AWARE for Panic Attacks

In his blog www.anxietycoach.com, Dr. Carbonell outlines the following steps in the AWARE approach that are the key to effectively managing a panic attack:

1. Acknowledge & Accept

Acknowledge the present reality – that you are having a panic attack and you feel afraid. Don’t try to ignore it, pretend it’s not there or tell yourself to “stop thinking about it” That doesn’t work! Simply acknowledge your fear. And acknowledge that you are not in danger.

Then acceptance comes in. The goal here is to get comfortable with being uncomfortable. Remember, acceptance does not mean liking it, wanting it or approving of it. Rather, it means acknowledging and accepting that it exists in the present moment in an open and non-judgmental way, instead of fighting it. You accept your fear, rather than fight it - just like you might accept a headache (you wouldn't fight back against it by banging your head against the wall). Working with your panic attacks is the key to overcoming them.

2. Wait and Watch (and maybe Work)

The next step involves ‘waiting’ – this is where you take pause and do your best to stay where you are without doing anything, in contrast to fleeing the scene, trying to find your safety person or struggling with how you’re feeling. Remember, the latter efforts to find relief only makes your panic worse.

Dr. Carbonell suggests that you don’t tell yourself that you CAN’T leave – this might make you feel trapped and that too will make things worse. Rather, try and postpone your urge to leave in order to find relief. Let relief come to you.

While you’re ‘waiting’, this is a really good opportunity to ‘watch’ how the panic works and how you respond to it, while you’re in the middle of it. Dr. Carbonell encourages his patients to fill out a panic diary during the attack that you can download here (with instructions here).

The ‘work’ part comes in if you’re in action while the panic attack comes on, like if you’re driving, for example, you’ll need to keep doing this.

3. Actions (to make yourself more comfortable)

As Dr. Carbonell explains, your job is not to end the panic attack (because it will end no matter what you do, so it’s best to do what you can to make it as comfortable as possible, rather than doing what makes it worse). Your job is to make yourself as comfortable as possible as you ride it out. He suggests a number of strategies to help you do this:

·       Belly breathing (deep, diaphragmatic breathing – starting with an exhale!)

·       Talk to yourself silently about what’s happening (i.e. “It’s okay to be afraid”, “This will end”, “This isn’t dangerous”, “Fine! Let’s have an attack, it’s good opportunity to practice my coping”)

·       Be in the present and re-engage with whatever you were doing before the attack started

·       Work with your body (i.e. go through progressive muscle relaxation of various body parts one at a time)

4. Repeat

If you feel better, but then start to panic again (this is normal, you may actually go through several cycles), simply repeat steps 1-3.

5. End

Remind yourself that your panic attack will end, because they always end.