Updated: May 5, 2019
A boring but important reminder: I am not a professional CBT therapist; however, I do have years of lived experience of panic attacks and I managed to overcome them with this method, without any medication. I can't guarantee that this method will work for you, but I hope it will. This is a method I came up with before I even knew what CBT was; I didn't get it from a therapist or copy it from a book, I came up with it myself, accidentally. It isn't, knowingly, underpinned by any scientific evidence-based research; rather, a lot of common sense and trial and error.
Why choose this method?
In my opinion, panic attacks and panic disorders are more physical than they are mental. They aren't just excessive worrying, and I don't even believe much of the time that our intrusive thoughts initially cause our panic attacks.
I believe, often, the frightening physical symptoms arise first which then causes the panicky thoughts, which in turn causes a panic attack.
This is often why I believe we often feel like our panic attacks “come out of the blue” or “for no reason” as our minds aren’t simultaneously in a state of a panic, or weren't so before the physical symptom arrived.
See my previous post called “Physical Anxiety: How I Overcame Panic Attacks” for my own theory of "anxiety hangovers" and why I believe we often get the physical symptoms before the intrusive thoughts.
Even when the negative thoughts do arise first, I believe they are only exaggerated and turned into a full-blown panic attack because of our bodies physiological responses such as: the palpitations, stabbing pains in the chest or feeling like you can't breathe.
As a result, I came up with a method that targets the physical symptoms of panic attacks via training myself to perceive them differently. I found that once I had the physical symptoms under control, the thoughts were much easier to manage. After all, it is very difficult to think rationally when you physically feel like you're having a heart attack...
The 4-Step Challenge Overview
Here is the CBT method I used to fight back against my panic disorder/panic attacks and overcome them for good. Give it a blast.
A. Choose one physical symptom to focus on.
E.g. Stabbing chest pains. This is the first symptom you are going to try to overcome, you might want to try your most feared symptom.
This is probably the most important point to remember when trying this method. It is really important to focus strongly only on this 1 physical symptom that scares you; it may sound counter-intuitive but you have to almost obsess about it. Your brain can't focus on more than one fear at a time, so you should hopefully mainly experience and fear this particular physical symptom and not any others.
This takes balls. It is important to remember that this method of focusing on 1 specific symptom may even induce the symptom, causing it to happen more frequently, but this is a good thing as you have more opportunities to practice the CBT method and hopefully overcome it quicker. If there is one thing I know about people who endure frequent panic attacks, it is that you've got balls.
B. Try this 4-step challenge.
Every time you feel the physical symptom coming on, E.g. when you feel a sudden chest pain, try this 4-step process:
1. Say out-loud “this is just anxiety” (acknowledge it).
2. Say out-loud “this insert symptom is not dangerous” (rationalise it).
3. Say out-loud “this will pass” (Remind yourself it's temporary).
4. Distraction. Distract your mind with a mental game or though-provoking question (See below).
Repeat steps 1-3 if you need. Emphasise NOT dangerous, and WILL pass. Say it quite slowly.
It's important that you say the specific symptom you are experiencing. E.g. "These chest pains are not dangerous."
Try not to get downbeat if you still have a full-blown panic attack, especially for the first few days or weeks, keep persevering with it; Just having the presence of mind to try this process when you get a physical symptom is a success initially.
Repeat the 4-step challenge as many times as it takes until you have trained your brain that the chosen specific symptom is not dangerous or scary. Think about how many times you have interpreted this symptom as dangerous, therefore it might take a while to re-wire your brain and change your thoughts!
Eventually, after several days - a few weeks, you will hopefully have trained your brain to stop a full-blown panic attack arising from the initial fear of that symptom. Once you stop fearing that symptom, eventually, it stops manifesting itself in the first place. I.e. Once you are no longer scared of chest pains, you will no longer get chest pains. WEIRD.
D. Congratulate yourself.
That was difficult, not to mention terrifying. That took balls! You should be very proud; and this shouldn’t sound patronising. Before you move onto the next symptom, stop and take stock of what you have just accomplished. If you can do it with that really scary symptom, you can do it with any!
E. Repeat steps
Choose another symptom to overcome. I went through a long list, even ones I was only "slightly scared of" and ones I felt that “just annoyed me”.
My list of symptoms looked something like this: Heavy head, dizziness, light-headedness, chest pains, difficulty breathing, scared of and feeling like I will swallow my tongue, arm pains, sinking feeling in chest, not being able to swallow, eye-twitching, depersonalisation (although I never wrote them down).
After I attacked each symptom individually, I ran out of symptoms to be scared of, so I suddenly had no way of a panic attack starting, and as a result, I no longer had a panic disorder.
Guidance For The 4-Step Challenge
Example of 4-steps challenge card to carry around with you:
Copy these cards above, change “chest pains” to whichever symptom you want to overcome. (I realise some might be singular so change “these” to “this” etc).
Write your own list of distractions on the back (or copy mine). The items crossed out on the back are distractions I would have already completed. See "List of distractions" below for some examples.
Print it out and stick the front and back together. It might be worth getting it laminated so it doesn't get crinkled in your pocket. (If you live in the 21st century you could just take a picture of this or save it in a folder on your phone too as someone kindly pointed out to me!)
Example of how to do the 4-steps challenge:
First, make sure you carry the card around with you at all times. When you feel the scary physical symptom that you chose to focus on, say these 3 things out-loud and quite slowly:
1. “This is just anxiety”
2. “These chest pains are not dangerous”
3. “This will pass”
If it hasn't quite sunk in, repeat steps 1-3. Emphasise NOT dangerous and WILL pass. Try to say it slowly.
4. Say 10 words beginning with P: Purple, Parsnip, Pear, Pineapple, Pier, Perhaps, People, Pedophile, Pepper, Pig.
If you finish this quickly, choose another letter and play again. If you are trying to remember something e.g. For "Childhood crush in chronological order" exercise below, double-check in your head that the order is correct, how do you know?
List of distractions
Choose some of these and write them on the back of your card for the distraction phase of the 4-steps challenge.
Thought provoking questions
Your top 5 favourite animals in order and why?
Who is your favourite actor/actress and why?
What would you like to have accomplished in 5 years’ time?
If you won the lottery tomorrow, what is the first thing you would do?
The favourite place you've ever visited and why?
What places in the world would you like to visit in the next 5 years?
Do you like your own birthday? Why/why not?
Favourite computer game you've ever played and why?
Who is your favourite ever teacher? Why?
What did you have for tea yesterday?
Remind yourself of your childhood crushes, try put them in chronological order.
Pick something you can see and say the word. Play word association, you have 5 seconds to think of another word. If you lose, try again.
Name ten things beginning with insert letter
Find some riddles online and write them on your card and try and work them out. E.g. What gets wet as it dries?
Make up your own when you run out, google more riddles etc.
After You Read This:
Give it a blast! Take 5 minutes to make a card. Carry it around with you wherever you go, when you feel the onset of the physical symptom you have chosen, try the 4-steps challenge.
Re-read this guidance if you need, it's a lot to take in.
Become a member to keep updated for when I post my next self-help post, there's no catch and I won´t bombard you with emails, but feel free to bombard me!
Panic Peer Recovery to try fully recover from panic disorder with guidance from someone who has been there and done it.
Any questions? Get in touch!