I don’t have panic disorder, but I get really anxious. What can I do?

There are several ways that people can manage their anxiety symptoms themselves. Here are some simple techniques you can practise.

Reducing anxiety with slow breathing

Part of the 'fight or flight' response is increasing the rate of breathing. This would be useful if you did need to fight or run. An increase in breathing can be triggered as part of the automatic 'fight or flight' response. Common sensations of overbreathing include feeling lightheaded, dizzy, things feeling unreal and feeling breathless. If you experience these sensations when anxious it is possible that overbreathing is playing a role.

Some people with panic disorder may be more anxious in general and may overbreathe in other situations, whereas other people with panic disorder only tend to overbreathe in association with certain situations. You can demonstrate for yourself how an increase in breathing can affect the way you feel by deliberately overbreathing until you experience sensations such as feeling dizzy and lightheaded.

Learning to slow your breathing can be a useful way to control symptoms of panic and may be helpful in combination with cognitive and behavioural therapy techniques. The slow-breathing technique (see below) is a skill that is easy to learn and can be used at times when you experience symptoms of the 'fight or flight' response.

Even if you do not usually overbreathe it may be a useful strategy to focus attention on slowing yourself down to remind you to challenge what you are saying to yourself.

It is important to practise this technique until you are able automatically to start slowing your breathing in response to anxiety-provoking thoughts and/or situations. Over the next few weeks it would be helpful to monitor your breathing rate at different times throughout the day and to practise the technique.

Remember that it is much easier to prevent a panic attack than to stop one. The best approach is to start slowing your breathing at the first signs of anxiety. Breathe using your diaphragm (lower stomach), not your chest. Top of page

Slow-breathing technique

Take a regular breath (through your nose) and hold it for six seconds (use a watch). When you get to six, breathe out and say the word 'relax' to yourself in a calm, soothing manner.

Breathe in and out in a six second cycle (in for three, out for three).

Continue breathing this way until the anxiety symptoms of overbreathing have gone.

There are a number of good tapes and CDs available. It is not important which one you choose - the important thing is taking time to relax.

What is relaxation training?

Relaxation is the voluntary letting go of tension. This tension can be physical tension in the muscles or it can be mental (or psychological) tension.

When we physically relax, the impulses arising in the various nerves in the muscles change the nature of the signals that are sent to the brain. This change brings about a general feeling of calm, both physically and mentally. Muscle relaxation has psychological benefits as well as physical. Through relaxation training you will learn how to recognise tension and achieve deep relaxation.

When someone is in a continual high state of tension, it’s easier for a panic attack to occur because the body is already highly activated. A minor event, such as getting stuck in traffic, can trigger further tension, which in turn can lead to hyperventilation (overbreathing) and panic.

Constant tension makes people over-sensitive and they respond to smaller and smaller events as though they were threatening. By learning to relax, you can reduce general levels of arousal and tension, and gain control over these feelings of anxiety. Top of page

Meditation

There are many different types of relaxation that can achieve similar benefits. Choose to do something that you feel comfortable with and try to find time each day to relax. Possible types of relaxation are meditation, yoga, or tai chi. Any of these may be useful if they reduce tension for you and are used often.

Guided imagery

If you feel anxious about doing something hard it may be useful sometimes to practise doing it in your mind first. For example, if you don't think you are ready to drive the whole way across a bridge on your own perhaps you can try to imagine yourself going some of the way across.

It is important that you think of yourself doing this in a successful, calm way, even if you think it would be hard. Imagine you are coping OK. Other situations that can be practised in imagination are plane travel, train travel, weddings and job interviews.

Exercise

Many people with panic disorder avoid doing aerobic exercise as the increase in heart rate and faster breathing may remind them of panic symptoms. Through interoceptive exposure (facing the symptoms and sensations that you fear) it is important to gradually start increasing the amount of exercise you do. This is an important part of stress management. Aim for three sessions of exercise per week, choosing activities that you enjoy and varying the type of exercise so that you are able to establish and maintain a routine.Top of page

I think I have panic disorder - can I help myself?

Educate yourself

'Don't panic!' This is important advice and the title of a quick and easy-to-read book on panic disorder by Dr Andrew Page. It is available in most major bookstores and costs approximately $10. This is money well spent!

Another good book is 'Living With It', by Bev Aisbett, which is available in most bookshops.

Educate yourself - read, speak to your health care professional, and you might look on the Internet. Some useful websites are included at Appendix 3.

Slow breathing technique

This has been discussed in previous sections and is included in the books listed above.

Become an expert on your health. Libraries can be a good place to find information cheaply. Top of page

Facing fears can be hard work

Expose yourself to things you fear… but do it gradually. Write a list of things you avoid because of your anxiety and start to slowly reintroduce these activities into your life. Be kind to yourself and set achievable goals. Reward yourself for success even if it didn’t go as well as you had hoped.

For example, a person who is afraid of driving because of their anxiety may set a goal to be able to drive to an unknown suburb 20km away. They might start with short trips in familiar areas and gradually increase the distance from home and explore unknown places. It is important to feel some anxiety during the exposure exercises and to 'stay with' the anxiety until it reduces.

If you find after a few weeks using these recommendations that you are still experiencing panic attacks and/or avoiding situations, it is important that you get professional help in treating your anxiety disorder.

Facing fears can be hard work. Support and advice from a professional may be vital.