Contents:

1. Recovery from panic disorder
2. Refocus your attention
3. Challenge your thoughts
4. Relax your body
5. Slow your breathing
6. Avoid avoiding
7. The Panic Disorder Self-Report Scale (PDSR)
8. Treatments for panic disorder
9. Acting opposite
10. Talking therapies
11. Dealing with things
12. Repairing relationships
13. Avoid alcohol and drugs
14. Self-help resources
15. Act now!
16. Helping agencies
17. Disclaimer
18. Page 1: Panic Information

Recovery from panic disorder

There are several ways of dealing with panic.

• Refocus your attention
• Challenge your thoughts
• Relax your body
• Slow your breathing
• Avoid avoiding

Refocus your attention

When we're anxious our attention narrows and turns inwards; and when we focus on our worries and bodily sensations we tend to intensify them. The mind fills with doubt and fear. It's a useful skill to be able to gently lift our attention away from fearful thoughts and place them elsewhere. Whenever you notice yourself dwelling on twinges, pains, aches or sensations that might trigger anxiety, gently coax the mind away to something else - preferably something around you, instead of some sensation from within.

Try looking for, noticing and attending to something beautiful or in some way pleasing to you, whatever that might be.

Challenge your thoughts

Sometimes we might catastrophise - that is, think about the very worst possible thing that could happen. For example, when we notice shortness of breath we might jump to the conclusion that it's a heart attack, instead of muscle tension.

We might have a pounding head caused by a fast heartbeat, and think we're having a stroke or that we have a brain tumour.

If you recognise thoughts like these, stop, take a deep breath and ask yourself how likely a serious problem really is. Muscle tension is a lot more common that a heart attack! Palpitations are more common that brain tumours.

Breathlessness and pain are common symptoms of panic attacks, so rather than make them worse by alarming yourself, speak calm and soothing words to yourself inside your head. Speak them aloud if it helps. Say something like:

'I know this is just anxiety, I've come through this before, nothing bad will happen, I will stay and breathe slowly until it passes, I will be fine.'

In time we can let ourselves know that nothing bad will happen; that we really will be fine. When we truly believe this, panic loses its grip over us.

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Relax your body

Starting with your feet, tense and relax your muscles, progressing up your calves, to the muscles in your thighs, up over your chest and into your arms and hands. Tense and relax the muscles in your shoulders, neck, jaw and scalp.

The more you practice, the easier this will become. Making a conscious effort to relax your muscles helps the body calm and reduces panic. There are many freely available relaxation exercises on the Internet, some as MP3 files that you can download and use.

The benefits from relaxation don't come straight away, rather they accumulate over time. Continued practice is the key.

Slow your breathing

1. Place the flat of your hand over your stomach
2. Open your mouth and breathe out with a sighing sound. As you breathe out, allow your shoulders and upper body muscles to relax
3. Close your mouth and pause. Keep your mouth closed and breathe in through your nose, your stomach should move out as you breathe in
4. If your shoulders rise again or your stomach doesn't move out, slow down and try again till you're breathing by pushing your stomach out
5. Breathe out slowly, gently and deeply
6. Repeat steps 3 - 4 - 5 until you feel more calm

Breathing by pushing out your stomach means you're using your diaphragm to breathe, that's the large muscle underneath your lungs. This helps you relax and breathe more deeply.

You might find you're taking in a bit more oxygen like this, so might feel a little light-headed. This is nothing to worry about, just slow down if this is the case.

Avoid avoiding

It's easy to understand how it can seem to make sense to withdraw, to shut the world out. Fear of panic attacks and the desire to avoid embarrassment means we can avoid stressful situations. We might choose to pass up on social situations, do our shopping over the Internet; avoid stress at work, whatever it takes to avoid the places, people or situations where we think we might panic.

The problem with avoiding situations is that our fear grows stronger. We avoid things because we fear what will happen if we don't. The more we avoid, the less we can challenge our fears.

The Panic Disorder Self-Report Scale (PDSR)

The PDSR was developed in 2006 as a way of detecting panic disorder. Helping to identify the problem helps people get the right treatment.

Questions one to four assess whether a person has had recurrent and unexpected panic attacks, and if so, the total number of attacks. Questions five, six and seven assess worry and change in behaviour in response to panic attacks. Questions eight to nineteen ask about twelve symptoms associated with panic attacks.

You are then asked to rate distress and interference caused by panic attacks. The PDSR concludes with a question to verify that most panic attacks peaked within 10 min, as well as two questions to rule out substance and medically-related causes.

You can download a PDF copy of the PDSR form here: Panic Disorder Self-Report (PDSR) Feb16.pdf

Panic Disorder Self-Report (PDSR)
		No	Yes
1	During the last six months, have you had a panic attack or a sudden rush of intense fear or anxiety?	□	□
If YES, please continue
If NO (you have not experienced a panic attack), please leave the rest of this form blank
When was the most recent time this occurred? (please record date)
2	Was at least one panic attack unexpected, as if it came out of the blue?	□	□
3	Did it happen more than once?	□	□
4	If YES to 3, approximately how many panic attacks have you had in your lifetime?
If NO to 1, 2, and 3, please leave the rest of this form blank, otherwise continue
5	Have you ever worried a lot (for at least one month) about having another panic attack?	□	□
6	Have you ever worried a lot (for at least one month) that having the attacks meant you were losing control, going crazy, having a heart attack, seriously ill, etc?	□	□
7	Did you ever change your behaviour or do something different (for at least one month) because of the attacks?	□	□
If YES to 5, 6 or 7 please answer the following questions:
Think back to your most severe panic attack. Did you experience any of the following symptoms?
8	Shortness of breath or smothering sensations?	□	□
9	Feeling dizzy, unsteady, lightheaded, or faint?	□	□
10	Palpitations, pounding heart, or rapid heart rate?	□	□
11	Trembling or shaking?	□	□
12	Sweating?	□	□
13	Feelings of choking?	□	□
14	Nausea or abdominal distress?	□	□
15	Numbness or tingling sensations?	□	□
16	Flushes (hot flashes) or chills	□	□
17	Chest pain or discomfort?	□	□
18	Fear of dying?	□	□
19	Fear of going crazy or doing something uncontrolled?	□	□

