Panic attacks: skills to help
Hey, so we are here to talk mental health. How would you describe yours?
I’m struggling mostly with Dissociative Identity Disorder and Complex Post-Traumatic Stress Disorder (CPTSD), which causes a lot of anxiety and panic attacks in my daily life. Over the past months I’ve found myself dissociating a lot more and I also struggle with flashbacks and insomnia.
I was always an anxious child, but it wasn’t until about 7 years ago that I had what I would call my first panic attacks - the main symptom of which was dizziness and the fear of fainting. Back then I was in therapy for depression, which I've also had from a young age. Through therapy the dizziness reduced, and I learnt to control my anxieties. But for the past two years I've been having a lot more panic attacks, where the symptoms are sweating, rapid heartbeat and feeling unable to breathe. Last year I went to hospital for 6 weeks to get better, but right now I’m very anxious and find it hard to leave the house alone. I also dissociate a lot.
Some people won’t know the term ‘dissociation’, could you explain what this is?
Dissociation means part- or complete-disruptions in aspects of consciousness, identity, memory, physical actions and/or the environment around you. Symptoms can vary from person to person. I often feel detached from myself, and I can experience amnesia about parts of my daily life - sometimes when I have dissociated I won’t know how I got from one place to another, which is a very scary experience.
When we talk about a Dissociative Identity Disorder, it means that an individual can contain more than one personality - it’s also known as Multiple Personality Disorder. I would like to mention that I don't like the word 'Disorder' - for me ‘Dissociative System’ would feel like a better term.
Some people find a clinical diagnosis of a mental health problem to be useful, others prefer not to be classified in this way. What are your feelings about this?
I was without a proper diagnosis until last year. My diagnosis before that was ‘depression’, but my symptoms are much more complex than this. I was glad to have a diagnosis, of Dissociative Identity Disorder and CPTSD, as now I can read about it and learn more about what it is and what happens to me. But there are a wide range of symptoms for any diagnosis, and everyone will experience symptoms differently. The problem with a diagnosis is that everyone gets put in the same box. But on the whole, for me, it’s been good to get a diagnosis as now I can work with it.
You’ve recently been learning new methods to cope with your panic attacks - can you share what these methods are, and how helpful you find them?
Yes, there are a lot of skills people can learn to cope with panic attacks, and it’s up to each person to try them out and see what methods work for them. The most important thing for me when experiencing panic is to try to stay grounded in ‘reality’ and check whether the anxiety I am feeling is real or not - but this is often easier said than done.
I practice the skills when I’m not having a panic attack, in order to train myself for when an attack does happen. When I started learning these skills I tried to do them 3 or 4 times a day. Here are some of the skills I have learnt:
5-4-7 Breathing: Count to 5 while you breathe in, hold the breath for the count of 4, then breathe out for the count of 7. You can continue this pattern for as long as you feel you need to.
Fast Breathing: Breathe in 4 quick breaths, then breathe out fast 4 times.
Counting 5-4-3-2-1: Count 5 things that you can see, then 5 things you can hear, then 5 things you can feel. Then do this with 4 things, then 3 things, 2 and 1. Rather than just saying to yourself “I can see a cushion” try to describe where it is, what colour it is, what it is next to e.t.c. “I can see a cushion which is on the sofa, has sunlight falling on it, looks soft, and is red with blue dots”. The aim is to shift your awareness back to the place where you are. If you can’t, for example, hear anything then just say to yourself “I can’t hear anything”.
Counting backwards: To distract myself from the anxiety I sometimes count backwards, for example subtracting 7 from 200 (193, 186,...). You want to choose a number which is slightly challenging for you - although in moments of high panic even a very simple calculation like minus 2 can be a struggle.
Counting steps: Walking is in itself a good activity, and I often count my steps while I walk.
A strong stimulation: A strong scent or taste, such as a strong mint or gum, or the smell of lavender.
A Bullet Journal: I keep a 'Bullet Journal' where I keep track of my anxiety over each month. You can have a page for a whole month, a week or a day. I make note of my mood, my anxiety level, and panic attacks - it’s really useful to track them over time. I also track sleep, appointments, social events, diet, whether I’ve taken my vitamins. Also, I keep a page where I list something that I am grateful for on each day & where I write what happened on that day. I also write inspirational notes or poems or little positive reminders. It may sound like a big effort, but it takes just 10 minutes of my day, and it helps me to have a daily routine. To get started with a ‘Bullet Journal’ this article explains more.
Ground yourself: Try to feel grounded in the environment - lean against the wall, and feel it against your skin. Or feel your feet on the ground.
Imagination: Imaginative exercises can help - if I am having flashbacks I imagine a place where there is a safe, and I open it, put the flashback inside, and lock it away inside the safe. This is however a skill which I would recommend that people learn together with a therapist.
Music or games: I can find it helpful to focus on music, other people like to play games on their phone.
Puzzles, colouring or knitting: To calm down after a panic attack or from high tension I do things like a puzzle or colouring - other people say knitting helps them.
When you are suffering with your mental health, is there a word that accurately describes how you are feeling?
I’m not so good at describing things with words, but I sometimes draw how I feel. It often feels dark and without an ending; it’s overwhelming. I think Jorgy Flecha described depression well: “I think if I were to describe the feeling it would be an empty black hole that you’re alone in and you can’t find a way out because it’s so deep, and every hour someone passes by this hole and throws a brick at you.” Here's a little sketch of this which I drew in my Bullet Journal:
Do you talk to your friends or family about your mental health?
One thing I’ve learned for myself over the years is that it can be very helpful to talk to friends about how I'm feeling. There are some people who have disappeared from my life while I’ve been struggling with my mental health, but there are others who have built up a support group for me. Most of these people live together with me in a shared apartment, and if I get panic or flashbacks I have the possibility of asking for help. They also help me with going to appointments, doctors or getting the shopping - and I’m really thankful for their support.
I think if you have people around you who support you then the most important thing is to communicate regularly about what is going on, both for me and for them, and how much time and energy they have to be able to support me. At the moment I try to not only rely on friends, but also search for professional support. Once a week I go to a counsellor, and I’m looking for a therapist, but it’s hard to find a good one. I’ve also applied for a caseworker who would be able to help me go out. I think it’s important to reflect my own needs and try to build up a network of people who can help me cope with my mental health.
I’ve also recently started going to an osteopath, which is very good - trauma leaves a memory in the body, so working with someone who can locate the stress in the body and work to remove it is very useful.
If someone is now in a similar situation to you when you were most struggling with your mental health, would you have any advice for them?
I think the most important thing is to decide what you need in that moment, and whether your friends or ‘family’ can help, but also whether it would be good to seek out professional help.
There is still a stigma around talking about mental health - how does it feel to be talking about it here?
I’ve taken my time to think about the questions, and it has been good to reflect on the progress I’ve made. If my answers can help someone that would be great. There are so many people who struggle a lot, and we should not stay silent. A lot of people have given me advice and help, and so it feels good if I can now do this for other people.
Personally I’ve found learning about the different skills to cope with panic attacks really useful, and I imagine many more people will too, so thank-you very much!