I get many questions about how to help a loved one dealing with an anxiety-related illness or disorder. I speak about my Panic Disorder openly in the FIGGI community in the hopes that we can understand what it is, how it is different from “just being stressed,” and hopefully normalize it. I hope to remove the guilt and the shame of being prone to panic attacks and the stigma that we are not strong or up for complex and challenging tasks or jobs.
It is in this spirit that I write this post. We all have our journeys, and putting pressure on others to walk the path the same way we do is unfair and unattainable. We may not all be looking to reach the same goal post, and even if we are, we may not be interested in acquiring it the same way. Life also always happens and does not always make it possible for us to follow the directions set by others. Sometimes we need to veer off the path, climb over the mountain, or swim the stream.
I also know what it feels like when people stare at you in horror. When someone abandons you mid-attack because witnessing it is way too much to take. I understand the impact this has on me. I also understand what it feels like to fight for your life (that is your reality during an attack) while someone screams at you to “just calm down.” You don’t think I am actively trying to achieve that status? Another favorite is enduring full days of brewing tension and sickening anxiety only to be reminded of how overly sensitive you are and to just “stress less.”
Based on the above and the fact that you love the person going through this, here are a few things to do and not to do when a loved one has a panic or anxiety attack.
Don’t assume – Ask them what they need.
This is the most important one, but it comes with non-negotiable instructions. This one can never be attempted during an attack or anxiety high. This is one to explore when your loved one is calm, in a good space, and in a safe conversational environment. Ask them what they need most from you during an attack. Do they want to be held or not touched? Do they need fresh air or time alone in a quiet space? Do they need you to tell them it will be okay or offer silent support? Only they know what chases them during these attacks, and they are the best ones to explain what helps and calms them down the most.
Ensure you listen attentively, keep notes, and revert to this when the attack hits. Always maintain patience when the instructions they give are not working. Attacks take as long as they take. Knowing you are there helping, patiently and non-judgmentally, helps them navigate the storm.
Another critical instruction for this one is that your loved one also needs to take responsibility for their own journey to health. They need to be involved in this conversation, be committed to trying the techniques you discuss, and explore a good communication plan with you. For example, code words when they think an attack is coming, communicate when an attack is in full force, etc.
An example from my life is the code words my husband and I have. When I say I am “stressed,” we both know I am talking about everyday stressful events. The stress will dissipate naturally as the situation is resolved.
When I say I am “anxious,” we both know I am standing on or heading toward the proverbial ledge. I do not have a panic attack yet, but I am heading that way or feel like I am heading that way. During this stage, I prefer it if my husband knows where I’m at but that he keeps acting normally. In this stage, I don’t want someone jumping into action to help me because this signals to my mind crisis is here. Right now. This makes me even more anxious because I feel it is real and will happen. Someone else can see it, too, so it must be true. In this stage, we are still actively trying to avoid a crisis. Even though my husband goes about his day, he keeps a watchful eye on me to see if I get worse, offering me moments to meditate or practice breathing, etc.
When I use the word “panic,” it’s all systems go. No more going about everyday activities, breathing exercises, and meditation. I have passed the point of this kind of help; I am now in my mind’s fight or flight crisis mode, and I need to ride out the storm with the assistance below.
Know the medications your loved one takes
Your healthcare provider, preferably your psychiatrist, must properly diagnose any anxiety disorder. If you suffer from this, you may also see a therapist. The psychiatrist is in charge of your medication and usually prescribes some type of SOS medication to be used when you are having an attack. You should know which medication is their SOS medication and where they store it. If this has been prescribed by a doctor, and this is their current treatment plan, help them to take the medication if needed.
When I am having an attack, I start shaking uncontrollably. I cannot hold or open things. My mind is racing; I forget where my SOS medicine is and freak out even more. So to have my husband also know where to find my SOS medicine and help me take the correct dose is a lifesaver to me.
What to say and how to act
When you are having an attack, a thousand things are racing through your mind every second. “Am I going crazy? Do others think I’m crazy? Are they mad at me? I’m dying! I need to calm down!” You are actively fighting a war, and unfortunately, you are on the losing side in most cases.
While this storm is raging, it does not help your loved one to state the obvious or to shout out instructions they cannot possibly hope to follow at that moment. You must stay calm and not show impatience or any kind of judgment. During an attack, my senses are heightened, and I pick up on every sigh and raised syllable. So, avoid phrases and words like the following:
- Calm down, or you need to calm down.
- Stop panicking, or there is nothing to panic about.
- Why are you so anxious?
- You’re acting crazy.
Instead, revert to your pre-agreed approach to support you spoke about during calmer times. Depending on what you agreed to, quietly sit close to them, offering silent support. Otherwise, try encouraging phrases like:
- You’re not alone; I’m here for you.
- I will help you. I won’t leave you.
- You are going to be okay; we are going to work through your steps together.
How to ride out the storm
There are a couple of helpful things you can discuss with your loved one to try during an attack. I recommend researching different panic breathing exercises to calm them down. For now, I will give an example of what works for me during an attack.
The first thing we do is get me outside. When a panic attack hits, you often feel like you “need to get out!” I need cold or fresh air, fast. I usually walk up and down in the same line, shaking my hands and arms, just focusing on not dying (as it feels to me).
I like having a brown paper bag with me at all times. One of the first and worst things is hyperventilation. I have tried many times, but breathing exercises elude me entirely in this state. I breathe into the paper bag until I no longer feel like I will pass out. Then we start number breathing together, like this:
- Hold up your hand and spread your fingers wide.
- With your other hand, trace your index finger up along the side of your thumb, breathing in during the action.
- When your index finger reaches the top of your thumb, hold, even if just for one second.
- Trace your index finger down the other side of your thumb, now breathing out during the action.
- Continue this with each finger.
Then I try grounding and mindfulness. It helps my mind focus on something else. My husband takes me through 5-4-3-2-1. He asks the questions and gently nudges me to stay present and answer in as much detail as possible.
- 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.
The most critical piece of the puzzle is patience. The panic hangover will still follow, and your loved one will need your support, not your judgment or impatience. A panic attack takes everything out of your body, exhausts you emotionally, and drains you mentally. Getting back into a normal, functioning space takes a few days. So expect severe fatigue, a lot of sleep, decreased appetite for a few days, bad migraine attacks, and difficulty getting back into routine tasks.
Suppose your loved one has been diagnosed with Panic Disorder. In that case, it’s essential to keep an eye on them after the attack to ensure they are not changing their behaviors. For example, when I have a panic attack, I feel like I am choking. To avoid having another episode, I sometimes get scared of eating, thinking I have to swallow and may choke. I am susceptible to overstimulation: loud noises, large crowds, and bright lights. When I’ve had an attack, this is worse. I tend to isolate myself, not wanting to leave the house or see people. This is the time to gently nudge your loved one to face the fear. Go to the mall, see a movie, talk to a neighbor. Always assure them you will be there for them should something happen.
This is not an easy road, but it can get better. I am so grateful to my incredible support system, without which I would never have gotten through the initial diagnosis and the attacks that followed.
Love and Light