How to manage anxiety and panic attacks

Anxiety and feelings of panic are common in older people, but these emotions can still be very difficult to manage, particularly given the ongoing effects of the coronavirus pandemic. While it is important to be able to recognise the most common symptoms and talk about your concerns with family, friends or even a doctor, there are a number of things that you can do to manage anxiety and panic attacks according to leading psychologist Dr Ashley Conway.

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What is anxiety and what causes it?

Anxiety involves worrying, often about non-specific things, and usually affects individuals in different ways. Essentially, it may last longer and occur more frequently for one person than it does for another.

Sometimes, worries may appear without any obvious trigger and are often centred around a variety of "what ifs?", i.e. things that have not actually happened. These worries, and anxiety problems in general, often get worse in times of stress. 

Anxiety can manifest itself in a variety of different ways from general anxiety disorder (GAD) to panic disorder to phobias to social anxiety and even to OCD.

What is a panic attack?

A panic attack is something that occurs in a discrete period of time where there is a sudden onset of intense overwhelming fear. This fear usually occurs in the absence of a real threat or danger, but there is often a sense that something awful is about to happen. There is then a desire to escape from the situation in which the panic attack is occurring.

Panic attacks are more likely to occur following distressing experiences and at times of high stress, and although (at the time) they might seem to go on forever, they often peak in a relatively short period of time, typically 10 to 15 minutes, and then subside.

Panic impairs thinking and usually involves a feeling of being out of control either physically, emotionally or both.

What are the symptoms of anxiety?

Anxiety and panic attacks can result in both physical and psychological symptoms.

Physical symptoms

A person may experience:

• Tension
• Shaking
• Poor sleep, tiredness and fatigue
• Digestive tract problems, such as feelings of nausea and IBS
• Increased sweating

With more acute anxiety and panic, there will often be:

• A sensation of breathlessness and chest tightness
• A feeling that your heart is pounding harder or beating faster
• Light-headedness or dizziness
• Odd neurological sensations, such as tingling or numbness, in some parts of the body

Psychological symptoms

The most common symptoms include:

• Feeling on edge
• Experiencing difficulty in concentrating

Some people find that ongoing anxiety can make them irritable, and what the doctors call "an exaggerated startle response" (being jumpy) is not unusual.

For panic attacks, the principal psychological symptom is extreme fear. This may be very general, but often it will involve fear of a physical disaster, such as having a heart attack, becoming unable to breathe, or even dying.

Or it might be focused on something more psychological – a fear of losing control in some way, such as running away or doing something foolish in front of others. Often during a panic attack, the individual may experience a kind of dissociation, i.e. a sense that they have become disconnected from themselves or the world.

When should I see a doctor?

If you have any concerns about your health or wellbeing, it is important to call your GP and seek treatment.

There are three reasons for this:

1. It is possible that the anxiety is associated with a medical condition, such as a hormone problem (thyroid or other), so medication may help

2. Getting a check-up can help to reassure you that there isn't anything physically wrong (please note, at present due to the coronavirus pandemic, your appointment may be over the phone or a video call)

3. If you have any concerns about your psychological wellbeing, it can often be helpful to get professional help from an experienced psychologist

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10 things that you can do to help manage anxiety and panic attacks

1. Recognise the triggers

Notice anything that triggers your worrying, e.g. not hearing from a family member for a while. Identify which worries you can do something about and which you cannot. For those that you can do something about, make plans and create change, e.g. call the person and check that all is well. For those that you can do nothing about, learn to let go, e.g. a distressing item in the news may be upsetting, but worrying about it will not change anything.

2. Try not to catastrophise

Consider the likelihood of various outcomes, and whether or not they are truly catastrophic. The mind can be managed by challenging catastrophic thinking. Events can be unpleasant, annoying, upsetting etc., but they are rarely catastrophic.

3. Be aware

Become aware of any existing behaviour patterns that may be making things worse for you (e.g. does the anxiety get worse when you are with certain people or in certain situations?) and work out strategies for dealing with these situations.

4. Relax

Learn a relaxation technique - meditation or visualisation are both really helpful - or try this simple breathing technique:

- Place one hand on your abdomen and one higher up on your breastbone.

- Keep your lips together and breathe in and out through your nose so that only your lower hand is moving. Breathe low and breathe slow (approximately three seconds in and four seconds out is about right for most people).

Just remember: nose, low and slow.

5. Avoid avoidance

Do not avoid situations that you have found difficult in the past. Your mind can unlearn fear responses to these situations if you work at it. Write out a hierarchy of situations you tend to avoid, and work your way through it. Let's say you have three situations that provoke anxiety for you: using lifts, queuing in supermarkets, and talking in social contexts (usually described as social anxiety). Rank these three situations in order of perceived difficulty. Then, make a point of practising those situations you think are easier to manage or complete until you feel your fear response ebbing. Once you've worked at the 'easy' situations, move on to the ones that you were more anxious about.

6. Control eating habits

Avoid skipping meals – a low blood sugar level can increase the likelihood of panicky feelings in some people. Eating small amounts regularly is much better than going hungry and then having a large meal.

7. Limit caffeine and alcohol intake

Limit the amount of (or even give up) caffeinated drinks – coffee in particular, but caffeine is also present in most fizzy drinks, some non-prescription medication, and in high quantities in many energy drinks. While a small amount (one or two units a day) is unlikely to do any harm, higher levels can often produce a rebound effect, which can worsen anxiety.

8. Be aware of your feelings

Panic is more likely to occur following bereavement or other stressful events. This is worse when the feeling is bottled up. Express what you are feeling to an empathic partner or friend, but if you have difficulty expressing your feelings, learning assertive communication is likely to be helpful.

Assertive communication is:

1. Expressing what you are feeling

2. Identifying the event (not the person) triggering the feeling

3. Conveying what you would like to happen, e.g. "I get worried when people don't let me know that they are safely home from a journey, so would you ring me to let me know when you are back?"

9. Understand the meaning of anxiety and panic attacks

Understanding what anxiety and panic attacks entail is the first step to tackling them. Read up on the subject and educate yourself. There are two videos on panic attacks that you can watch here.

10. Keep busy

Find something to do as anxiety and panic can worsen if the mind is not occupied. An activity or task, however simple, will not only provide a means of distraction, but also a sensation of regaining a level of control. Do something constructive, which can be anything from gardening to checking bank statements, or something enjoyable, like going to visit a friend or writing a letter.

Dr Ashley Conway is a Harley Street psychologist with over 25 years of professional experience and works with individuals with a wide variety of problems, including anxiety and panic attacks, trauma reactions, and stress-related illnesses.  

Disclaimer: The information on our health pages is only intended as an informal guide and should not be treated as a substitute for medical advice. Gransnet would urge you to consult your GP before you begin any diet if you're concerned about your weight, have existing health conditions and/or are taking medication.

Other things you might like:

How to cope with depression

HRT for over 60s: what you need to know

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