How to Manage Panic Attacks

The New York Times

By Julie Halpert

April 12, 2020

The sudden, short-lived feeling of anxiety, shortness of breath and disabling fear can be confused with symptoms of coronavirus. Here’s what to do about it.

Anna Daniels, a 27-year-old living in Chagrin Falls, Ohio, was scheduled to start a new job as a nanny on March 30. But that has been put on hold indefinitely because of the coronavirus pandemic. She has been unemployed since the end of February. Ms. Daniels’s fiancé works for the local government and is considered an essential employee, so her days have been spent alone. It has taken a severe emotional toll.

“I can’t go to the gym or socialize with my family. I can’t provide for myself. It’s like my world is crashing,” she said.

On March 26, Ms. Daniels was in bed watching the news, when suddenly her vision started to get blurry. Her chest tightened, and she couldn’t breathe. “I thought I had the coronavirus and could die from this,” she said. “It was one of the worst experiences I have ever had in my life.” After 20 minutes, her symptoms subsided and she realized she had suffered her first panic attack.

The coronavirus pandemic is affecting the entire globe, and it’s no wonder that, as a result, many people may be experiencing panic attacks for the first time. A panic attack comes on suddenly, bringing with it short-lived disabling anxiety, fear or discomfort.

It’s an activation of the body’s physiological “fight or flight” response, which is triggered by a perceived threat, said Dr. Paul Nestadt, co-director of the Johns Hopkins Anxiety Disorders Clinic. “So all the things your body would want to do if you’re near a tiger become activated at the wrong time,” he said.

Your heart starts racing and pumping blood so your muscles have the fuel to run and fight and get yourself out of danger, said Lynn Bufka, senior director of the American Psychological Association. Yet most of the time when people are having a panic attack, they’re not responding to something that requires running or fighting. “Sometimes it can be invisible triggers,” she said. Panic attacks can be terrifying. “It’s the feeling you have when you’re about to cross the street and there’s a bus right there,” she said.

Panic attacks are fairly common even under far less dire circumstances. A study in Arch Gen Psychiatry indicated that one in four Americans will have at least one panic attack at some point in their lives. But coronavirus seems to be causing many people to suffer panic attacks within a short time. “There’s an increased level of stress due to all this uncertainty,” Dr. Bufka said.

Dr. Neha Vyas, a family medicine doctor with Cleveland Clinic, said she had spent a majority of her time over the past few weeks trying to manage anxiety related to the pandemic in patients. Making matters worse, some of the symptoms of a panic attack — tightening of the chest and breathing difficulties — are often confused for symptoms of the coronavirus.

Dr. Vyas says there are telltale differences between panic attacks and coronavirus symptoms. Panic attacks come on suddenly and typically last only 15 to 20 minutes, while coronavirus symptoms emerge over a few days. With coronavirus, shortness of breath is usually accompanied by other symptoms, like a fever and a cough, neither of which is present with a panic attack.

“There’s no one particular symptom that’s diagnostic of the coronavirus. It’s a group of symptoms,” Dr. Vyas said.

As a result, calling your health care provider to get advice — instead of heading for a visit in person, which risks exposure — is important.

Dr. Vyas points out that panic attack symptoms can be similar to those of a heart attack. So if a patient has certain conditions — a cardiac history, high blood pressure, excessive sweating or pain down their arm, neck and back — that can be cause for greater concern. She would encourage patients with cardiac risk factors who are experiencing these symptoms to seek immediate medical attention.

Lauren S. Hallion, an assistant professor in the psychology department at the University of Pittsburgh, is a leader of a newly formed group of over 100 researchers and clinicians called “PsychVsCovid,” which is pulling together resources on handling the virus. The group created several outreach initiatives, including one to develop a set of guidelines and resources for patients and clinicians to help distinguish between panic attacks and Covid-19, the disease caused by the coronavirus.

“For healthy people, a panic attack isn’t dangerous,” she said. But being able to identify a panic attack is helpful because even just realizing that you’re having one can help it dissipate, she said.

Dr. Bufka urges those experiencing a panic attack to practice full, consistent breathing to combat hyperventilation. Dr. Nestadt said it helps to reassure yourself that you’re safe and that the uncomfortable feelings will pass. He suggests using relaxing distractions, like listening to music. A technique called “5, 4, 3, 2, 1” is another distraction method: You stop to notice five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste.

Dr. Vyas also recommends exercising, which can relieve anxiety.

Ms. Daniels said she was trying to stave off future panic attacks by taking six-mile walks to breathe fresh air and be around nature. She has also returned to art, a hobby she pursued in high school. “I’m focusing on minor activities to try and plan out my day, so I don’t freak out, and have something to do.”

It’s hard to watch a loved one in distress. Still, Dr. Nestadt said, it’s important not to intervene automatically. First, ask if the person experiencing the attack wants space or support. Above all, don’t tell the person to “just calm down,” Dr. Bufka said. Acknowledge their fear, let them know you’re there to support them and help them to problem solve. Ms. Daniels said her fiancé was able to calm her down by holding her face, encouraging her to breathe and assuring her that everything would be fine and to take it one day at a time.

If panic attacks are interfering with your daily functioning, it’s worth considering seeking treatment from a professional.

When looking for professional mental help for the first time, go online or call and ask your primary care provider for recommendations. Dr. Nestadt suggests checking out your insurer’s website for a list of providers. Keep in mind that not all those providers will take new patients, or some may no longer be accepting insurance. But it’s the best way to find a provider in your insurance network.

Another source is the Anxiety and Depression Association of America’s Find a Therapist site, where you can enter your address to find verified providers near you.

During a time of stay-at-home orders, many providers are agreeing to see patients virtually. Medicare can now pay for care provided through telehealth that occurs under a much broader range of conditions. Again, it’s important to check with both your insurance provider and mental health professional to determine what is covered.

“The rate of panic attacks is a symptom of general anxiety,” Dr. Nestadt said. “They peak during times of stress.” He’s hopeful that once we make inroads in getting the virus under control, we will feel less anxiety, he said. “And we might see fewer panic attacks as well.”