Ask Asad: I have panic attacks and once tried to kill myself – what should I do?

Dear Asad,

I am an 18-year-old college student. Since childhood, I have been looked down upon by people around me. I was humiliated and bullied by my siblings and class fellows. I was a quiet child but as I grew up, my shyness turned into a mental disorder. A few sincere teachers realised my problem but even they did not fully understand. I even attempted to commit suicide after a panic attack when a teacher forced me to deliver a speech in front of my class. Since that incident, panic attacks have become a common occurrence and my anxiety has caused be great humiliation.

The situation is so bad that now even hearing the name of a restaurant and other social places make me anxious. Eating in front of others or walking in the street makes me nervous and I have had several panic attacks in front of my whole class. I have not met my cousins for a very long time and I have missed weddings and other celebrations of my own uncle and other close relatives. My extended family has forgotten my face as they haven’t seen me in years.

I don't know how to live in this competitive world. Trying to meet new people or speak in class only worsens my anxiety. Going to bazaar or a shop is like going for a battle. Even thinking of being in a social setting such as a relative’s home makes me extremely nervous and trivial routine tasks are very difficult for me.

Now, I have lost control over my thoughts. I spend hours thinking about events that might occur in the future but have no basis in reality. I start speaking or moving suddenly without any control.

I have seen the destruction of my self-respect at the hands of my social anxiety. I don't know what should I do after completing college? I don't know how will I face my cousins who I have not seen for many years? I don't know how will I travel to another city for university admission? I don't know how will I introduce myself to the class on the first day of university? I don't even know how to go to a doctor for treatment?

Anxious

Dear Anxious,

I am quite sad to hear that you were humiliated, bullied and looked down upon by people around you since childhood. That was cruel of them and must have made your childhood a tough one. My heart-felt sympathies for that. I hope and pray that your future life is a happier one. Amen!

What you are suffering from is commonly known as Social Anxiety or Social Phobia. Your panic attacks are due to that. Many people get nervous or self-conscious on an occasion, like when giving a speech or interviewing for a new job. But social anxiety is more than just shyness or occasional nerves. With social anxiety, your fear of embarrassing yourself is so intense that you avoid situations that can trigger it.

Social anxiety involves intense fear of certain social situations – especially situations that are unfamiliar or in which you feel you will be watched or evaluated by others. You may be afraid that people will think badly of you or that you won’t measure up in comparison to others. These situations may be so frightening that you get anxious just thinking about them or go to great lengths to avoid them, disrupting your life in the process.

The good news is that no matter how painfully shy you may be and no matter how severe your social anxiety is, you can learn to be comfortable in social situations and reclaim your life.

Although there are a few techniques that you can try out for dealing with social anxiety, it is not something you can completely treat on your own without professional help.

Social anxiety is best treated with a combination of psychotherapy and medication. It is sometimes the most effective treatment for it. Talking with a therapist or a doctor is a crucial step in diagnosing and understanding the condition.

One of the most common and effective forms of psychotherapy for social anxiety is Cognitive Behavioural Therapy (CBT). It focuses on changing your thoughts in order to change your feelings and behaviours. It functions to train your thoughts and behaviours to support you and not to cause you problems.

When seeking out treatment, find a therapist that practices CBT. Your therapist will help you identify unproductive thinking patterns.

As far as medication is concerned, your doctor will prescribe anti-depressants or anti-anxiety medicines. They are likely to prescribe high dosage of anti-depressants when the treatment begins, and slowly decrease the dosage when the treatment is ready to finish. This caution is because starting and ending a course of anti-depressants can sometimes lead to side effects that are similar to a panic attack.

In addition to psychotherapy and medication, there are several steps of self-care that you can take in order to help care for yourself and to cope with your condition.

Look for support from family and friends

Ask your family and friends to help you face your fears instead of avoiding them and be patient while you confront your anxiety.

Explain your situation as clearly as possible. If you are struggling to describe panic attacks, print off information about panic attacks for them to read. This can be helpful for people who don't get panic attacks and who may have a hard time understanding what they are.

People that care about you will appreciate knowing how you're actually feeling. You may be surprised at how supportive they will be and how helpful their support might feel.

Join a support group

Talking with others who have attacks may help you feel in control of your condition and lead to helpful panic attack management resources. Group members can share strategies for facing and managing anxiety and their successes.

Challenge negative thoughts

Social anxiety sufferers have negative thoughts and beliefs that contribute to their anxiety. Challenging these negative thoughts is an effective way to reduce the symptoms of social anxiety.

The first step is to identify the automatic negative thoughts that underlie your fear of social situations. The next step is to analyse and challenge them. Through this logical evaluation of your negative thoughts, you can gradually replace them with more realistic and positive ways of looking at social situations that trigger your anxiety.

Try to stop avoidance behaviours

While it may be very unpleasant, you should do your best to regularly face the situations which trigger your fear and panic. In modern life, exposure to public places is inevitable, and the more you resist, the worse the consequences will be for your life.

