Panic Attacks
“I was on my way back from work on the subway, when I suddenly found it really hard to breathe. I was sweating, clutching at my tie desperately. I could feel my heart racing, and my knees felt very weak. I was terrified -I honestly thought I was going to die!”
Have you ever experienced anything similar?
What is a panic attack?
A panic attack is much more than experiencing anxiety. Although it involves anxiety symptoms, such as palpitations, shortness of breath, dizziness, feeling weak, chest pains, trembling; it also includes the feeling that something terrifying is happening to you, such as losing control, going crazy, or even having a heart attack. This is why when someone suffers from a panic attack they desperately try to escape from the situation, and might even go to ER to check that they’re not dying.
What can happen after a panic attack
After having experienced a panic attack, some people can then develop frequent panic attacks and/or worry constantly about having another one. This is what is known as Panic Disorder, where you’d constantly be worrying about having another panic attack and its consequences (losing control, fainting, etc). In other cases, people fear being in a place where it would be hard to get out of if they did have a panic attack, and therefore begin to avoid certain places (supermarkets, public transport, the cinema, etc), leading them to isolate and even struggle to leave their house.
Problematic ways of coping
Since experiencing a panic attack is so terrifying, some people adapt their life in order to reduce the chances of having another one. This may mean that they stop doing things where they might experience symptoms similar to the ones in a panic attack (such as exercise), or they may be scared of going out alone in case they have a panic attack and there’s no one there to help them. In the same way, some people use substances to gain a sense of ease, or constantly check their bodily symptoms to ensure that they aren’t close to experiencing a panic attack (which can in fact trigger even more anxiety and actually lead to a panic attack). This of course has a huge cost on their social as well as personal life, narrowing down their world more and more each time since they would be cutting out on meaningful things in their life.
What to do instead
If you have identified any of the above behaviours in your own life, then it seems like therapy might be a good option for you. Your therapist would analyse your case, and help you understand what it is that triggers and maintains your own anxiety.
To simplify, what you’d be working on together is for you to regain control of your life. What would you be doing if it weren’t for this constant fear? What do you feel that you are you missing out on? What plans and choices would you be making, both in your day-to-day life as well as generally speaking, if it weren’t for this dreadful fear? In this way, you would be helped to reduce the avoidant behaviours (such as having quitted exercise, or declining social invitations, for instance). Escaping from these situations has probably helped you feel relieved in the moment; however, they have just maintained and increased your fear in the long-run, making you feel even more trapped. Your therapist would help you create your own personal ladder of fears so that you can together begin to confront those situations gradually, starting off with those that seem more manageable, and lastly overcoming the harder ones. You wouldn’t be plunging into these situations -at the same time, you’d be learning coping skills to help deal with the triggering feelings that may arise. Some of these tools might be deep breathing exercises, encouraging self-instructions and grounding exercises, for example. In fact, you would practise them together in session. For instance, if your mind is constantly on the look out for signs that you might be having another panic attack, you will learn that they are actually false alarms, so you would practise to make room for these uncomfortable feelings (with exposure techniques, allowing you to overcome ‘the worry hill’) and you would identify those panicky thoughts as anxiety speaking and learn to not buy into them (this is what we call ‘defusing’ from our own thoughts). Most importantly, your therapist would help you question what the worst thing about feeling that you’re losing control might be, and find if you experience that in other areas of your life too.
What to do if you actually did have a panic attack
Each case can be different, but generally speaking, it is advised to find some physical space (don’t have people leaning on you or talking too close to you, and try to find some place with fresh air). Then put into practice grounding strategies to bring your mind back to the present moment. One of my favourite ones involves going through the five senses -trying to mentally name five different things you can see, four different things you can hear, three different things you can touch, two different things that you can smell, and to take one big, deep breath. This will help bring your attention to what’s really going on around you, and not to what your anxiety is telling you that you’re experiencing.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Children, adolescents and adults
Languages: English and Spanish
How can I improve relations with my adolescent child?
This is a question many parents frequently ask me. When children are small, things are easier - they tell us everything that has happened to them during the day, they ask us for help, and ask to spend time with us. Teenagers, however, are at a stage when they want their own space. Their opinions differ from ours, and the activities that we suggest doing may seem boring to them.
