking several pots of coffee
a day! Stopping this level of caffeine intake alone May end the panics. At least a
decrease is very likely. When one has stopped having panics, sometimes one cup
of coffee can trigger a panic.
3. Refrain from more than one or two drinks or taking recreational drugs.
Even social use can trigger a panic for some. Cocaine and amphetamines are
stimulants. Marijuana can make some paranoid as well as trigger panics.
4. Learn and practice deep breathing (http://drmikemiller.com/media.html) throughout the
day, especially when you are NOT feeling anxious.
People often hyperventilate during a panic. Breathing is frequently rapid and shallow,
only using the top part of the lungs. Deep breathing generally helps people feel more
relaxed. Also known as belly breathing, one breathes slowly and deeply. Practicing
when you are NOT anxious allows you to get better at using this skill. This will help
make this a much more effective tool.
5. Learn about anxiety and panic attacks. Two places to start are
http://drmikemiller.com/panic.html and http://nimh.nih.gov/health/topics/panic-
Knowledge is often power. Recognizing that your symptoms are anxiety and NOT
something dangerous. When one understands what is going on, they are in a MUCH
better position to use these tools.
6. Shift your focus away from a microscopic monitoring for internal sensations.
People who have panics are understandably concerned about not having more
panics. This frequently results in people monitoring for any internal sensations. While
doing so, there are often thoughts like “What if I have another panic?” “I'm sure that all
the doctors are mistaken and I really DO have a physical problem that WILL KILL me!”
7. Give a release to your tensions, whether by exercise, walking, dancing, etc.
Any healthy release of tension and stress will help make you that much less likely to
have a panic. Part of this is a release of tension stored in the muscles. Another
benefit of physical activity may be a shift away from obsessive, catastrophizing
thinking. I have referred to this as “Getting into your body (in a healthy way) and out of
your mind.” Even brief walks can be beneficial.
8. Stay in the present as much as possible. Focus only on the things that need to be
attended to today.
Anxiety resides in thinking and catastrophizing about the FUTURE. Take a moment
and consider if anything terrible will happen to you in the next 10 seconds. All of you
will realize there is no danger at this time. Nor is there likely to be danger in the future
for most. Even if one knew they are terminal, worrying has no adaptive function and
will not help.
9.Monitor your “What if” thoughts. Decatastrophize these thoughts.
There is a “What if” attached to any worry. “What if I'm late? What if they hate me?
What if I choke and forget everything I've learned?” What ifs are followed by some
predicted negative outcome. One can ask questions like, “How likely is it that I won't
get ANY questions right on the test, especially since I'm so well prepared? What
reason do I have to predict they will hate me?” Look at the facts, NOT what your
strong negative feelings may be telling you.
10. If you have trouble letting go of any of these thoughts, try writing them down and then
putting the paper in a folder or someplace away from you.
Some find writing down their worries helps them release those worries. Sometimes,
when you look at what you have written, you will see how absurd the thoughts are.
Physically placing these away from you can help you “distance” yourself from your
strong negative thoughts.
11. Use coping statements such as “These symptoms may be miserable, but are NOT
One can also label the worries as the lies the anxieties are telling you. Most important,
tell yourself the reality that you are NOT in any danger.
12. Work to rid yourself of other negative thinking.
Unless you challenge your negative thinking, it will only grow stronger. This
strengthens your “Emotional reasoning” that everything is messed up, that nothing will
ever work out, and that you ARE in danger. You FEEL so strongly that you are, you
then Know that you are in danger.
13. If you begin to experience panic symptoms, try deep breathing. This often stops the
symptoms from blooming into a full panic attack, if caught soon enough.
For those who have practiced and are able to use deep breathing, using it at the
beginning of anxiety often stops what otherwise may have grown into a panic. The
ability to do this can also give you some sense of mastery, compared to the feelings of
being out of control that most with panics feel.
14. If you have a panic attack, shift your focus off of your symptoms. One option is by
subtracting 7s, starting at 100 (100, 93, 86...)
Rather than catastrophize what “WILL” happen to you, shift your thoughts to neutral
topics, such as math. If you are too upset to subtract 7s, try 3s. If you are in public,
you might count how many people you see who are wearing red. In essence, shift your
thinking AWAY from your internal sensations to something outside of yourself.
15. At least once a day, reflect on what you have to be thankful for that day.
As stated earlier, unless you challenge your negative thinking, it will only grow
stronger. One way of doing this is to purposefully focusing on what has gone RIGHT in
your life, that day. One might also say this helps you look at the glass as “half full,”
rather than worrying about what is NOT in the glass, as well as the likelihood that you
will lose the rest of what IS in the glass.
16. Go back to 1.
It is critical to get to where you can monitor yourself for negative thoughts and then to
accept that they are just negative thoughts and that you are NOT in danger.
This is not intended to be an exhaustive listing of every technique that anyone has
ever found helpful. For example, some may pray for the strength to realize that the
negative thoughts are NOT what is real and that they are safe, despite the strong
feelings that are saying otherwise.
Mike Miller, PhD
Copyright © 2008 - 2009. Michael Miller. All rights reserved.