How to Control Panic Without Xanax

Anxiety disorders are among the most common mental health issues in America and they are a common route to developing a substance use disorder. Panic attacks may be a symptom of a panic disorder or perhaps of post-traumatic stress disorder. People who experience frequent panic attacks are often prescribed a fast-acting benzodiazepine such as Xanax to cope with their symptoms or they may self-medicate with alcohol, marijuana, or other substances. If you have struggled with panic in the past, the thought of having to give up these crutches may sound intimidating but it’s possible to learn to control panic without them. 

If you have experienced panic attacks in the past--which are characterized by shortness of breath, racing heart, confusion or disorientation, squeezing in the chest, feeling of impending doom, or feeling like you’re about to “lose it”--then you should certainly seek professional help. In the meantime, the following tactics can help you weather a panic attack.‍

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Understand What Panic Is

‍Part of the reason a panic attack is so frightening is that people who experience them are often not aware of what’s happening. The symptoms are similar to a heart attack and, in fact, many people go to the emergency room because they think that’s what’s happening. If you believe you’re having a heart attack, that will clearly make you more anxious, which will only increase your panic. It’s actually pretty hard to distinguish between a panic attack and a heart attack based on symptoms alone. Context makes a big difference. For example, if you’re under 40 and you have had panic attacks before, your symptoms are more likely panic. Symptoms such as squeezing in the chest, pain that radiates to the jaw or arm, or a ripping sensation in the chest or back is more likely a heart attack. When in doubt, it’s better to err on the side of caution and seek medical help.

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More generally, it’s important to understand that panic is what happens when your fight-or-flight system gets out of control. Perhaps something causes a bit of anxiety--a test or a confrontation--and that bit of anxiety signals a threat, and then you get stuck in a sort of feedback loop. The first step in controlling panic is to realize that anxiety, in appropriate amounts and in appropriate circumstances, is a useful emotion. The next step is to understand the role your own mind plays in escalating anxiety.

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Identify Catastrophic Thoughts

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The next step is to identify the thoughts that are amplifying your panic. These aren’t typically hard to spot, but the trick is to remember to be aware of them when you’re under stress. For example, when you feel anxiety or panic coming on, you may be thinking something like, “Oh, I’m having a panic attack--or a heart attack!--this is awful, I’m going to die, I’m going to go crazy, why can’t I stop this?” and so on. These kinds of thoughts only make things worse. 
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When you find yourself thinking these thoughts, there are two ways to respond. First, you can challenge your catastrophic thinking. For example, if you’re thinking, “I’m having a heart attack! I’m going to die!” think instead, “I’m only 25, so it’s probably not a heart attack, there’s no radiating pain or other symptoms. If I still feel this way in half an hour, I can go to the hospital. It’s probably just anxiety and anxiety can’t hurt me,” and so on.

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The other way to cope with these kinds of thoughts is to step back and be an objective observer. This takes a bit of practice and regular mindfulness meditation might help. When you do this, instead of trying to guess what every sensation might mean, you just observe it. “Oh, I’m feeling anxiety and now I’m feeling short of breath, which is making me feel more anxious. I mainly feel it in my stomach,” and so on. By accepting your anxiety and experiencing it without trying to suppress it or push it away, you avoid compounding your distress. 

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Breathe Deeply

‍As noted above, an anxiety attack comes when your sympathetic nervous system or your fight-or-flight system gets out of control. The fastest way to get it back under control is to take some slow deep breaths. Since constricted breathing is often a symptom of panic, this may be challenging but if you can manage it, it will calm you down pretty quickly. The exhale is especially important for stimulating the vagus nerve, which activates the rest-and-digest system. 

Try taking 10 to 12 breaths with a regular rhythm such as inhaling for three seconds, exhaling for six seconds, and pausing for a second before repeating. Research suggests that a rate of about six breaths per minute is ideal for relaxing and synchronizing your pulmonary and cardiac rhythms. Again, it can be challenging to slow down and breathe deeply when you’re having a panic attack, so just do what you can; even if your breathing rate isn’t perfect, it’s the aspect of your physiology that you have the most control over.‍

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Pay Attention to Your Environment‍

Another good strategy during a panic attack is to connect with your immediate environment using a grounding strategy. The idea is to use sensory input to connect to the here and now. Panic is always about what might happen--you might pass out or lose it, and so on, and wouldn’t that be awful? The initial anxiety likely stemmed from worries about potentially catastrophic outcomes from failing a test or interview or whatever. Grounding yourself with sensory input allows you to forget about all of that stuff and focus on the present. 

One common grounding technique is the 5-4-3-2-1 technique: Identify five things you can see around you, four things you can feel, three things you can hear, two things you can smell, and one thing you can taste. Take a moment to really experience each thing you identify. If you’re in a hurry, figure out which sense helps ground you the fastest and focus on that. It’s generally a good idea to practice this technique--and the other techniques, such as breathing as well--regularly, at least once a day, so you are more comfortable using them when you need to.

Panic is not an easy problem to deal with. The essence of panic is that it undermines your ability to think clearly and regulate your emotions. The best approach to treating a panic disorder or post-traumatic stress disorder is to work with a professional therapist to uncover the roots of the problem and develop comprehensive solutions. These typically involve a mix of behavioral and cognitive strategies, possibly with the aid of non-addictive medications, such as SSRIs. The strategies outlined above can help in the moment, but it’s also important to practice them in advance. If you need to use a grounding technique, for example, you don’t want to be thinking, “What was that technique again?” You want to recognize the onset of symptoms and automatically use a strategy that works for you.

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‍At The Foundry, we know that emotional regulation skills and treating any co-occurring mental health issues are major factors in long-term recovery success. We emphasize the treatment of trauma, including PTSD, as well as other anxiety disorders. We know that mental and physical wellness is key to recovery success. To learn more, call us today at (844) 955-1066.‍