When fear, panic, and anxiety have overwhelmed your client’s mind, it can be difficult for any therapeutic intervention to break through. In these instances, clients need concrete ways to find relief in the moment—and fast.
Not only can we help our clients develop strategies to cope during a panic attack, but we can also provide them with tools and strategies to make future panic attacks less likely.
These are the tools and strategies that will make clients less prone to panic and as a long-term solution, even reduce panic in the future. While crisis cards can help a client in the moment, these wellness cards are the long-term strategies to help chip away at anxiety and reduce vulnerability to panic.
1. Nutritional Tools for Anxiety
There's a lot of research these days in nutritional psychiatry, which looks at how food can impact mental health.
What I’ve found in my clinical practice is that a lot of folks with long-standing anxiety also have long-standing GI issues. There are some theories that individuals are interpreting their GI symptoms as anxiety, but also that GI disturbances impact your mental health.
Eat Well and Often
When you don't eat regularly or if you’re eating junk food, your blood sugar crashes. That makes you feel very jittery, and that experience feels a lot like anxiety. If you’re trying not to set yourself up for panic, you want to keep your baseline as steady as possible.
Mind Your Gut
There’s increasing research linking poor gut health to anxiety and depression.
Taking probiotics and eating high-fiber foods are two ways to maintain good gut health. Probiotics can be found in yogurt and fermented foods, and they’re also available in capsules and powder form. Foods high in fiber include chia seeds, whole grains, and oats.
This can be a really simple step if you’re thinking through what you can do today to start to reduce your vulnerability to anxiety and panic. Simply add an antioxidant, like blueberries, spinach, or almonds, to your meal today to start reaping the benefits.
2. Daily Mindfulness & Relaxation
It’s also very helpful to figure out a daily mindfulness or regular relaxation practice that works for you.
When you’re under chronic stress, the body releases a lot of cortisol. If you aren’t doing a lot of stress management practices, you typically have high levels of cortisol just floating around in your blood at baseline.
The more stress you're under, the more exacerbated your panic experience is going to be, because you've already got some adrenaline hormones running through your body. Then the fight-or-flight response kicks up the cortisol even higher, so your panic experience is going to be exacerbated.
By incorporating daily mindfulness, you're helping your system to not only keep your resting cortisol levels low, but also to train your body to easily go into a state of relaxation instead of a habitual state of chronic stress.
This doesn't have to be as in-depth as a full meditation practice. While that can be hugely beneficial, it can be very overwhelming to folks with anxiety. For those starting out, here are some simple strategies to start small.
A walking meditation is a great way to get movement in and to play around with some mindfulness concepts.
You’re simply taking a walk and focusing on shifting your attention first to the mechanics of your step. Lift. Carry. Place. Lift. Carry. Place.
If this gets old, you can focus on the sounds surrounding you. Focus on what you're seeing and observing. This is engaging in mindfulness in the present moment.
Anxiety tricks you to go into the future. Mindfulness keeps you in the present moment, where typically nothing bad is happening.
Progressive Muscle Relaxation
This is a classic relaxation tool from cognitive behavioral therapy (CBT). The idea is to move throughout the various parts of your body, tensing and then relaxing each part so you're noticing the differences.
A good way to play around with this is just even simply putting your hands in a fist, feeling that tension, holding that for a moment, and then relaxing your hands, noticing the differences between tension and relaxation.
You can go through your entire body systematically in that same way. You're training your body to relax by noticing the differences between tension and relaxation.
This is one of my personal favorite tools, because we all have intentions to do mindfulness frequently, but life gets in the way. Relaxation reminders are a very manageable way to get started making sure that you're regularly attending to your nervous system and stress levels.
This involves figuring out ways to remind yourself to take a moment to relax, so when you are reminded, you'll just simply take that deep calming breath, roll your shoulders back, or think to yourself to relax.
You can use tangible things as relaxation reminders, like your car keys or a photo in your office. Every time you see that object, you’ll be reminded to take a deep breath and unclench your jaw. Technology can be helpful as well. You can set a reminder in your smartphone around three times a day.
3. Post-Panic Tools
I like clients to think that a panic attack should never be in vain. They're very difficult to go through. Just like any kind of difficult experience, it can feel a little more worthwhile if we can learn and improve from it.
Rest and Refuel
The first step after a panic attack is taking a moment to rest and refuel, especially if it was one of your more intense panic experiences. Your body really exerted a lot of effort, because it thought it had to fight or flee, and now it's exhausted afterwards.
After this depletion of resources, you want to give yourself a little time to rest and refuel. Some ideas are drinking water or eating some protein. It’s important to go easy on yourself for a little bit. Think of it as akin to strenuous exercise. It's understandable if you feel drained. You want to be kind to yourself as much as you can and help yourself get back to baseline.
What Was Happening?
These next two strategies involve making sure you really learn from each panic experience in order to help you manage it much more effectively the next time.
First, it’s helpful to really think through what might have triggered a panic attack. What was it in your situation? What thoughts were you having? Is there a particular cognitive distortion you can catch?
Were there reasons you were vulnerable to a panic attack? Had you not been sleeping well? Had you been physically inactive? A panic attack can be a good lesson and reinforcer to then go back and try to work on wellness tools.
Each individual is going to have different coping skills that they gravitate toward. Depending on the context of the panic experience, some of those coping skills may not be available. Plus, some things just don’t work as well on different days. That's why you want to have lots and lots of tools at your disposal, so you can move on to the next strategy if something isn’t working.
If you figure out a couple tools that work for you, make sure you have them available to you next time panic strikes. If you notice you didn’t have enough tools on hand, then you know it’s time to add more strategies to your toolkit.
Discover 58 Powerful Practices to Help Clients Find Peace from Panic
Created by anxiety expert Dr. Elena Welsh, The Panic Deck contains proven therapeutic tools to reduce panic. Now you can use the same tools Dr. Welsh developed and used in her therapy room to help her clients eliminate panic and fear.
Crisis cards offer practices to use during a panic attack to help you find relief in the moment.
Wellness cards consist of strategies to use in your daily life to reduce vulnerability to future panic.
Whenever you’re feeling overwhelmed – whether by panic attack or by everyday stressors – these powerful practices will help you find peace.
Elena Welsh, PhD, is a licensed clinical psychologist who specializes in working with clients with anxiety disorders from all walks of life in both inpatient and outpatient treatment settings. She also works with a wide range of mood and depressive disorders, including bipolar disorder, major depression, and post-traumatic stress disorder/trauma-related mental health issues.
Dr. Welsh has published articles in various medical and research journals and is the author of The Cognitive Therapy Workbook for Panic Attacks; Trauma Survivors' Strategies for Healing: A Workbook to Help You Grow, Rebuild, and Take Back Your Life; Getting to Good: A Guided Journal; and 5-Minute Stress Relief: 75 Exercises to Quiet Your Mind and Calm Your Body. She has served as an adjunct faculty member at various universities in Los Angeles.
Dr. Welsh received her doctorate degree from the University of Maryland, Baltimore County and completed advanced clinical training through a postdoctoral fellowship at Gateways Psychiatric Hospital in Los Angeles.
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