What do I do when I have anxiety attacks?

This is a very common question in my practice. Panic attacks typically emerge from an underlying issue (ex. Depression, low self-esteem, fears). To decrease your anxiety symptoms it’s recommended to seek treatment with a therapist who specializes in working with anxiety disorders and most importantly one with whom you feel comfortable with.

In my practice I educate clients about their anxiety and discuss building a framework with helpful tools for decreasing anxiety:

1. Starting a daily mindfulness practice. For example: listening to guided meditation; engaging in deep breathing exercises; yoga practice; or other positive calming activities.

2. Understand your negative and positive thoughts. Many times we tend to focus on the potential for bad things to happen. Increase positive self-talk when feeling down or when anxious. For example: "I don't need to worry, I am calm and relaxed".

3. Exposure to fearful or anxious situations. This can be accomplished under the care of a mental health professional. Many times we shy away from things that make us feel uncomfortable or insecure. This may led to an increase in isolating behaviors resulting in difficulty in performing things we were once able to do. For example: leaving the house; presenting in front of others; going to social events; and having conversations with people. However, the more we expose ourselves and practice the use of our positive coping skills (ex. deep breathing) the chances of anxiety will decrease.

I hope this was helpful. Keep in mind, a therapist can help with guiding you through self relaxation and improvement.

The other two post answers to your question are very good and I don't feel the need to repeat what has already been said quite well, but I will offer one other option I have been able to utilize quite successfully with those dealing with panic attacks.  Chain analysis is a fantastic way for your to map out the situation starting with the prompting event, the chain of events ((links) that lead up to the behavior - in this case a panic attack, and then what the consequences were.  See the illustration below:

This is very useful in that it lays everything out for you to see so that it becomes possible to alter one of the links leading up to the unwanted behavior (panic attack), allows you to come up with strategies for similar situations (prompting events) and allows you to understand how you are reinforcing the behavior when it does occur (consequences).  Finally - it would also allow you to identify any particular vulnerabilities, such as not enough sleep, poor nutrition, trauma history or having a cold the time it occurred.  Working with someone who utilizes a behavioral approach, such as DBT or behavioral analysis, you can find solutions that replace one of the links and therefore breaks the chain of events.  

Anxiety is simply your system communicating to you that you are in danger. The issue that I see in most of my clients is that they try to reason with this anxiety. You do not reason with sensory states in the body. If your system tells your in danger (your stomache feels like it is knots, your heart is beating out of your chest,) validate by just being present with it. Take your breath to it. Breath in and out of that space. Say ok, I am in danger. I always tell my clients, "a crying baby wants to be held, not told to shut up." Listen to your system, validate it like you do a child and see what happens. 

The are two ways that such anxiety can be dealt with. One is an attempt to replace maladaptive thinking by examining the distorted thinking and resetting the fight-or-flight response with more reasonable, accurate ones. As an example "I'm scared of spiders." But if you change the thinking from being scared to "I'm bigger than the spider," it allows the mind to reach a calmer state of mind. 

Mindfulness-based therapy can also help  focus on the bodily sensations that arise when you feel anxious. Instead of avoiding or withdrawing from these feelings, remain present and fully experience the symptoms of anxiety. Instead of avoiding distressing thoughts, open up to them in an effort to realize and acknowledge that they are not literally true.

Although it may seem counter-intuitive, fully realizing the experience of anxiety enables the release of over identification with negative thoughts. You can practice responding to disruptive thoughts, and letting these thoughts go.

By remaining present in the body, you'll learn that the anxiety being experienced is merely a reaction to perceived threats. By positively responding to threatening events instead of being reactive you can overcome an erroneous fight-or-flight response.