How to Deal with an Anxiety Attack
What to do when anxiety threatens to take over.
Posted April 8, 2019
It first happened in the fall of 1978, during a meeting of the psychology department. The professors were engaged in a full-fledged fight—yet again—and all I wanted was for them to stop.
Suddenly, I felt I was going to pass out. My heart was racing so fast I couldn’t count the beats. Something in that awful fighting had triggered an anxiety attack the likes of which I’d never felt before. As I tried to come up with a plan for escape, the room suddenly quieted and looked at me.
I opened my mouth but no sound came out. My eyes darted helplessly around the room, taking in the horrifying sight of so many others looking at me. I struggled to breathe.
After what seemed like ages (but was probably only 10 or 15 seconds), the perplexed group went back to their fighting as I was left still clutching my chair, opening and closing my mouth like a fish out of water, having never uttered a sound.
And so began my journey into the hell of panic disorder.
What Most People Don’t Know About Anxiety
Unfortunately, my experience with anxiety is not unusual. Anxiety disorders are among the most common forms of mental struggles, with nearly 40 million adults being affected each year in the U.S. (that’s roughly 20%).
If you are reading this and suffer from anxiety, let this be a reminder that you are not alone. In fact, every third person you ever meet is going to suffer from anxiety at some point in their lives.
Acceptance and Commitment Therapy (or ACT in short) and other evidence-based treatments offer valuable tools and techniques to effectively deal with all forms of anxiety. But while anxiety disorders are highly treatable, only 37% of those affected receive treatment.
That is just not good enough.
There seems to be a widespread false notion about what anxiety is and what can be done about it. And apparently, the answer for most people is “nothing”.
“Nothing can be done about anxiety. You either have it, or you don’t. And if you have it, there’s not much you can do about it. This is how it has always been, and this is how it will always be.”
This notion is not only wrong, but it’s also dangerous because it leads millions of people to needlessly suffer without hope for betterment. As a psychotherapist who has treated countless of people with anxiety over the past decades, and as someone who has personally struggled with panic disorder for many years, I know the role of anxiety in our lives can lessen. The burden can be lightened and anxiety can assume its more proper role of warning us against real danger.
To change the unhealthy role that anxiety sometimes plays we need to learn how to address anxiety in day-to-day situations, so instead of running from our fear, we can face panic situations head-on. And in order to learn how to do just that, we first need to talk about baseball.
How To Deal With An Anxiety Attack
Step 1: Let Go of Rules
Suppose you want to learn how to play baseball. It’s useful to learn the basic rules before you get on the field, like how the game is played, and how points are scored.
However, once you are on the field, relying on the rules no longer helps you. It doesn’t help you to think about “how to hold a bat”, or “at which specific angle you need to take a swing” while you are facing the pitcher. The more you engage these analyses, the more likely you are going to miss the ball because you are too caught up in your own head.
You can try this out at home right now. Stand up and walk across the room, but with every single step think hard about the exact rules of walking. How do you lift your feet? In what order? And which part of your sole touches the ground first?
The more you focus on the “right” rules of walking, the more unstable your walk is going to be. And this is exactly what it’s like dealing with anxiety.
It’s useful to learn the basic processes first about what anxiety is, and how to effectively address it. However, once the anxiety sets in, focusing on the “right” thoughts and actions will not help you. In fact, entertaining these thoughts will keep you stuck in your own head and further pull you into your anxiety.
Dealing with anxiety is not a matter of following a specific set of rules. The rules can at best bring you to the edge. Instead, effectively dealing with anxiety requires you to let go of these rules and allow yourself to have “imperfect” thoughts and actions, so you can put your attention where it matters.
Step 2: Embrace Opportunities to Practice
When we are struggling there is often an “oh no” quality to the flow of events. “Not now”, “not again”, “this is too much”, “why me”, or “when will this end”. It’s as if some moments belong and others don’t, and we are winning when we get the “good” ones, and we are losing when we get the “bad” ones.
In actuality, however, all moments belong. All moments are opportunities for growth, especially hard ones. When else can we work on dealing with difficult thoughts and feelings?
We can practice the skill of dealing with anxiety through meditation, therapy, or workbooks. But ultimately, the best place to practice these skills is in the context of anxiety itself.
We can practice in the context of a small anxiety storm, such as when we’re stuck in traffic. We might then notice judgments of others, a childish pull to throw a tantrum, rising emotions, and physiological reactions. And while we notice this inner struggle, we also notice that there’s more going on in the present moment.
We hear the sound of the song on the radio, and we notice the children in the car next to us. And we recall that we are going somewhere and that being stuck in traffic is part of this bigger journey.
As those smaller moments are mastered, we can even practice in the context of a large anxiety storm - perhaps when experiencing waves of anxiety right before standing to speak in front of a group. This, again, is an opportunity to notice what comes up.
We notice the familiar cacophony in our head, the pull to run away as if we could run from our own bodies. We feel the beats of our heart and the sensations of our physiological reactions.
And we notice something more than just ourselves. We see the faces of the human beings in front of us, and we recall that we stood up on the stage to say something in the service of others. We direct our attention to what we came to do and let go of all the rest even as it thunders on.
Gradually, gradually, we can learn what to do inside the storms, small, medium, and large. Bring on “not now” or “not again” or “this is too much”. They are just thoughts to notice. Bring on sensations. They are but your body reacting. And bring on life. Successfully dealing with anxiety comes down to practice, and whenever difficult thoughts and feelings come along, you find yourself in an ideal opportunity to practice.
Step 3: Meet Your Anxiety With Curiosity
Would it be possible to be genuinely interested in your experience of anxiety? I mean really genuinely interested?
You can learn to explore your anxiety, without having to run from it. You can even set limits on the time and situation, by making a commitment like this:
“I am going to go to place _____ where I will likely have an anxiety attack, and I will stay there for _____ amount of time.”
And then go there with no secret outcome in mind. None. Your goal is NOT to have any less anxiety. Your goal is NOT to feel it so often that something different will happen.
Instead, go there out of genuine interest in what this anxiety even IS. Stay present with yourself and look carefully, with an attitude of genuine interest, curiosity, and openness at your own experience. Like a scientist discovering a new planet … or when you were a small child looking at the clouds.
Exactly what thoughts show up? Note them. Name them. Watch them. What bodily sensations? Where do they begin and end? How do they ebb and flow? What emotions to feel (watch closely and name each -- there are far more than “anxiety”!) What are you pulled to do?
If you are not sure you can do this, set the timer so short that you are 100% sure. One minute. Or even just ten seconds.
You can evaluate how you did by this standard: Were you psychologically present, and were you open to what came up? Not passively open like “I can tolerate this”, but really curious and open. Like a little boy playing with a weird bug. A sure measure is this: Are you now more or less willing to do it again?
If you can do it for ten seconds, can you do it for one minute? If you can do it for one minute, can you do it for ten minutes? If you can do it at the drugstore, can you do it in the mall?
Painful emotions, difficult thoughts, odd sensations, unwelcome urges -- none of these are 100% under your control. Sufficient force can take away your behavioral control. You can lose your freedom; you can lose your comfort. Only a few things are under your absolute control. What do you care about and will you choose to be present or not to your own experience? Those are things no one can take away, so long as you are conscious.
Don’t give it away. Don’t let your anxiety fool you into thinking that you have to give away your presence and caring. Only you get to choose those parts.
The anxiety may go away or it may not. What matters is whether you will show up to your own experience and restart doing the things you care about but stopped doing because of anxiety. Walking that walk is how you regain your ability to say “yes” to life. When you learn how to do that, your anxiety is no longer in charge. You are.