Don't Leave

Okay so I think the single most difficult thing for me during my panic disorder treatment was staying put during an attack.  Your mind is telling you to leave whatever situation you are in - to run away, to go home.  And it is extremely hard not to listen to it.  You just feel this intense need to escape.  This is all part of the fight-or-flight response: your body is responding as if you were faced with a bear.  Of course it is going to tell you to run away!!  But to overcome panic disorder you need to show your amygdala that there is actually no real danger.  You are not faced with a bear and your life is not threatened in any way.  In order for your amygdala to understand this, you can't give into this need to escape.  If you have an attack at your desk at work and then you go into the bathroom to calm down, you are indirectly telling your amygdala that yes, there was danger at your desk, it was very scary so you "escaped" from your desk.  Your amygdala will then recognize your desk as dangerous and you will continue to have anxiety and/or panic associated with being at your desk at work.  

To break this cycle, it is absolutely imperative not to give into the need to flee the situation.  You just have to sit there and breathe through the attack.  It actually helps to talk yourself (or as I prefer, your amygdala) through the situation.  If you are having a panic attack at your desk at work, you can say something like "Oh so I see that my fight-or-flight response must have gotten triggered by some set of cue at my desk.  Interesting.  Well I am just going to sit here and continue to work on this document.  There is nothing dangerous about the situation I am in so there is no reason for me to get up and leave."  The trick here is that you cannot be angry with yourself because anger actually comes from a very similar emotional place as fear so you don't want this to trigger further attacks.  You just have to be matter-of-factly with it.  Just observe your emotional and physical response with curiosity.  And don't get up.  I know how hard it is to stay put with all of the adrenaline coursing through you - you might squirm a little and that is okay.  But try really hard not to get up and leave. 

Another mistake that I have made in the past is to try to figure out what the cues were that triggered the attack.  I became almost obsessed with figuring it out.  The problem is that when I didn't find a "satisfying" answer I had a lot more trouble coming out of my anxious state.  The best thing to do is try not to overanalyze the situation.  Just say "Yep, something here must have triggered my panic attack.  Okay.  Well that's fine.  Doesn't matter what it was.  I'm just going to continue what I was doing".  (this is very hard, just to warn you!!).  The good news is that if you can manage to do all of this, to stay put and talk to yourself without anger and to not overanalyze what trigger may have caused your panic, your attack will probably last about 90 seconds (this is how long it takes your body to break down the adrenaline that has been released).  

I don't know about you, but I can handle 90 seconds of discomfort every once in a while.