For this reason, it is important to show interest in their hobbies in order to share time together; this could be following a TV series or watching sports matches together. Another important element is asking them for help because teenagers feel that we are constantly telling them what to do. Therefore, if we ask them for advice, or they explain to us about topics they know more about, they will feel that we are validating their opinions and treating them like the young adults which they are. In the same way, when they tell us about their problems and dilemmas, we should not start by saying "You have to ...", but listen to them, ask them what they have thought about doing, and then suggest alternative courses of action, always validating theirs, of course
The most important thing to remember is that one of the most important steps of interacting with adolescents is to encourage their independence. There is not an instruction book that works with all teenagers, but, as a general rule, it is important to allow them to make mistakes and learn from them. Above all, parents should make their children aware that they are always there to listen and give advice when they need it.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Children, adolescents and adults
Languages: English and Spanish
Interview with Miriam Mower
Hello! Thank you for taking the time to answer these questions.
First of all, can you tell us about your position at King’s College? What do you do, and who do you work with?
I’m the school counsellor for secondary students. I can either see students on a regular basis (weekly appointments) or as a “drop-off”, which just means that a student can pop by to see me if he/she needs someone to talk to then and there. Therefore, I can either work with them to teach them all sorts of strategies (social skills, stress management skills, self-control, etc), or just help them out in a particular stressful moment, such as if they’ve fallen out with a friend, or feel overwhelmed with an exam, for instance.
As well as this, I also carry out assessments at school for class and exam arrangements for those students with attention problems or learning difficulties, amongst others.
I also give talks on eating disorders, on how to cope with exam stress, or on any other topic which mightneed addressing.
How would you describe today’s adolescents?
Adolescence has always been a difficult age. It’s when you feel like you’re an adult and want to make your own decisions, but at the same, since the prefrontal cortex has not fully developed, you get easily overwhelmed, choices are more short-term and impulsive, and on top of this, you haven’t fully created your own identity, so you’re curious and want to be independent and different.
Today’s adolescents go through this same process but in a very different context to the one we did, with an important influence of technology. This means that they have more distractions (video games, mobile phones, etc) but also that they have an added social pressure through social media. Although this can seem like a great way for them to bond and keep in contact, in fact, it can many times be a crucial factor of their social stress or low self-esteem.
What are some of the main problems that adolescents struggle with?
Due to the complicated process that adolescence involves, it’s very common for adolescents to experience high levels of stress or low self-esteem. The root of this depends on each individual- it can be social, academic, related to their own self-concept, or a combination of all them. In more extreme cases, this can even lead to anxiety, depression, eating disorders or even substance abuse.
This is why it’s so important to work on prevention. Many times, adolescents feel blocked or overpowered, and being supported and guided in a more problem-solving direction helps not only by teaching them these life skills for the future, but also prevents them from developing any other issues. We should work on certain traits that can make them more vulnerable, such as the need of urgency, needing things to happen here and now; having unrealistic expectations, or being excessively demanding.
What are your Golden Rules for parent-child communication?
Communicating with adolescents during adolescence can be hard. We must try to keep a balance between wanting to tell them what to do, and allowing them to make their own mistakes to learn from them. In fact, many adolescents claim that the reason why they never reach out to their parents is precisely because they don’t want to hear “I told you so” or to get judgy looks. It’s essential to validate whatever is concerning your child (even if their dilemmas seem minor) and encourage them to come up with a solution (“And what options have you thought of?”) instead of rushing to tell them what to do. Of course, it’s fine to give your opinion and guide them in a subtle way (“..Hmm.. I see what you mean… But what could be the consequences of saying that? Is there a chance that she might get mad and not count on you anymore?”). “Te lo dije” ni sentirse juzgados. Es esencial que validemos cualquier preocupación que tengan, por mucho que desde nuestro punto de vista no parezca ningún dilema, y fomentar que elaboren posibles soluciones o alternativas (¿Y tú qué has pensado? ¿Qué opciones se te ocurren?”), en vez de correr a darles nuestro consejo en forma de orden (“Es que deberías decirle…”). Por supuesto que podemos darles nuestra opinión y guiarles de forma indirecta, diciendo por ejemplo: “Mmm.. Entiendo a lo que te refieres…pero, ¿qué consecuencias podría tener decirle eso?¿Tú crees que podría enfadarse y dejar de contar contigo?”.
