Managing Panic Attacks: The Technique of Riding the Wave
If a panic attack is a wave of fear, perhaps we can learn to surf it.
Posted Aug 16, 2018
Move outside the tangle of fear-thinking.
Live in silence.
Flow down and down in always
widening rings of being. (Rumi)1
A panic attack is an “abrupt surge of intense fear or intense discomfort that reaches a peak within minutes.”2 Its symptoms include sweating, palpitations (racing heart), shortness of breath, trembling, dizziness, tingling, chills, etc.
In my first and second post, in this four-part series, I explained the nature of fear and panic attacks; in the third post, I discussed leaning into the fear: Managing the panic by observing (objectively and without judgment) the various feelings, sensations, and thoughts associated with each attack, while remaining grounded (i.e. oriented to the present time and place).
Today, in my final post, I describe another (potentially counterintuitive) technique, that of riding the wave of panic.
The wave of panic
Imagine a nice hot sunny day. You are sunbathing on the beach. You then decide to go for a swim. The water is warm and comforting. Sometime later, while swimming, you suddenly notice a huge wave barreling toward you. What do you do?
Perhaps you attempt to fight the wave—by swimming toward it, or by tensing up and trying to “stand your ground”—or flee from the wave—by swimming frantically toward the shore.
But this is one of those times that our physiological fight-or-flight response does not appear to be helpful. Is there a third option?
Yes, you could ride the wave.
Sounds scary, doesn’t it? And it is.
No doubt a big wave has a lot of power; however, if you do not try to oppose it, and if you instead just go with it, you are likely to find that the wave is far less powerful and scary than you thought it was.
Somewhat similarly, when we desperately reject and resist a wave of fear, the wave will seem and subsequently become considerably larger and more threatening, creating a vicious cycle. See Figure 1.
Indeed, as a result of our own extreme reactions to our feelings and sensations, we will no longer need to manage only the original wave of fear; no, we will need to navigate a rough sea of panic.
Let us assume, for discussion's sake, that we are now fully convinced that resisting fear or fleeing from it does not work. So we are finally willing to surf the wave of fear.
To do so, we firstly need to be fit and healthy; secondly we need to practice. Let me begin with the second requirement.
The wave machine
Real surfers have a number of options for practicing riding the waves. Surfing champion Kelly Slater has even built a 100-ton wave machine that can produce “professional-grade artificial waves.”
Riding the wave of panic, of course, is different. Unless we happen to be having a panic attack, we can not practice riding the wave. Or can we?
One technique, called interoceptive exposure, tries to recreate some specific panic-related symptoms (e.g., dizziness, palpitations, sweating) in an intentional and controlled way.3 Repeated exposure could diminish the fear associated with the particular sensations, and disrupt the vicious cycle of panic.
Below I list a few panic attack symptoms, followed by interoceptive exercises that try to recreate these symptoms. Those of you with health conditions should modify the activities as needed (or consult with your healthcare provider). The duration of these exercises is generally a minute or more
- Not getting enough air: Wear nose clips and breathe through a straw.
- Hyperventilation: Breathe in and out very rapidly.
- Dizziness: Spin around in an office chair.
- Rapid heart/breathing rate: Run in place.
After you do one of these activities, notice your sensations, feelings, and thoughts. Rest. Then try another. If one exercise feels particularly effective at recreating the unpleasant sensations of your panic attacks, repeat the exercise regularly so that you can get used to these sensations.
The healthy and skilled surfer
An obese and undisciplined person who stays up all night drinking and smoking, and rarely exercises, is unlikely to be able to surf a big wave, let a lone a giant one; riding the same giant wave, however, may be manageable for a skilled surfer who is disciplined, healthy, and fit.
This difference in preparation is even more significant when it comes to riding the wave of panic. Not only does one’s health influence the ease with which an episode of anxiety might be managed, but it also affects the size and force of the wave itself!
Why? Because the calm ocean of a healthy and peaceful mind is less prone to sudden spikes of extreme fear (not to mention other mental health issues).
Examples of skills and lifestyle changes conducive to well-being are listed below.
- Eating healthy (reducing the use of caffeine and alcohol)
- Quitting drugs
- Getting adequate sleep
- Regular exercise
- Relaxation practices (e.g., breathing exercises, yoga)
- Emotion regulation practices (e.g, self-help cognitive-behavioral therapy)
- Regular social interactions
- Improved communication skills
In my previous article, I mentioned the importance of grounding for leaning into fear. This is no less relevant when we think of panic as wave.
There are different ways to feel grounded. Some people feel grounded when they focus on their breath or sensations associated with the breath (e.g., around the nostrils). Others focus on the sensations in a specific part of their body, like their hands.
Another option is to touch the objects around you or to touch a special item that you carry with you, especially an item with an Earthy feel to it.
A friend of mine, who has experienced severe traumas, once showed me a beautiful rock that he had found on a beach many years ago, on a day that he happened to feel very relaxed and happy. The rock, he told me, not only grounded him but also reminded him of all the good that was still possible.
No matter which method you choose, remember that the goal is to feel grounded, not to oppose or escape the fear. Ride the wave of fear while feeling grounded in the present, your body, and your breath.
Conclusion and summary
We have reached the end of this four-part series on panic attacks. I hope that you have found my posts useful in helping you understand the nature of fear, and finding ways to cope with or conquer your panic attacks.
I would like to leave you with this summary of major points from this series of posts:
A panic attack is an episode of intense fear. A number of medical/psychiatric conditions can either cause or be mistaken for panic attacks. Therefore, it is important to see your healthcare provider for assessment and potential treatment.
Panic attacks have been associated with a vicious circle of fear: A fearful misinterpretation of some physical symptom(s) causes new sensations or leads to intensification of the current ones. Subsequent fear-based misinterpretation of old and new symptoms further reinforces the vicious circle.
A cognitive approach to managing panic attacks requires that you remain grounded while leaning into the episode of fear with curiosity and interest, and observing your feelings, sensations, and thoughts. Like a scientist.
A behavioral approach requires regular exposure to the physical sensations associated with panic. That is, to intentionally ride smaller waves of panic in a controlled way, before facing the more unpredictable and powerful ones.
A more general strategy for reducing panic attacks and the risk of other emotional disorders, is to adopt a healthy lifestyle:
Eat well, get adequate sleep, and exercise. Maybe even learn to surf.
1. Rumi, J. (1995). The essential Rumi (C. Barks, Trans.). San Francisco, CA: Harper. (Original work published in 13th century)
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author
3. Hofmann, S. G., Bufka, L., F., & Barlow, D. H. (1999). Panic provocation procedures in the treatment of panic disorder: Early perspectives and case studies. Behavior Therapy, 30, 305–317.