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Dr. Steve
Dr. Steve, Psychologist
Category: Mental Health
Satisfied Customers: 370
Experience:  19 years conducting therapy; book author; newspaper columnist; former co-host of radio show
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My question is concerned with an issue of coping when having

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my question is concerned with an issue of coping when having panic attack. I do know all the recommendations: stay in place, don't run, do the abdominal breathing, etc. Well, it does work, but only to a certain extend - I still get full-blown panic attacks. Any other tips and recommendations?

Hi Lena:

Great question. Panic attacks seem to be becoming more common, so your question is quite timely. Too, it sounds as though you have been down the road of therapy (both self-guided or with a professional) and are onto some good suggestions.

The one aspect you did not mention is controlling your thoughts during the attack. Activating the parasympathetic response through physical exercises like the ones you mentioned is absolutely essential, but often times a person in the throes of a panic attack is also going haywire between their ears - in other words (and I did not mean to be glib), the anxiety is being shot up because of intrusive thoughts that basically convince the person that they are either in grave danger, or (literally) that they are going to die.

So to answer your question directly, I would recommend going through some mental visualization exercises meant to encourage relaxation. Find the scenario that works best (and fastest) with you, and begin to take control of your mind while you are doing the breathing and stopping. Arrest any thoughts which drive anxiety ("I am going to die," "I am having a heart attack," "I cannot stop this attack," whatever it is for you). And this sounds rather simple, but it takes some practice.

Lastly, it seems that folks who tend to bottle their emotions up are more prone to panic attacks. So if you are an internalizer, I would also recommend finding safe outlets for the anxiety or tension you experience throughout the day. Allow yourself to relieve the pressure rather than continuously shaking the sealed soda bottle.

And remember, all the technology in the world still has not identified what exactly is the mechanism that triggers these sympathetic arousal attacks. You may be dealing with them for awhile, although the current research seems to show that the attacks lessen in duration, frequency, and intensity as you age.

I do wish you well. If you are satisfied with the response, please hit "Accept." This is the only way I receive credit for my answer. Thanks-

Dr. Steve

Dr. Steve and other Mental Health Specialists are ready to help you
Customer: replied 7 years ago.

Hi Dr Steve!

Thank you for the answer.

You clearly hit the spot there: intrusive thoughts. Well, I'm having those even when talking on the phone during the p. attack. And I'd like to know how to battle/replace those.

Obviously, I'm aware of the principle: try to replace a negative thoughth with a positive one, like "I'm petrified of this awful attack" - " It's okay to have a panic attack", "I feel dizzy and mighth faint" - "You've never fainted before", etc. The major problem here is that I do not believe it myself, it is not okay to relax or to accept the panic attack, and even if I've never fainted before, there are no guarantees that I won't faint now, at this particular moment.

I believe, you might be sensing not only the in-build negativism in my line of thought, but also some bizarre need of making logical conclusions and reasoning with myself ad absurdum about the same subject. How can I go about that?

Visualisation is an issue, undoubtably. I know that one must imagine a pleasant place/situation, where one had been genuinly happy and relaxed. Well, I do not recollect any. It allways has some sad/ regretful/over-intense emotions attached to it. Shall I mobilise my hyperactive imagination and fantasise some dream scenario?

Best regards,


Hello again, Lena:

Here is where your therapist may have dropped the ball. A couple thoughts:

(1) When you are practicing thought replacement, you cannot replace a profoundly negative thought with a positive one - it is just too far away from your reality, and will therefore be rejected (as you mentioned). I have clients begin with a very simple neutral statement: "I'm okay." Other therapists will advise the following: "I'm strong enough." But again, you're asking too much to shoot for a statement that is a light year from where you are at. The process takes a bit of rehearsal, and a willingness to withstand a few failures along the way.

(2) As for visualization, many clients are in your exact predicament... namely, they have trouble coming up with a positive image. The one I give to them is to imagine they are on a raft bobbing on the sea. There are a number of reasons I use this one (fear of water notwithstanding!), but in general a safe image should (a) incorporate all 5 senses, and (b) be a place where the client also feels some node of relaxation.

If you are satisfied with the response, please hit "Accept." That is the only way I receive credit for my answer. Thanks-

Dr. Steve

Dr. Steve and other Mental Health Specialists are ready to help you