Panic attacks typically begin suddenly, without warning. They can strike at any time — when you’re driving a car, at the mall or in the middle of a business meeting. A panic attack occurs when the body experiences a sudden surge in adrenaline out of proportion to any perceived danger or threat. A person can be sitting at their desk typing, yet feel as if they are being chased by a lion. The body is responding with a level of adrenaline appropriate to a dangerous situation, but it’s not realistic for the situation the sufferer is actually in. Symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.  You may fear having panic attacks so much that you avoid certain situations where they may occur. The condition can become so severe that it can cause agoraphobia – a fear of leaving the house. When this occurs, it is known as panic disorder.

What can you do to reduce and cope with panic? Here are some suggestions. Pick the ones that seem right for you:

Deep Breathing

Taking control of breathing is the first step to controlling a panic attack. The goal is to create a slow stream of air by breathing in and out while focusing on your breath. This prevents hyperventilation and a buildup of carbon dioxide in the blood. It is helpful to practice mindful breathing outside of panic attacks so you know how to use the technique when you do have an attack. There are apps and YouTube videos people can watch to practice breathing techniques. Some great smartphone apps include Dare, Rootd, Anxiety No More, ACT Companion and Pacifica.

Progressive Muscle Relaxation

Another strategy is learning to relax the body. This technique involves tensing and untensing various muscle groups. This lowers the overall tension and stress levels that can contribute to panic attacks. Start with the feet and work up to your forehead. Tighten the muscle while taking a deep breath in, hold for a few seconds and then release the tension while breathing out. Move up the body, one muscle group at a time.

Mindfulness

This is the act of accepting thoughts as they come, but not letting them get out of proportion. It is a mental framework designed to help people stay present in the moment without worrying about the past or fearing the future. Mindfulness incorporates many relaxation and meditation techniques.

Cognitive Behavioral Therapy

Panic attacks can originate from thoughts that have become deep-seated worries. Cognitive behavioral therapy (CBT) is an effective, lasting treatment for controlling panic attack symptoms. CBT challenges fearful thoughts. What are you afraid will happen? Is there evidence to support these fears? A practitioner trained in CBT can equip an individual with the tools to successfully control and defuse a full-blown panic attack.

Yoga

There are many uncomfortable physical symptoms of panic and anxiety, such as feelings of tension, tightness, and pain sensitivity. Yoga postures, known as asanas, help ease the physical discomfort that is caused by anxiety or panic. Asanas work to stretch, lengthen, and balance the muscles. These postures can assist in releasing built-up muscle tension and stiffness throughout the body.

Cut Down on Sugar and Eliminate Caffeine

Although many people can’t start their day without coffee, caffeine can trigger panic attacks for people because it is a stimulant and can cause people with anxiety to have palpitating hearts and shaky hands. Sugar can cause blurry vision, difficulty thinking, and fatigue, all of which may be interpreted as signs of a panic attack, thereby increasing worry and fear. A sugar high and subsequent crash can cause shaking and tension, which can make anxiety worse. While dietary changes alone cannot cure anxiety, healthy eating habits can minimize symptoms, boost energy and improve the body’s ability to cope with stress.

Stop Smoking

If you think smoking calms you down, think again.  A study of thousands of smokers shows that they are three times more likely than non-smokers to have panic attacks and panic disorder. Tobacco smoke may induce panic attacks in susceptible individuals. And nicotine has a stimulating effect on the brain.

Reduce or Eliminate Alcohol

There are clear links between alcohol and anxiety, and between alcohol and panic attacks. Alcohol can trigger panic attacks because it can cause low blood sugar, dehydration, increased heart rate, and increased levels of stress. A drink from time to time is not harmful, but when people use drinking to deal with anxiety and panic, they can experience severe consequences. Like other frequently abused substances such as caffeine or cocaine, the combination of alcohol abuse, hangover, and withdrawal can lead to an increased risk of panic attacks. As a consequence, this kind of abuse can result in both an alcohol addiction and more severe anxiety and panic disorders.

Medication

There are many anti-depressants, mood stabilizers, and benzodiazepines like that can help keep panic under control when combined with therapy. Antihistamines (such as hydroxyzine) and beta-blockers (such as propranolol) can help mild cases of anxiety as well as performance anxiety, a type of social anxiety disorder. Patients need to keep in mind that benzodiazepines carry the risk of tolerance and addiction and are better suited for short-term or “as needed” usage.