Don't do it alone. Having a trusted friend or family member with you when you are on the bus, at the store, or in any other triggering situation can be a great help.

Accept the panic attack

People who experience panic attacks are less likely to accept their emotions and are more likely to try avoiding them. That’s why CBT is used for treating panic attacks; it is used to change your thinking about panic attacks in order to reduce your overall anxiety, and thus, reduce the likelihood of a subsequent attack. Therefore, if you accept the attack it may prevent future attacks from happening.

Engage with the panic attack rather than trying to fight it. This may sound counter intuitive, but it works! Think a thought such as, "I am having a panic attack and I accept the panic attack. I know that it is just a reaction in my body."

Breathe deeply

Engaging in deep breathing exercises can be very helpful in reducing the anxiety associated with panic attacks. When in the middle of a panic attack, it’s likely you will struggle to breathe naturally. The best way to work through a panic attack is to turn your attention to your breathing.

If you find yourself panicking in a public place, try to focus on controlling your breath instead of fixating on fearful or anxious thoughts. Breathing slowly and deeply will help naturally calm your body's physiological response to fear, reducing its severity.

Breath awareness can end a panic attack and decrease their frequency overall.

If you are new to deep breathing, try a simple exercise by first putting yourself in a calm and relaxing environment. Then, focus on your breathing and take deep breaths in through your nose and out through your mouth. Make sure to slowly exhale and breathe all of the air out.

Exercise regularly

Physical exercise, especially cardiovascular exercise, has been shown to reduce panic attacks and anxiety. Exercise serves as an outlet to physically release tension which can lead to emotional release as well.

Exercise is one of the best ways to reduce anxiety because it releases endorphins in your brain which make you feel happy.

Yoga has been shown to reduce anxiety and sympathetic nervous system activity in individuals who have panic attacks.

Try the art of mindfulness

Mindfulness is being in the here-and-now by focusing your attention on your current feelings, sensations, experiences, and surroundings. It helps to reduce anxiety because you are concerned with what is happening right now instead of regretting the past or worrying about possible future events that have not happened yet.

It is associated with focusing intentionally on the present moment. Instead of worrying about a possible future panic attack, or thinking about past panic attacks, you focus solely on what is currently going on in your own awareness (sights, sounds, sensations).

Relax your muscles

Through a technique called progressive muscle relaxation, you can learn to intentionally control the relaxation of your muscles throughout your body. This exercise can be particularly useful during times of heightened anxiety or stress as it can reduce the likelihood of a panic attack.

Put yourself in a safe and comfortable place, preferably laying down with your eyes closed. Start by tensing your feet and toes for 5 seconds or so, and then releasing for about 10-15 seconds. Then tense your calf muscles for 5 seconds and release. Continue working your way all the way up your body, tensing and releasing each muscle group as you go along.

Regulate your sleep cycle

When you are sleep deprived, you are more vulnerable to anxiety. Individuals who experience panic attacks commonly have sleep issues as well. Anxiety can contribute to difficulty falling asleep, and waking up multiple times throughout the night.

Have a regular sleep-wake cycle. Set your bedtime and stick to it. Set your alarm to wake you up in the morning. Most adults need at least eight hours of sleep per night for optimal functioning.

Try deep breathing or progressive muscle relaxation if you have trouble falling asleep at night.

Utilise grounding techniques

Grounding exercises are useful while you are experiencing a panic attack. Grounding is called grounding because it helps “ground” you, meaning you can momentarily detach from painful emotions. It allows you to focus yourself on something else in order to cope with a panic attack.

A mental grounding exercise is to name all of the cities or colours you can think of. A physical grounding exercise is to make funny faces, shake your legs around, or run cold/warm water over your hands.

Control your stimulant intake

Stimulants such as caffeine and nicotine can increase your anxiety and incidence of panic attacks. They speed up many of your physiological processes, which could make a panic attack more likely and may also increase the frequency of panic attacks. They may also make it harder to calm down from a panic attack.

Instead of drinking something that increases anxiety and can produce panic, try drinking chamomile tea. If you are used to drinking coffee or other caffeinated beverages on a daily basis, you can slowly taper your use of caffeine over time instead of quitting immediately.

Focus on your talents

Everyone has some talents. So do you. Find out what they are and focus on them. This will boost your self-confidence which in turn will reduce your panic attacks.

Recognise that you are not alone

The reality is that around 1 person in 20 suffers panic attacks. This may even be an underestimate, because lots of people either don’t get properly diagnosed or don’t seek treatment.

It's often a great help just to know that you are not the only one suffering from panic attacks.

All the best!

Asad

Asad is a counsellor, life coach, inspirational speaker and a personal-development expert. He advises on social, personal and emotional issues. You can send him your questions for this weekly column at [e-mail] with “Ask Asad” mentioned in the subject line and provide as many details as possible.

Note: The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Express Tribune.