Between 2013 and 2018, a collaborative effort between Singapore General Hospital and Duke-NUS Medical School focused on screening patients who frequented the Emergency Department (ED) of local hospitals for panic attacks and the more severe Panic Disorder.
What they discovered was significant: a startling 24 percent of ED attendees presenting symptoms like chest pain, giddiness, shortness of breath, or heart palpitations met the diagnostic criteria for a panic attack. But before we delve into how to de-escalate a panic attack, let’s take a look at what it constitutes.
What is a panic attack?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a panic attack is defined by the presence of four or more symptoms, spanning both mental and physical realms.
Mental symptoms may include feelings of unreality (derealisation), detachment from oneself (depersonalisation), or fears of losing control or dying. Meanwhile, physical manifestations can include:
- Chest pain
- Chills
- Excessive sweating
- Feeling of choking
- Feeling dizzy, unsteady, lightheaded, or faint
- Heart palpitations, pounding heart, or accelerated heart rate
- Hot flashes
- Nausea or abdominal distress
- Numbness or tingling sensations (paresthesias)
- Trembling or shaking
- Sensations of shortness of breath, difficulty breathing
Unlike the gradual onset of anxiety, panic attacks strike suddenly and fiercely, often peaking within minutes before gradually subsiding. In those tense moments, every passing second can feel like an eternity as individuals grapple with overwhelming panic and a sense of disorientation.
Why do panic attacks occur?
Fear is a natural reaction to a situation that seems scary. Even though public speaking isn’t life-threatening like encountering a bear in the forest, fear activates our fight-flight-freeze response, a system designed to prepare us for dealing with danger.
This manifests in myriad ways, ranging from mild anxiety to intense feelings of overwhelm. A panic attack, therefore, can be seen as an extreme manifestation of fear. You can think of it as a false alarm, mistakenly triggered in the absence of a physical threat. While panic attacks may be unpleasant and scary, they are not dangerous. They are part of a well-meaning system designed to protect us, not harm us.
While panic attacks can be observed in or linked to mental health conditions such as Panic Disorder and Generalised Anxiety Disorder (GAD), they can also occur out of the blue or in response to situations where our anxiety levels are raised and “alarm system” is triggered. These situations may include stressful events and difficult emotions related to past experiences.
Panic attacks at work
In today’s high-speed work environments, the prevalence of anxiety comes as no shock. In 2023, workplace anxiety, alongside its companions stress and depression, collectively accounts for a staggering 50% of all work-related ill health cases.
Highlighted by the Anxiety and Depression Association of America, the primary stressors in the workplace include:
- Deadlines
- Interpersonal relationships
- Staff management
- Dealing with issues/problems that arise
These pressures persist day in and day out, contributing to the alarming statistic that 28% of American employees have encountered anxiety or panic attacks.
In Asia, where conversations about mental health remain shrouded in stigma, one can only imagine what a scary experience it must be to have a panic attack at work. Fortunately, there are ways to de-escalate a panic attack at work and in other settings where the assistance of a mental health professional may be out of reach.
How to de-escalate a panic attack at work
1. Retreat to a quiet and private space
Whether it’s finding solace in a bathroom stall or seeking refuge in a quiet stairwell, retreating to a private area can provide a reprieve until the symptoms subside.
If feasible, distance yourself from the triggering environment—a simple explanation like, “I’m not feeling well, I need some fresh air,” or, “Excuse me, I’ll be back shortly, just need a moment,” can suffice.
If physically removing yourself from the situation isn’t possible, take a deep breath and mentally transport yourself to a serene place, even if just for a fleeting moment. By focusing on thoughts of joy and tranquillity, the power of your mind can help you navigate through the storm until calmness washes over you once more.
2. Initiating breathing exercises
Once you have found a calm environment, breathing exercises can serve as a “Reset” button for your nervous system, currently in overdrive.
