/ mental health

5 Things to Remember When You're Struggling With Anxiety and Panic Attacks

This post outlines the five pointers for dealing with anxiety that I wish I’d had to hand a few years ago.

While it’s targeted at people who struggle with high anxiety—such as panic attacks or generalised anxiety disorders—this line of contemplation can work for other negative emotions, because it deals with the basic difference between thoughts and feelings.

We all worry about what to eat, what to wear and who likes us, but high anxiety tends to be more physical and intense in nature, easily fooling you into thinking you’re having a heart attack or brain seizure. It’s not unusual for someone experiencing an attack to admit themselves to A&E under the assumption that they are literally dying.

Suffering from high anxiety and panic attacks is like having someone you trust regularly whisper death threats into your ear. The threat feels 100% genuine. You hold on for dear life, and then things are ok. Your friend is nice to you again. The anxiety is gone, and you're left bruised and confused.

I have lived on and off with this flavour of anxiety for about 4 years… I’ve seen 4 different therapists, read a lot of books, and tried a lot of different approaches to understanding and alleviating my anxiety. Overall, the changes I’ve made and the therapeutic processes I’ve participated in have had a huge impact on my day-to-day well-being.

(If you too are struggling, and you haven't seen a therapist yet, then that is your next step. Go and talk to someone about it—it will do you a world of good.)

As anxiety is so common, I am interested in the principles that underlie it. What reminders can we use to ward off the suffering caused by anxiety and panic attacks? Can we condense it down into something simple?

We're not going to dive into the physiology or causes of anxiety. You probably know most of that. These pointers are for those times when you’re already anxious, already circling the plughole, and you need something to pull you out.

Making use of these reminders takes practice. Just reading about them won't help. It will sound trite or obvious. What matters is how you act in the moment.

You need to build your own images and structures around them. Even if they sound hollow at first, remembering them when you begin to feel uneasy will improve your ability to meet anxiety with courage. They target a level just below what you are aware of, so what matters is not that you are 100% convinced of their efficacy, but that you just step through them, in spite of the doubts.

Engage with them, speak them out loud. Go through the motions no matter how hopeless it feels. One by one, step by step.

1) This is anxiety

Anxiety is an appearance that does not match the underlying reality. It is not what it seems. It feels intense and life-threatening. It feels like your body is failing. But this is anxiety.

Those feelings are literally what anxiety is, what it does. It’s happened before. You got through it then. It’s happening again. You’ll get through it this time.

Anxiety thrives through misdirection: by setting off explosions and terrifying noises all around you. The best way to respond is to pull the anxiety out from thick fog it lives under and scream bloody murder.

By naming it and giving it shape and form, we know what we're dealing with.

It's the difference between:

Everything is falling apart, I'm losing it...

and

I am feeling anxious

The first statement is a multitude of fears, complicated and overwhelming. The second statement is not comfortable, but it is simple.

This way we’re being 100% explicit about what is actually happening here, rather than engaging with the unending stream of catastrophic thoughts that anxiety is throwing your way.

Call it what it is, based on your having experienced it a thousand times. Are there any symptoms that can’t be explained by anxiety? This is anxiety.

Make it clearer. Say out loud what you fear:

  • “I am anxious because I think x is about to happen” (x can be anything like: my heart is about to explode, my brain is about to shut down, I am about to lose my mind/collapse/soil myself in public… You get the idea. You'll have your own favourite expiration fantasies.)

Externalise it and see that the primary state right now, the eye of the hurricane, is anxiety itself. Nothing more, nothing less. Very human, very common.

2) Anxiety is OK

Right, I am anxious. It’s what my mind does sometimes. It’s not my fault. I haven’t chosen to suddenly feel terrible. I didn't make a wrong turn and end up driving off the edge of sanity.

In saying “anxiety is OK” there is an acceptance that:

  1. I am experiencing anxiety, but also:
  2. I am an anxious person. This is what happens to me sometimes

Both are important.

Repeat to yourself:

  • I allow and accept these anxious feelings
  • I allow and accept these anxious thoughts

Really try and stay with the anxious sensations. I know this is tough, but those sensations can’t hurt you.

The more you practice not running away, the less you will fear the anxiety. The less you fear the anxiety, the less it will arise. It is the recoil from the anxiety that keeps it coming, like a playground bully who can smell the fear of his victim.

What we are doing here is to accept the feeling, and disarm the thought.

You’ve already made the thought clear. By making it clear, you disarm it. You reveal its nature as something mechanical, passing, fleeting. You unveil it as a habitual message that pops up in response to the anxiety, like a tape loop. The message arrives in many forms, but its particular form is largely irrelevant.

What’s primary is the feeling: the anxiety.

