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Panic attacks are scary to experience and scary to observe. Far more extreme than feeling “panicky,” a real panic attack is when someone experiences sudden, intense physical symptoms — racing heart, sweating, shaking, dizziness, shortness of breath, nausea. The individual interprets these symptoms to mean something is terribly wrong. People often believe they’re dying or “going crazy.” It is not uncommon for people to go to the emergency room for fear they are having a heart attack or another medical emergency.
In my clinical practice, parents often ask for help with how to approach their teen during one of these attacks. They have often already tried with less than favorable results.
Many parents are scared by panic attack symptoms, which can lead them to share their anxiety with statements such as “You are scaring me.” Some believe they are attention-seeking and either walk away or make remarks such as, “Snap out of it.” I have talked to a lot of parents who want nothing more than to help but find themselves not knowing what that would entail.
In the long-term, the most beneficial step is to seek professional help. While one panic attack does not require intervention, it is uncommon for people to experience one attack without others, or without more general high levels of anxiety.
Research shows that the most successful treatment for panic disorder is a combination of antidepressant medication prescribed by a psychiatrist and cognitive behavioral therapy (CBT). Many clinicians, myself included, recommend CBT as the first-line treatment, with medication added if necessary, to make the patient comfortable enough to participate in CBT.
While these interventions will be effective long-term, the question remains as to how to help in the moment. When faced with your teen’s panic attack, it is crucial to accept their perceptions and emotions as genuine and valid. Even if his or her fears and reactions don’t make sense to you, the anxiety is very real. A basic validating statement would involve stating, “I can see you are really anxious, and I would like to support you however I can.”
In a moment of calm, you might ask your teen what they will find helpful. There are some teens who will want to be left alone and you can respect that wish. Alternatively, he or she may just want you to sit quietly with him/her and will find comfort in your presence. Finally, there are two sets of strategies you can help your teen use (with their permission).
The first of these skill sets is identified with the acronym T.I.P.P. As described in my article, “How Can I Help My Teen With Their Strong Emotions,” TIPP skills decrease emotional arousal by increasing activity of the parasympathetic nervous system. Panic attacks are one form of extreme arousal. As such, it can be beneficial to assist your teen in applying these techniques.
Tip the temperature of their face with cold water or ice. The extreme version of this skill involves having them place their face in a bowl of cold water for 30 to 60 seconds. More moderate approaches involve splashing cold water on their eyes and cheeks or placing a wrapped ice pack over their eyes and cheeks.
Intense aerobic activity for 20 minutes is the second of these skills. By increasing their heart rate, they will decrease their state anxiety. Some examples might be running, or bursts of jumping jacks, or push-ups. If a teen finds this helpful, one can join them, so they don’t feel alone, or judged.
Paced breathing, wherein the goal is to slow down the pace of inhaling and exhaling, is the third of the TIPP skills. Ideally, breathing is slowed to roughly five or six breath cycles per minute. In addition, it involves inhaling deeply from the abdomen at a slower rate than exhaling. Again, this is a great exercise to do with your teen.
Finally, with Paired muscle relaxation, the intention is to pair muscle relaxation with breathing out. The strategy involves tensing muscle groups, noticing the sensation of tension while breathing in. One then releases the tension and notices the sensation of it gradually lessening while breathing out. By increasing awareness of physical tension, we also increase awareness of relaxation and decreased arousal. There are great guided meditation apps that can help you and your teen with this practice.
In addition to TIPP skills, grounding strategies are frequently helpful when one is experiencing a panic attack. These techniques may help distract your teen from what (s)he is experiencing and refocus attention on what’s happening in the present moment. In my experience, the most comprehensive of these techniques is the 5-4-3-2-1 method.
Working backward from 5, guide your teen to use his or her senses to list things in the current environment. For example, one might start by listing five things she hears, then four things she sees, then three things she can touch from where she is sitting, two things she can smell, and one thing she can taste. Encourage teens to make an effort to notice the little things you might not always pay attention to, such as the patterns in the carpet, or the sounds of passing traffic.
Neither TIPP skills or grounding exercises are cures for panic attacks. However, they are very helpful in decreasing the immediate distress. By learning them yourself, you can be most helpful to your teen. Practicing these exercises together is also a great way to communicate to your teen that you take his or her anxiety seriously and that (s)he is not alone.
References
Linehan, M.M. 2015.DBT Skills Traing Manual, Second Edition. New York: Guilford Press
Grounding techniques. (n.d.).
jmu.edu/counselingctr/files/Grounding%20Techniques.pdf
