How to Help a Friend with Panic Disorder

Panic attacks are almost as frightening to an observer as they are to the person experiencing them. People experiencing panic may suddenly look pale and complain of feeling dizzy or faint or "weird." They may feel their heart racing, and may insist that they are having a heart attack. They may sweat, flush, shake, pant, and look ill. A person in a panic state may get angry or start crying or just look dazed. They may insist on leaving where you are now and going home or to the hospital. Of course the first few times the panic sufferer will probably be taken to a doctor or emergency room. This is entirely appropriate. A thorough medical evaluation is important to rule out dangerous medical conditions that can cause these symptoms.

After medical clearance, a patient is told he or she is having panic attacks. A panic attack is essentially a communication problem. In a panic attack the brain apparently misreads physical sensations and turns on all its alarms at once. It feels as if you were crossing the road and you suddenly saw a semi-truck driving straight for you. You run and you trip. You cannot hear anything but the blasting of the horn, you cannot see anything but the headlights, and you cannot escape.

The problem for the people with panic disorder is that, despite repeated assurances by the doctor that they are not ill or dying; they are having miserable, but harmless and treatable panic attacks, they may still fear and avoid the experience. At this point reassurance is useless. People prone to panic attacks may want to avoid all places where panic episodes have occurred in the past. The panic attack sufferers may get alarmed at the first twinge of anxiety and go to elaborate lengths to prevent the next attack. Ultimately these avoidance strategies do not work and over time they will seriously restrict the person's life. They may come to see themselves as ill or weak or disabled and unable to ever have a normal life.

It is important for you not to minimize the intensity of the experience. Panic does feel overwhelming. What both of you need to remember is that it is temporary. The best advice for both of you is to: FLOW with it.

     Face it

     Let the feelings come

     Observe the sensations

     Wait

This advice applies to you as well as to your friend. You can help best by staying calm. Face it that you are going to be there for a while. Most attacks last from ten to twenty minutes with after-effects of lesser anxiety that last for several hours. Find an out-of- the- way spot where both of you can wait for the anxiety to subside. If your friend wants to talk, listen. If he or she wants to keep silent, don't ask questions. If your friend is in counseling, he or she will have been instructed not to fight the feelings. This is the most helpful advice you can give. Mention it only if the friend seems to be struggling or if wants to leave immediately. (Patients are told that it is best to stay where they are until the panic has passed). Help him or her do that.

You may be tempted to try to figure out what is "causing" the anxiety. This is pointless. They don't know what caused it. You don't know what caused it. Doctors don't know what causes it. Often the attack just comes out of the blue. All we know is the tendency to have panic attacks runs in families. We think it has something to do with breathing. We know it is more prevalent in people who have mitrovalve prolapse. We also know that exploring origins is not a useful coping strategy. Staying put, accepting the feelings, and waiting is helpful. Some patients are able to practice slow breathing during that attack. Some people feel better if they keep walking. If that is helpful, fine. Other quick fixes, such as reaching for a pill, running for an exit, or calling their husband, their mother or the doctor again, are not likely to be helpful, and are likely to be problematic in the long run. So, stay in the Flow yourself!

After the attack has subsided some people may be ashamed, embarrassed, apologetic, or even angry that you witnessed their distress. This is the time for reassurance. Tell them that it is not their fault and that you do not think less of them. If they have not tried cognitive therapy, suggest it. They are not alone. Anxiety disorders are the most common group of emotional disorders. There is a lot of information available. Take a look at the website for The Anxiety Disorders Association of America, www.adaa.organd for the American Psychological Association, www.apa.org. The more informed you both are, the less scary the occasional panic attack will be.

Bonnie Lee Fraser, Ph.D.
Clinical Psychologist