Embrace the anxiety, embrace the fear. Give them your full attention. But when it comes to the thoughts, you don't have to give them an ear. By all means, verbalise what they're whispering, but realise that you have a choice about whether to listen or not.

Accept the anxiety, disarm the thought.

3) Anxiety isn’t dangerous

Anxiety is readiness, it is adrenaline, about-to, and can-do.

Imagine being on a rollercoaster, watching a scary movie, or competing against someone in a race.

You would be experiencing many of the same symptoms as anxiety attack, but in a very different context. Your heart rate would increase, adrenaline would be released, you would sweat, your focus would narrow. You’re ready. You're excited!

Your body is ramping up. It’s not dangerous. No-one dies from being wired and ready to act.

Can you name a time when an anxious spell or panic attack has unearthed a genuine medical condition? I need a genuine diagnosis here that you would have missed, were it not for anxiety, and I won't be accepting self-admissions or suspicions.

We can actually reframe how we interpret the sensations of anxiety in the momeny by using the acronym FEAR:

Feeling Excited And Ready

When you feel the fear, announce to yourself that “I am feeling excited and ready!” This is a well-studied psychological technique known as cognitive reappraisal. It sounds too simple, but it can be surprisingly effective.

4) Anxiety always passes

Anxiety lives on a bell curve; it builds, peaks and then tails off.

Bell_Curve

Sometimes it lasts longer, sometimes it’s very quick. Sometimes it starts very suddenly and fades slowly. But it always finishes with the inevitable descent back into “normal.”

Your body can only make such a scene for so long. When the rhinoceros has failed to come charging through the wall, and the house remains standing, your nervous system takes note and moves on.

Every time you’ve been anxious, it has passed. This time will not be any different.

Let this fuel you. You don't need to perform any great feats or find a solution to your existential crisis. Just hold tight, reason as much as you are able, but take it easy on yourself. It will pass regardless of what you do.

5) Anxiety does nothing to prevent the perceived disaster

To accept our anxiety without indulging our catastrophic thoughts feels like we’re driving with our eyes shut: it will never work, you'll hit something any second.

Anxiety implies it has a solution, a way forward. Here, here, look at me, we have to do something NOW, this is serious!

But anxiety does nothing to prevent the perceived disaster. Think about it. Even if your worst fears were true, what way forward is anxiety offering you? It’s got nothing. It's not offering any ideas, or showing you anything useful, or revealing anything more than you knew at the start.

Like the poor Emperor with no clothes, it's parading naked around the grounds, proclaiming to be the authority on all things.

It's literally pointing at nothing. It's not an urgent message, it just is what it is.

Anxiety is what anxiety does.

So those are the five reminders:

  1. This is anxiety
  2. Anxiety is ok
  3. Anxiety isn't dangerous
  4. Anxiety always passes
  5. Anxiety does nothing to prevent the perceived disaster

Bonus: 6) Call the bluff

When you've built up some competence in the above reminders, there is one further step you can take to really throw a spanner in the works:

Ask the anxiety for more.

Stand up in the middle of the storm and demand a conclusion. If it feels like something is about to happen—and this is the defining characteristic of anxiety—then ask for it now.

If the fear is that your brain is melting, demand complete meltdown now. If you think your heart is about to stop, demand complete failure immediately.

Channel the latent anger and frustration that accompanies the suffering of anxiety. You are fed up with being taken on a ride like this, over and over.

Stop resisting and throw yourself towards it. If it's going to happen, then let's have it.

It will feel scary, uncomfortable, wrong. But it is this habitual resistance to anxiety—the belief that it will hurt you, the fear of impending doom—that perpetuates the cycle. The more you can stand there and see that nothing happens, the less venom anxiety has to strike with.

Like a cartoon plane spluttering to the ground, it cannot continue. By demanding what you were previously running from, we rob the anxiety of its fuel.

Postscript: Practice, and a Book

I actually finished the final draft of this piece whilst feeling really anxious. I haven't felt like this in quite a while, but some random ache in my head set off a cascade of fears and medical diagnoses whilst making lunch. It's what my mind does sometimes.

Writing about anxiety when you’re anxious is not something I recommend, but it allowed me to field test these points as I was trying to articulate them. Doubts came from every direction, but I went through each reminder one by one. Some of them rung hollow, but in a few minutes, I was feeling better. I always do.

The more we practice not running away, the less we will feel like we have anything to run away from. It takes practice and patience, but I hope these reminders help you to stop running. You have a choice. You have options.


The above reminders are a distillation of the principles that have helped me the most when I've felt anxious.

The biggest influence and my favourite book on anxiety is Dare: The New Way to End Anxiety and Stop Panic Attacks Fast. I'll be writing a review on it soon, but if you want to get your hands on some of the best tools for tackling anxiety, this is the book to buy. It's the first book I pick up whenever my anxiety flares up, and it always grounds me and points me in the right direction.