Many years ago, just after getting certified as a scuba diver, I was under 90 feet of water and needed to clear my mask. As I lifted the bottom of the mask to blow out the water, I suddenly felt an intense rush of fear, could not catch my breath, felt lightheaded, and had an urgent need to escape. Problem was that being 90 feet underwater meant that I could not just shoot up out of the water—I would need to go up slowly, or I could damage my lungs. Thankfully, I knew there was one thing that would help me deal with the panic—pause my breath for a little while, just long enough for my suddenly depleted carbon dioxide levels to rise, and for the oxygen to get back to my brain so I could think straight.
If you’ve ever had a panic attack, you know the feeling of being overwhelmed, feeling lightheaded, short of breath, your heart pounding, not being able to form a coherent thought, feeling tingly and nauseous. You may have worried that you were dying or having a heart attack or going crazy. The good news is that none of that was true. Panic attacks are very scary, but otherwise harmless. The reason you experience all those unpleasant physical sensations is primarily due to a breathing dysregulation that happens when you panic—overbreathing, also commonly known as hyperventilation.
My previous post on breathing explains exactly what happens when you overbreathe. To summarize here briefly, overbreathing happens when you breathe out too much carbon dioxide. This results in lack of carbon dioxide in your blood, which prevents oxygen from being released from your bloodstream and reaching your brain, muscles, and other organs. Lack of oxygen is the reason why you experience lightheadedness, shortness of breath, tingly fingers or toes, difficulty thinking clearly, nausea or other stomach discomfort, feelings of agitation and unreality.
People might experience panic attacks for a number of reasons. Sometimes panic attacks are a result of panic disorder, a condition where the person experiences great fear of the physiological sensations of the panic attack itself, the so-called fear of fear. The person may be afraid that these sensations mean that she or he is having a heart attack, dying, or going crazy. The fear of the sensations remains even when the person is reasonably sure they are not going to die or go crazy.
People might also experience panic attacks when they are exposed to an object or situation they are afraid of (a phobia), such as dogs if one is afraid of dogs, or being on an airplane or having your blood taken. For some people, panic attacks happen in social situations when they are afraid of being judged or coming across as stupid. Panic attacks can also happen for people who have experienced traumatic events, particularly when they are somehow reminded of these events. Finally, panic attacks can happen in completely unexpected situations when a person experiences fear even if they would not expect to be afraid (like me in the scuba diving situation).
No matter the reason for your panic attack, it is an intensely unpleasant experience. Most people struggle to stop the panic attack the moment they feel one coming on. Unfortunately, it is that struggle that is likely to exacerbate and prolong the panic attack. This happens for two reasons. One, the struggle exacerbates the already strong fight-or-flight or fear response that comes with the panic attack, revving up your nervous system, and producing even stronger sensations of fear. Two, the struggle to catch your breath, usually through taking big deep breaths, makes you breathe out even more carbon dioxide and further decreases the amount of oxygen available to your brain and body. The more carbon dioxide you breathe out with those big deep breaths, the less oxygen is being released from your bloodstream, and the more lightheaded, foggy, tingly, nauseous, and scared you feel.
If you experience panic attacks, you’ve probably read a lot of advice about how to get through them. You’ve probably heard the advice not to fight with the panic, but rather allow it to happen while mindfully being present with the sensations. This is great advice, except that when you are in the middle of intense fear and panic, it may be difficult to convince yourself to allow the experience and to be present with it. You might have read about some multi-step processes for dealing with panic. The problem is that the brain fog that comes with panic makes it very difficult to think of all the steps that you are supposed to take.
I suggest using this simple three-step approach which will address both of these problems and allow you to respond to the panic attack in a healthier way without getting stuck. Use these steps if you find yourself having a panic attack: Hold, Breathe, Observe. If you are feeling anxious, but not panicky, follow the breathing instructions from my previous post.
1. Hold: As you find yourself in the arising panic, pause your breath for about 10 seconds—slowly count to 10. That’s it. No need to think of complicated steps, just remember to pause your breath.
If you pause after the inhalation, count to 10 and then exhale slowly. If you pause after the exhalation, count to 10 and then take in a small inhalation and exhale as slowly as you can. Then pause and count to 10 again. Repeat 5-6 times, or until you start feeling more clearheaded and less overwhelmed.
Pausing your breath allows your carbon dioxide levels to rise and more oxygen to be released from your bloodstream to your brain and body. With each pause, your carbon dioxide levels rise a bit more, bringing more oxygen to your brain, and reducing the intensity of suffering.
2. Breathe: As your breathing stabilizes, continue breathing low and slow:
- Shift your breath from your chest to the belly.
- Take a normal size comfortable breath in, as if you are smelling a flower (no need for a deep breath).
- Exhale as slowly as you comfortably can, either through the nose or through pursed lips, as if you are blowing out a candle.
- Do not rush to the next inhalation. Let your body inhale for you when it’s ready. And let your next inhalation again be a normal-size comfortable one, followed by a long, slow, complete exhalation.
- Continue breathing low and slow for a few minutes and into the third step.
3. Observe: As the intensity of distress subsides, you will likely find yourself more willing to mindfully attend to your present experience and allow whatever sensations you become aware of to stay without trying to push them away. Just observe. It might help you to structure your observation around your senses: what do you see, what do you hear, what do you touch, what do you smell, what do you taste? This exercise will allow you to accept whatever is happening in your awareness without a struggle. Panic will subside on its own.
You might be wondering whether you should breathe into a paper bag when you are having a panic attack. The short answer is No. Here’s why. Breathing into the paper bag does help raise your carbon dioxide levels and increase oxygen release, which is why you so frequently see people do this in the movies and on TV. However, when you breathe into and out of the paper bag, you don’t know how much carbon dioxide you are actually getting. If you’ve been breathing into and out of the paper bag for a while, the concentration of carbon dioxide may be higher than necessary and oxygen may be in short supply. In addition, you would have to actually have the paper bag with you. Pausing your breath for 10 seconds, on the other hand, will not deprive you of oxygen, and does not require carrying around any props.