Panic Attack Protocol

Panic attack: “characterized by a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger… Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.”

1 Recognition

1 Familiarize yourself with the common symptoms (see Appendix A)

⠀

2 Establish a Safe Environment (see Appendix B)

⠀

3 Stay Calm and Composed

⠀

4 Recognize the reality of what they are feeling and experiencing (see Appendix B)

⠀

2 Immediate Response 

1 Encourage slow breathing (see Appendix C)

⠀

2 “Stabilize the Plane”

⠀

3 Offer reassurance  (see Appendix C)

⠀

3 Post Care

1 Make a plan 

⠀

2 Document Incident

⠀

Appendix A: Recognition

“Recognize the Symptoms”

~Panic Attack Physical Symptoms:~

• Heightened sense of danger
• Feeling you might pass out or faint
• Dizziness 
• Heart palpitations, pounding heart, or racing accelerated heart
• Headache, pounding head, flushed head feeling 
• Trembling or shaking 
• Sweating 
• Shortness of breath (feels like one is being smothered)
• Chest pressure, pain, discomfort, or fullness feeling
• Turning pale
• Tense muscles, muscle pain and stiffness
• Dissociation (feels like things are surreal, dreamlike, out-of-body like)
• Weak in the knees
• Burning skin/Pins and needles
• Hot and cold flashes
• Numbness and tingling sensations - Paresthesia
• Nausea, stomach, or abdominal cramping, discomfort/knot, or distress
• Choking sensation, tightening throat, it feels like your throat is closing, it feels like something is stuck in your throat
• Dry mouth 
• Inability to calm your body down 
• Crying 

⠀
~Panic Attack Feeling/Emotional Symptoms:~

• A feeling of overwhelming fear or impending doom 
• Feeling of going crazy or losing control 
• Feeling you are in grave danger 
• A surge of doom and gloom 
• An urgency to escape
• Feeling detached from reality 
• Feel weird, suddenly confused, difficulty thinking straight 
• Irrational and confused thinking 
• Feel like you can’t free your mind from the fear 
• Depersonalization (feeling detached from reality, separate from one-self, separate from normal emotions)

⠀Appendix B: Recognition

“Establish a Safe Environment”

~Some simple things you can do:~

• Offer them ice water or hot tea (the hot and cold temperatures can help regulate the sympathetic nervous system)
• Offer them tissues
• Offer them a blanket
• Put aside your stuff (computer/notebook/books) shows your full attention 
• Consider the distance between you and the counselee (crowding vs. distant vs. comforting)

⠀
~Some simple phrases you could say are:~

• “I’m here for you”
• “Is there anything I can get you?”
• “You are safe here”

⠀
“Recognize the reality of what they are feeling and experiencing”
~Explanation of the physiological experience~

• “The body’s stress response is supposed to feel powerful”
• Your body will calm down naturally in time”
• “Try to let this response run its course through your body”

⠀

Appendix C: Immediate Response

“Slow Down Physically”

~Breathing Exercises:~

• 4-7-8 (inhale through nose 4 seconds, hold for 7 seconds, exhale through mouth for 8 seconds)
• Diaphragmatic breathing (place one hand on chest and one on diaphragm; take breath through nose making sure diaphragm expands, pause, breathe out through mouth) (like this because it involves using multiple sense)
• Straw breathing (breathe through straw or pretend)
• Breathe with them

⠀
~Relaxation Methods:~ 

• Use ice and heat packs 
• Pick up or touch items (have them describe the object in as much detail as possible)
• Drinking water
• Offer to walk 
• 5-4-3-2-1 method (5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste)
• Have them talk about something positive (favorite music, favorite scents, etc)

⠀

“Offering Reassurance”

~Simple Truths to Express:~ 

• “You’re doing great”
• “This will pass, you can let it happen” (2 Cor 4:17-18) (Matthew 6:34)
  • You don’t have to hide it or fight it 
• “I know this is hard and I know this hurts, I’m sorry you feel this way.”
• “God may feel so far right now, but he cares for you” (1 Pet 5:7)
• He’s watching over you now (Ps 146:9)
• You are his child, what happens to you matters to him (1 John 3:1)
• Unconditional love still falls short of how much God loves you (Rom 8:39)
• Sometimes God loves us in ways we do not understand (Ps 139:17-18)
• He will heal your broken heart (Ps 147)

⠀
~Comforting Imagery~

• Songs:  i.e. Lord of Hosts (Psalm 46)
  Though oceans roar, you are the Lord of all
  The One who calms the winds and waves and makes my heart be still
  Though the earth gives way, the mountains move into the sea
  The nations rage, I know my God is in control 
• Verses: i.e. “He covers the heavens with clouds; He prepares rain for the earth; He makes grass grow on the hills.” Psalm 147:8

⠀