I rarely ever have panic attacks anymore, not since I started serious therapy and personal healing years ago. I did not have any throughout a traumatic breakup(s), I did not have any even when I lost my daughter. I grieved, I felt things so painful and intense that it was hard to breathe and impossible to get out of bed, but I did not have a panic attack.
Nowadays, when they do happen, it’s impossible to predict. I wouldn’t say they happen for no reason. Often the perfect storm of triggers and the right amount of serotonin in the brain is the recipe for panic soup, but they are so surprising when they do happen that they feel completely out of the blue. The swirling nauseous stomach, pounding heart, cold sweat, and feeling of absolute dread and doom is quite possibly the most acutely uncomfortable physical sensation I’ve experienced in my life. Even full-blown labor, pre-epidural, was not half as uncomfortable. At the same time, shame and humiliation of the way I feel and look to other people reinforce the panic.
How I get through a panic attack (without xanax):
1. Stay present, absolutely present. The mind wants to obsess over the future, the next five minutes, hours, or days. Force yourself not to. I do this by:
a) Rubbing my fingers over different textures, focusing only on the sensation of touch
b) Try to locate your own pulse in as many places as possible
c)With some practice during calm times, you can learn to become an observer of your own thoughts and feelings. By separating yourself from the body of anxiety and observing it, you remove its control over you.
2. Change your brain chemistry.
a) Do a physical activity, like power walking, or jumping jacks, if possible. The endorphins released will interrupt the fight-or-flight response.
b) use your left brain. Do math problems in your head. You cannot simultaneously sustain a flight or flight chemical response and your cerebral cortex to solve problems of logic.
You can also try this:
If you have access to a pen and paper while panicking, make a table with seven columns and several rows. In the first column, rate your panic using number from 1 to 100. For example, “85”. In the next column, write an anxious thought or fear that’s in your head at the moment. “I’m going to throw up and be embarrassed in front of my friends.” Next to that, write what you can do about it. “I will excuse myself and take a walk,” or “I will just use self-talk”. In the 4th column, write the worst case scenario, even a really ridiculous one. “My friends will laugh at me and call me names and never speak to me again.” In the 5th column, rate the likelihood of this actually happening with a percentage. “It is only 1 percent likely that my friends will react this way.” In the 6th column write the most likely outcome. “My friends will worry about me but understand if I’m not feeling well and need to leave.” In the last column, re-rate your panic level from 1 to 100.
By the time I’m done with the exercise, my left brain has taken over and forced the medulla of my brain to stop releasing fight or flight hormones. I always end up rating my panic level much lower in the last column.
I do NOT deep breathe, because this feels like a panic move to my subconscious, child-like mind. It does work for a lot people, though. I also do not talk about it with someone in that moment. It only feeds into my panic. Some people find it helpful to talk to someone they trust in the moment, but not me.
Does anyone else reading ever have panic attacks? What works for you, what doesn’t?
(I’ve taken paxil for over a decade now to increase the level of serotonin in my brain and as a result my threshold for panic attacks has dramatically increased. It takes lot more to trigger one for me and the frequency of panic attacks decreased from daily or weekly before paxil to only a couple times per year. Medication is a valuable tool that can increase the quality of your life, but having the know-how to overcome anxiety when you’re left to your own devices is even more important. If you can’t find the right therapist or self-help tools to find your best panic-defeating strategies, KEEP LOOKING. Don’t give up until you find them.)
Mother of All Things 
I’ve only ever had one and I honestly thought I was dying. It wasn’t until I googled the symptoms that I even knew what it was!
Thank you, these are good ideas. I had some days full of panic attacks a while back. Now I just get some raised anxiety sometimes. It doesn’t tend to be illogical or anything though, it’s usually a reaction to something.
I respect the amount of awareness that it takes to monitor that.
That was a big lesson for me this past spring. I don’t remember any occurring since, but just slowing down and focusing again seemed to be really important.
Thanks for writing that!