20 How much do these symptoms interfere with your daily functioning? (Please circle one)

0	1	2	3	4
Not at all	Mildly	Moderately	Severely	Very severely / disabling

21 How distressing do you find these symptoms? (Please circle one)

0	1	2	3	4
No distress	Mild distress	Moderate distress	Severe distress	Very severe

22	When you have bad panic attacks, does it often take less than ten minutes from the point at which the attack begins, to the point at which it reaches a peak or becomes most intense?	□	□
23	Just before you began having panic attacks, were you taking any drugs or excessive amounts (more than 4 cups daily) of stimulants (e.g. coffee, tea, or cola with caffeine)?	□	□
23a	If YES, what was it that you were taking?
23b	How much of it were you taking (in cups, etc.)?
24	Have you ever been diagnosed with a medical problem (e.g. hyperthyroidism, a seizure or cardiac condition, etc.) that could have caused your panic symptoms?	□	□

Add your results for questions 1 to 3, 5 to 19, and 22, 'Yes' scores one, 'No' scores zero. Questions 4, 23, and 24 are not included in the total score.

The score for questions 20 and 21 are each divided by two. Unanswered questions score zero.

The values of scored items are added to create a total score, ranging from zero to twenty-four.

A score of 8.75 provides the best balance between sensitivity and specificity. On the basis of this cut-off, 95% of research participants were correctly classified as having, or not having, panic disorder.

If your score is 8.75 or more, it is likely you have panic disorder.

Treatments for panic disorder

The vast majority of people with panic disorder are treated by their GP. Often medication won't be your prescriber's first choice, as some forms of talking therapy can be just as effective as tablets.

There are different approaches to the treatment of panic disorder. If at first you find one doesn't work, try a different approach until you find one that you feel comfortable with and that works for you. Research suggests that cognitive-behaviour therapy (CBT) is one of the most effective psychological treatments for panic disorder. Mindfulness and other forms of meditation can help too.

If you are taking prescribed medication it can take some time to work, so don't give up hope if you don't feel better straight away. Sometimes tablets work best when taken for a longer time and they shouldn't be stopped suddenly without medical advice.

Your first appointment with a GP can feel difficult, especially if you view panic disorder as a 'weakness' (it isn't!) so it might be helpful to write down what you want to talk about before you go. Make a note of any questions or worries you might have. Some people find it helpful to take a friend or family member along.

Panic disorder can make us feel alone, afraid and ashamed, making it hard to summon the courage to get help. A quick 'phone call to your GP can get things moving and start you on the road to recovery.

Acting opposite

Anxiety often makes us want to avoid people or situations. It can be very hard, but facing our fears and staying with people can be very helpful. Remaining in work or returning to work might be very hard too, but can help us keep a sense of control. Keeping a normal daily routine is usually much better than withdrawing. We might feel like shutting ourselves away, but doing so can make things worse. When we avoid a situation, it's harder to gain control over our fear. In fact, one of the most effective forms of treatment for panic disorder involves being helped to deliberately bring on a panic attack - this way we can truly convince ourselves that they won't harm us.

Talking therapies

There are many different types of talking therapy; the most effective for panic disorder is probably cognitive-behaviour therapy (CBT). In CBT, we learn to face our fears and about the ways in which our thoughts can make us more anxious and less able to cope. A CBT therapist will help you learn new skills to deal with panic and help support you face up to things you may have avoided.

Dealing with things

Putting off problems can make them mount up. Are there things in your life you're putting off dealing with? Might an advocate or some extra support help? The Citizens Advice Bureau can help with a range of issues from housing to money worries. Doing things to address our problems relieves the burden and helps us feel 'in control' again.

Repairing relationships

Are you struggling with a difficult relationship? Are withdrawal or panic attacks causing problems in your relationship? If so, you can contact Relate on 0845 456 1310, or you could speak to your GP about other types of relationship counselling.

Avoiding alcohol and drugs

Alcohol is a depressant - it lowers the mood. Other non-prescribed drugs are best avoided. If you think alcohol or drug use might be a problem, you can contact DAN 24/7 on 08080 808 2234. While drinking can seem to help with some of the symptoms of panic, it usually makes things worse in the long run.

Self-help resources

There are many good books and websites that can help. Again your GP, practice nurse or primary care mental health practitioner will be able to recommend from a range of excellent and helpful material.

Act now!

If you think you may have panic disorder, contact your GP. Some physical health problems can have similar symptoms to panic disorder; your GP will be able to help you eliminate any potential physical causes.

Helping Agencies

You can find a list of national agencies that can help with panic here: National Panic Agencies

Disclaimer

This material is for information only and should not be used for the diagnosis or treatment of medical conditions. We have used all reasonable care in compiling the information but make no warranty as to its accuracy. We recommend you consult a doctor or other health care professional for the diagnosis and treatment of medical conditions, or if you are at all concerned about your health.