Another common complaint from adolescents is that their parents only turn to them to tell them what to do and what they are not doing, so try to balance this out by acknowledging what they are doing and praising them for it. Also, don’t make all conversations revolve around school. It’s crucial for your child’s well-being that you still do leisure activities together, making room for family time. In the same way that you used to organise trips to the zoo when they were little, show interest in what they are into now and organise some time spent together on this.
Lastly, but most importantly, patience is the key skill for communicating with adolescents. They can have mood swings, claim that no one understands them, and get flustered really easily. However, we must remember to act as a role model to them- we can’t expect them to learn to calm down if we also snap every time they go hysterical!
Adolescence seems like a tough age. Why did you choose to work with this age group? What do you love about it?
Well, funnily enough, I find that adolescents’ flaws are in fact also their qualities. Yes, they can be intense and have many ups and downs, but this energy can also be expressed as an eagerness to learn how to cope with these strong feelings. Once you have a good bond with an adolescent, he/she is actually pleased and relieved to have someone to talk to about how they feel, so put a lot of effort into therapy.
I’ve always been interested in adolescence since it is a crucial stage when most of our first struggles start appearing- we have to make important decisions that will impact our future, school is far more demanding than it used to be, there are more social interactions, and consequently, there is more pressure to do well in them. However, if we properly support children through this process and teach them the right coping strategies, they will definitely be far more resilient in any future difficult situation that they might encounter, and actually enjoy this adolescence phase.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Children, adolescents and adults
Languages: English and Spanish
Empower Your Child
We have all had times when our children come home from school, upset because of a disagreement they have had with a friend. Our immediate reaction, once they have told us about the awful things that this friend has said or done, is to want to call that friend’s parents to make sure he/she is told off and doesn’t do it again. But is this really the best thing to do? In many cases, what actually happens is that the other child’s parents feel offended, as if their child was being accused of some kind of bullying, so it ends up being a dispute between the parents rather than the children.
Instead of rushing in to settle our children’s disputes, it is more advisable to leave it to them to work out, since it will teach them valuable life-skills such as problem-solving and social skills. We must remember that disagreements are a part of life, and we won’t always be there to rescue our kids from them. In order for them to be able to defend their rights adequately at school, university, work, or in future relationships, our children first have to learn to develop these skills. It is precisely through these disagreements where they will learn to do so, realising that people react in different ways from us, and that different ways of expressing ourselves have different consequences. Therefore, if instead of allowing them to put these skills into practice and we do it for them, they will always be awkward in any other future disagreements, expecting others to intervene for them. This will undoubtedly affect their self-esteem, since they will perceive themselves as dependent and incompetent. So, what can we do to help them in these situations?
The first step is actually to listen to our children. This seems pretty obvious, but it doesn’t only imply nodding and validating their feelings, it also means understanding what it is that has actually bothered them. Sometimes, it turns out that what for us seems the most offensive attitude isn’t really what has set them off. For instance, if your child tells you that he asked his best friend to play this new game that he had just invented, and that his friend instead went off to play with someone else, what might seem hurtful for us (preferring to play with someone else) might not be what has offended him (not being thrilled by his new game).
After listening to your child, the next step is to prompt him to see his friend’s point of view. Ask him why he thinks that he might be behaving in this way, or what might have upset him. In addition, ask your child if he can remember any time that he has felt like that, encouraging him to be empathetic.
Lastly, help your child come up with a solution based on mutual respect. Here it is very important to teach your child to be flexible and diplomatic. Most times, the best alternative will be to come up with a compromise where both of them will have to give in to some extent in order for both of them to be happy. Other times, if it is a situation where your child feels hurt because of something his friend has said or done, the solution might simply be to help him express his feelings, rehearsing how he will tell his friend how he has felt without being defensive or blaming the other person. However, other times the solution might actually be to teach your child to admit his mistakes and how to apologise to his friend for having overreacted.
In conclusion, although it can be really hard as a parent not to get too involved in our children’s disagreements, it is essential that they learn to deal with these situations themselves, since having parents do it for them takes away the chance for them to experience the satisfaction of having resolved the situation successfully. Just think about how gratifying it is to make peace with your friend after an argument! As Carl Whitaker explained: “Conflict should rightly be considered the fertiliser for life. While it is not always fragrant, it is crucial for optimal growth”.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Children, adolescents and adults
Languages: English and Spanish