Treating Panic Effectively

Panic attacks can be devastating. Knowing how to effectively deal with them is essential.

Source: Mohamed Hassan/Pixabay

Panic disorder can be devastating. It accounts for untold suffering and frequent emergency-room visits.

The mainstay for pharmacological treatment is SSRI or SNRI medications. Cognitive behavioral therapy (CBT) and mindfulness-based therapies can also be helpful. However, I’ve also seen the need for a quick psychological intervention, for multiple reasons:

• Immediate, high-quality, in-depth psychological care may not be immediately accessible.
• Some people are resistant to getting counseling for numerous reasons, including insurance coverage and financial limitations.
• SSRI and SNRI medications can take a month to have their full effect, and benzodiazepine medication can be addictive.
• With the right tools and information, patients may not need long-term therapy or long-term medication. (Treatment with SSRIs and SNRIs typically lasts a year.)

A 10-minute discussion and a simple mnemonic has helped many of my patients effectively deal with panic, often without needing medication or long-term therapy. Even for those who still need medication or therapy, reviewing the information has been an important adjunct.

Patients can remember the mnemonic HR BET by thinking of a baseball player whom they would bet on to have a home run or their “home run bet”: HR BET for short:

• Harmless: It’s helpful for patients to remind themselves that although panic attacks are very scary, they are usually harmless. It’s usually important for a patient to talk with their physician to ensure that the diagnosis is panic disorder and not another problem. Sometimes, further testing can help reassure both physician and patient.
• Resistance: Panic attacks are fueled by resistance: people get anxious about being anxious, leading to a vicious cycle of escalating anxiety. With less resistance, the panic attack will be briefer and less intense.
• Breathing: When people are anxious, they tend to breathe fast and high in their chests. Instead, slow mindful diaphragmatic breathing is helpful. Tune into the sensation of the abdomen slowly expanding with the inhalation and slowly relaxing with the exhalation. It may take time to get used to this style of breathing, and it may be helpful to first practice it when one is relaxed.
• Energy: Instead of calling it a panic attack, call it an “energy burst.” Instead of launching into that vicious cycle of resistance and anxiety, when there’s that first burst of energy, just feel the energy flow through your veins. You might use the energy to do something active or just feel it without resistance. Be like Popeye who just ate a can or spinach or a superhero who got an extra burst of energy.
• Thoughts: Remember that you don’t have to believe all of your thoughts. You also don’t have to resist your thoughts or wish them away. When you have a thought like “This panic will last forever,” you have two helpful choices: You can dispute it, in this case, thinking, “I’ve had this before and it always eventually goes away.” Or you can just note those thoughts as they come and go, without believing them.

This can be hard to remember in the midst of a panic attack. Therefore, I recommend that patients keep the five words in their wallet or take a picture of them on their phone:

• Harmless
• Resistance
• Breathing
• Energy
• Thoughts

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