When Fear Floods – Understanding and Confronting Panic Attacks

“It came out of nowhere. One minute I was on the bus on my way to school, and the next minute I was dying. I couldn’t catch my breath. My heart was beating out of my chest, and I was shaking so hard, I thought I was having a seizure.”

Meryl was having her first panic attack and it hit her like a speeding train. After her first episode, there were more. They struck in random places —at home while she watched her favorite TV show, on the bench during lacrosse practice, during Spanish class. The more frequent and intense the episodes were, the more terrified she became in anticipation of the next one.

If you’ve never had a panic attack, you likely know someone who has.
In the course of one year, 2.7% of the U.S. population experience them. The symptoms vary from person to person, but can include heart palpitations, chest pain or discomfort, trembling, numbness or tingling, fear of losing control or fear of dying. Simply put, a panic attack is a malfunction of the flight or fight response that activates the trigger even when there’s no immediate danger or fear.

As with other types of mental disorders, to avoid being stigmatized teens will go to great lengths to hide the fact that they suffer from panic attacks. Not knowing when or where one may occur wreaks havoc on their social and academic lives —it’s just safer and more comfortable to stay home.

Meryl had never been a particularly dependent child, but now she felt her parents were her only link to sanity when she was having a panic attack. At almost sixteen, Meryl was ashamed at this sudden reliance on her parents, and her shame soon turned to sadness and feelings of depression. When Meryl began staying home from school for fear of having an attack, Meryl’s parents called In Step for help.

We understand that when your child is experiencing real physical symptoms such as a racing heart, chest pain, sweating, trembling, dizziness, and nausea, it’s terrifying for you too. What if you decide not to take him to the ER and something terrible does happen? When your child vehemently protests going to school, with tears streaming down her face, how can you force her to go?

Panic Disorders (PD), like the one Meryl struggles with, are both terrifying and agonizing. As the parent, it’s extremely challenging to know how to handle both the panic itself and the avoidance behavior that comes along with it.

Here are Five Steps that can help:

Step One: Call a Spade a Spade
The first and most important step is for you to help your child recognize the symptoms of a panic attack. Help your child understand that these horrible sensations are a result of a physiological arousal stemming from anxiety. As distressing and unpleasant as these symptoms are, they are not dangerous.

Step Two: Ride Out the Wave of Panic
The scariest part of panic is the fear that the uncontrollable feelings will never end. It’s important to reassure your child that the panic will end. The sooner they recognizes this fact, the more quickly the panic episode will subside. Children prone to panic are typically more sensitive to bodily changes —reassure them that everyone experiences fluctuating physical sensations. Your child’s job is to learn to tolerate a very uncomfortable set of sensations. Your job is to help your child reinterpret physical feelings such as a rapid heart rate as uncomfortable, but not dangerous or life threatening.

In order to help Meryl develop a tolerance for the sensations she experienced during a panic attack, we recreated them. For example, I asked her to do jumping jacks so she could feel her heart rate rise. Over several sessions, and with practice at home, Meryl developed a capacity to tolerate the discomfort.

Step Three: Avoid Avoidance
Children with PD will purposefully avoid stressful situations (or any activity that induced a past attack). Don’t collude with your child on this. Avoidance is a slippery slope.

By the time Meryl came to In Step, she was already beginning to miss school. The typical cycle would go something like this:
1. The night before, Meryl felt significant worry about having a panic attack in school.
2. After much pleading by Mom and Dad the next morning, Meryl reluctantly went to school.
3. First period was math, her least favorite subject. As she feared, she had a panic attack.
4. Meryl (or the school nurse) called her Mom and Meryl, sobbing and crying, begged her to pick her up from school.
5. Wanting to do the right thing, Mom picked her up.
6. Initially, Meryl felt great relief.
7. Back at home, as the night wore on, Meryl felt increasing anxious.

Because, in the short term, the feeling of relief Meryl experienced from avoidance was so powerful, it was really difficult for her to break the cycle.

Step Four: Model Panic Busting Self-Statements
Children with PD frequently exhibit maladaptive cognitions that make their symptoms worse. In Meryl’s case, she interpreted her physical feelings as signs that she was going to die —she had to leave school to avoid disaster. Because these thoughts were automatic and predictive, they were destructive and felt too overwhelming to combat.

Along with a multidisciplinary team, Meryl’s parents tackled the school avoidance issue. The first step was to identify a safe person there who would be with Meryl to help her in case of a panic attack. Then, instead of calling home desperate to be picked up, Meryl could work through an attack without having to leave school.

In advance of a stressful situation, these self-statements can help your child learn to manage their feelings of anxiety:

  • “I’ve done this before; I can do this again.”
  • “What specifically do I need to do to manage this?”
  • “One step at a time; I can handle it.”

For when they feel overwhelmed:

  • “I always get through it.”
  • “It’s getting better each time.”
  • “There is nothing physically wrong with me. This will pass.”
  • “Don’t run away; Stick it out.”
  • “Nobody ever dies of anxiety.”

To reinforce the positive, post-panic:

  • “I did it. I got through it.”
  • “It wasn’t as bad as I thought.”
  • “I’m making progress.”
  • “I can learn to overcome my fears!”

Step Five: Encourage Relaxation Techniques
Relaxation training is an effective technique for managing anxiety. Help your child practice a daily series of deep breathing exercises followed by tension-relaxation technique, moving slowly to tense and relax all of the major muscle groups. Yoga also has great benefits to promote wellness and calm.

If you believe your child is experiencing panic attacks, please know that you are not alone. Mental health professionals at In Step and elsewhere are here to help you. If you have any questions or are interested in a scheduling a consultation appointment for you or your child, please call 703-876-8480.

The website Healthline has put together a list of books that offer other perspectives and constructive ways to address anxiety and panic attacks. Learning more about the disorder, researching and finding the right treatment, and understanding that support is available, is a good place to start.