Early on in the pandemic, as everyone battled to secure flour and loo roll, Claire Cantor, 55, from London found herself “in the supermarket clinging to the trolley for dear life.” She’d never suffered a panic attack before. Now it felt as if the world was falling apart around her. “I got shortness of breath, my legs turned to jelly, I felt dizzy and weak, and nauseous,” she says. Thankfully, she recognised what was happening and, drawing on years of yoga practice, she began breathing through her nose to calm herself down.
As the first lockdown began, a staggering 49.6 per cent of UK adults described themselves as highly anxious, according to the Office of National Statistics. Around this time, researchers at the University of California discovered a huge increase in internet searches indicative of acute anxiety – such as ‘signs of panic attack’ or ‘anxiety attack symptoms.’
Now, as restrictions continue to lift, mental health charities have warned that the return to offices, shops and social events could trigger a rise in stress and anxiety.
Dr Jennifer Wild, consultant clinical psychologist at the University of Oxford, doesn’t believe there’ll be a rise in panic disorders, but agrees that a general increase in anxiety and panic attacks is to be expected.
“People are likely to feel anxious because we all feel anxious around change,” she says. And for those who are already prone to anxiety, the end of lockdown will be particularly challenging.
As Claire discovered, a panic attack can be highly unpleasant. Paul Salkovskis, professor of clinical psychology at Oxford, and director of Oxford Health NHSFT Centre for Psychological Health, says it typically involves “a sudden onset of intense anxiety, accompanied by a range of physical symptoms which, at least initially, occur out of the blue.” Common symptoms include “heart racing, shortness of breath, pins and needles in the fingers, toes, face, hot flushes, feeling shaky and tense.”
Experiences vary. Hannah, 40, from Yorkshire, says that under exam stress as a student, she’d have panic attacks that lasted for two hours. “I found it difficult to breathe, and there was this awful pain in my chest. The only way to get through it was to lie on the floor. I thought I had heart problems.”
Chenoa Parr, 50, from Liverpool, under strain at work a while back, started having panic attacks as she arrived at the gym to decompress. “I’d get heart palpitations, get really sweaty. I couldn’t focus. I could never feel them coming on.” They occurred every couple of weeks. She adds: “I felt on edge all the time, and I was very anxious. But I was bottling a lot of it up. I think because of the way I dealt with my emotions, the stress and anxiety began to take the form of panic attacks.”
Despite the physical symptoms, the most effective treatments for panic attacks are psychological interventions rather than medication, says Wild: “which suggests that they are very much related to how we think.”
However, most people say there are no conscious thoughts prompting the panic attack. Last year, my 16-year-old son frequently suffered panic attacks in the mornings before his mock GCSEs. He’d hyperventilate, feel sick and as if he might pass out. Helplessly, I tried to reason with him – “But you’ve revised! Stop worrying.” He replied: “I’m not even thinking bad thoughts; it just happens.”
This is because specific thoughts aren’t the initial trigger, says Wild, author of Be Extraordinary. “There could be a trigger in the environment. It could be looking at your computer, knowing you have to revise. It immediately brings on those horrible anxious feelings. And then people’s thinking kicks in.”
Or we might notice a physical sensation. For instance, it’s normal for our hearts to skip a beat twice daily, but if we’re already on high alert – ‘sensitised’ – that sticky issue at work, for example, means you sense danger.
“You might spot you have a racing heart, and that might lead to some quick thoughts: ‘I’m going to have a panic’,” says Wild. “This leads to an increase in anxiety, which increases the physical sensations – the heart racing, the breathlessness, for example – which then leads to more severe thoughts: ‘I’m going to faint, or die, or have a heart attack, I can’t cope.’ Which increases the anxiety and fear. It’s a cycle.
“It’s very much how we interpret our thoughts, as well as our bodily sensations, that keeps anxiety going. And that’s the science of panic.”
Nauseous feelings during a panic attack are adrenalin-related – the hormone diverts blood to your muscles, away from your stomach. Salkovskis says: “It’s fight, flight, freezing preparation. You get adrenalin in all kinds of situations. Being excited, being angry, being anxious give you the same physical sensation – but they have a different meaning.”
Our response is often to seek safety, he says – so if it happens in the supermarket, you rush out of the supermarket. But this behaviour paradoxically increases anxiety.
“When you get out, you feel a bit better,” he says. “Instead of thinking ‘nothing bad happened,’ you think ‘something bad would have happened if I hadn’t left’. It prevents you from discovering that the things you’re afraid of don’t happen. So the next time you go to the supermarket, you think ‘Oh god, this is where I had that panic attack.’ You start to feel nervous. Your heart beats faster. And there you are again.”
Other common safety-seeking behaviours include breathing into a paper bag, sitting down and drinking water. In the moment they’re helpful, Wild says, “because people calm down.” But they won’t help put a stop to the panic attacks “because people think that every time I’m like this, I have to breathe into a paper bag – rather than discovering that anxiety is not going to harm me.”
Effective treatment focuses on changing our thinking, says Salkovskis, who was at the forefront of the development of cognitive behavioural therapy for panic attacks. Research shows that after CBT, 85 per cent of people recover, and stay recovered two years later. It’s also quick – most people experience change within a few sessions.
Meanwhile, in the short term, he says, “If you realise it’s a panic attack, don’t leave. Stay put until it goes away. Notice what your responses are.” Despite what you might have heard, don’t breathe deeply, he adds - when in an anxious state, this can lead you to hyperventilate and lose carbon dioxide, which worsens feelings of dizziness.
Instead, says Prof Salkovskis, you should take slow, shallow breaths. “Close your mouth, breathe in and out through your nose as slow as you possibly can. Wait for the symptoms to subside.”
Treatments include ‘behavioural experiments’ – helping people discover that their fears and beliefs, such as they’ll faint, are baseless. “It’s impossible to faint when your heart is racing,” says Wild. “So when my patients have a panic attack, instead of having them sit down and drink water, we jog on the spot, or run up and down stairs, and show them the heart is healthy and they are not going to pass out.”
It’s hugely helpful too, she says, “to shift our attention away from our body and our thinking to the outside world. Do something with your full attention, like make a cup of tea, focusing on the teabag and the boiling water, or go for a walk and focus on the leaves and the spring buds and the birds.” Or talk to a friend. (One morning, mid-panic attack, my son got a text from a classmate, saying: ‘I’m outside your house. Let’s walk to school together.’ I was amazed – his symptoms vanished.)
If you’re concerned about being out in the world again, says Wild, it’s a good idea to establish your fear and confront it. “One of the most helpful things these people can do is to spot what they are afraid will happen – such as ‘something bad will happen if I leave the house’ – and go out anyway, so they discover that nothing bad happens and they get through the situation.”
Salkovskis says it’s normal and understandable to feel uneasy right now about socialising – so recognise that, accept it and take it slowly. “And keep taking it just a little bit further.”