Deep breathing reduces the activity of the sympathetic nervous system, which is responsible for the fight-flight-freeze response, and stimulates the parasympathetic nervous system by decreasing your heart rate and reducing cortisol production. This, in turn, brings your body back to a state of calm and relaxation.
a) Diaphragmatic breathing (DRB)
Begin by inhaling slowly and deeply, allowing your belly to expand with each breath. This method is different from shallow or chest breathing, where only the upper chest moves during inhalation and exhalation.
b) 4-7-8 breathing
This method involves inhaling for four seconds, holding the breath for seven seconds, and then exhaling for eight seconds.
c) Box breathing
Begin by inhaling deeply, counting to four steadily as you feel the air fill your lungs. Then, hold your breath for four seconds, striving to maintain a pause without inhaling or exhaling, before exhaling slowly through your mouth for another four seconds. Repeat these steps until a sense of inner balance is restored.
Engaging in these practices reactivates the prefrontal cortex, the region of the brain responsible for managing stress and decision-making, while simultaneously soothing the amygdala—the brain’s threat detection centre—thereby tempering the fight-or-flight response.
3. Redirect your focus to the present moment
In the disorienting grip of a panic attack, it’s natural to fixate on your bodily sensations, which can often increase your sense of panic. Instead, it can be more useful to focus on your surroundings. Grounding techniques provide a lifeline to reality, helping you anchor yourself in the “here and now.” Consider these methods:
a) 5-4-3-2-1
Consciously engage each of your five senses—sight, sound, smell, taste, and touch. The 54321 method acts as a guide: identify 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.
b) Three items
Three items: Scan your surroundings and select three items. Delve into the details, describing each item to yourself with precision. Explore their colours, textures, shapes, and intended uses, and contemplate their origins.
c) Categorise and name
Opt for a category—be it colours, shapes, or textures—and survey your surroundings, naming all items that fit within that category. This exercise fosters mindfulness and helps ground you in the tangible aspects of your environment.
4. Visualise images that bring joy or calm
Whether it’s a place, person, or memory. Importantly, picture yourself in their presence and focus on as many details as possible. Like the grounding exercise, pay attention to what you can see and hear and feel.
Here are some examples to get you started:
a) Place
Picture yourself standing on the shores of a sun-kissed beach, feeling the warmth of the golden sand beneath your feet, hearing the rhythmic waves, and breathing in the salty tang of the ocean breeze.
b) Person (or pet)
Envision the gentle presence of a beloved person or pet, sitting beside you with a tender smile and comforting embrace. Feel the warmth of their hand (or fur) in yours and hear the soft cadence of their voice offering words of reassurance.
c) Memory
Transport yourself back to a cherished memory, whether it’s from childhood or a recent road trip. Recall the sound of laughter in the car, the cool wind in your hair, and the taste of sweet treats shared at petrol kiosks.
5. Remind yourself that you are safe
As the fear of losing control, or even dying, looms large in the throes of a panic attack, remember it is your body’s natural response to a false alarm. It may be unpleasant for the time being, but it will not harm you. Most importantly, it will pass.
To remind yourself of these facts, you may tell yourself:
“I am not having a heart attack. This moment feels bad, but it will pass.”
“I’ve had this feeling several times before and I’m still here.”
“I am resilient and capable of getting through this.”
Treatment for panic attacks at Intellect Clinic
While self-help methods may prove effective for some, panic attacks often hints at deeper underlying conditions, such as GAD or PD, and individuals experiencing them will do well to approach a mental health professional.
At Intellect Clinic, we can connect you with a clinical psychologist who specialises in assessing and treating such conditions. Even if a formal diagnosis isn’t reached, our psychotherapists and counsellors can support you in managing panic attacks, all while prioritising your comfort, privacy, and confidentiality.
Meanwhile, our Intellect app features Rescue Sessions designed to provide immediate assistance during panic attacks, especially when professional support is accessible. These sessions incorporate interventions discussed earlier, offering a lifeline of support in times of distress.
This article was reviewed by Emily Chau, a Clinical Psychologist at Intellect Clinic.
