how do you deal with panic attack during a life to death situation where you are running for your life?

Stress inoculation. Train to do something difficult under stressful conditions. That's no guarantee that you won't freeze up, but it should help. Once you've trained to do difficult things under stressful conditions, actually doing those things should help even more.

Is Picard asking about addressing fear in general in a highly stressful situation, or is he asking about having a panic attack specifically?

From the Mayo clinic: "A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying." It is a medical condition that can be treated. <http://www.mayoclinic.com/health/panic-attacks/DS00338>

If we're just talking about handling stressful situations better, then, yes, train regularly in a stressful task. This will take commitment, because, whatever activity you're training in needs to be safe -- or safe enough, because it should have some real risks. To manage risks well, you need to start small, gain skill, and gradually tackle bigger and bigger problems. One way to do it is through a good martial arts place with a strong practical focus -- and that includes developing the "fighting spirit," which means the proper psychology to get you through a violent conflict. I'd think sports that involve an element of danger and a lot of skill will help, too -- rock climbing, for example.

Also, it helps to train for the situation you want to be prepare for. So when you find yourself in the situation, you can just follow a pre-programed flowchart. You have something to do, something to focus on, so you won't give play to the fear inside of you screaming to get out.

There has been some discussion on this sort of stuff. I think it was Night Hiker who said he found it helpful to focus on the immediate tasks rather than on the big picture, and that was how he got out of an up-side-down submerged helicopter. That seems like a good tip.

I am addressing fear in general. People freeze up during danger.

Come to think of it, what are the ways to train for stressful situations? I suggested two ways in my previous post, but would like to hear other's input.

D.R. has it written on the sheet inside his survival kit. In case you get get lost, STOP. STOP, THINK, OBSERVE, PLAN. Or, sit down and make a cup of tea. Whatever works for you. The point is to slow your though process down and get focused on a task so you don't fall into panic mode.

I'm sure there are methods for general panic attacks as well such as focusing on breathing, counting to 10, etc. You want to put your mind to work, not let it run wild.

IMO, the old fashioned drill sergeant's performed this function. You were subjected to various forms of stress while training to perform your military duty. It helped you learn to deal with stress (aka fear) and still do your job.

Just thinking out loud (so to speak)...Without a drill sergeant standing over your head stressing you out, ask yourself what stress is and how can you duplicate it. Exercise -- work-out to elevate your heart-rate and then do whatever it is you want to accomplish while under stress. If you are literally running for your life, then wind-sprints might be a good exercise. Run hard to elevate your heart-rate and tire your muscles and then a nice relaxing walk back to the starting point where you do it again (and again and again). Condition yourself to that physical stress but without a mental stress component.

There's a book titled, "Mental Mechanics of Shooting, How to Stay Calm at the Center" which is not a plug for the book (hard to find) but for one technique on how to calm the fear/panic. Just do whatever it is while calm and when you do it for real, the calm will return when you do it for real -- theoretically. In the book the idea is to only practice shooting while calm. Add an elevated heart-rate but no external threat (drill sergeant) so you are actually practicing under physical stress, but not necessarily mental stress. It seems that if the authors theory holds, the act of doing should bring back the calm. You are returning to something familiar and your body responds.

OTOH, if you are in a panic when you practice, the act of doing may bring back the panic -- theoretically.

FWIW, $.02

I've never been in such a situation. From what I've read, it often helps to have planned in advance. For example, if you routinely take note of all the exits from any indoor space you happen to be in. On an aeroplane, count the number of seats between your row and the nearest exit in front of you and behind you. Even if your advance plan turns out not to be usable, it at least forms a starting point and helps put you in a viable frame of mind.

Breathing. There are specific, ritualistic breathing exercises that can help restore calm. I have wondered if the Litany against Fear would help, but I have no evidence either way. Proper breathing has a deep physiological affect beyond the psychological.

Honestly, I have not had a panic attack that I can remember. When my life has flashed before my eyes, it's kind of like everything slowed down. Afterward, I reflect on how crazy it was, but during the brief moment I'm strangely more calm. This happened just last weekend actually. I was driving and hit a patch of slippery road near a cliff. I lost control of the car. My girlfriend went completely nuts. I went completely silent, calm, and focused on what I needed to do to avoid a crash. The moment only lasted for about 3 seconds, but it seemed like about 10 seconds.

This may sound goofy, but I think I'm conditioned for this reaction from playing organized sports from a young age. Playing games and being expected to do well, it puts stress on a little kid. The kid eventually hardens himself and learns to control his senses and emotions. That stressful feeling of being expected to score (which is THE WORLD to a kid) is the same feeling I get when suddenly faced with a life-or-death situation.

So, what can adults do? As others have stated above, there are ways to train. I don't think it's enough to self-train. You need to enroll in an organized race, or something like that, where you're competing against strangers. Make a commitment to achieve a personal record or even win the race. That may not seem like a big deal from an observer's standpoint, but the person actually doing it feels stress that is uncommon in everyday life.

Picard isn't asking about panic attacks specifically, just fear in general.

The title of this thread is, "How do you deal with a panic attack?"

Normal fear is NOT a bad thing. Fear keeps me alive. However, panic is a debilitating type of fear. According to Dictionary.com, panic means "a sudden overwhelming fear, with or without cause, that produces hysterical or irrational behavior..." If fear becomes panic and I can't operate effectively, that's a bad thing.

All due respect to military training, but I think the military is interested in different objectives than someone who is merely trying to survive. The military often goes on missions where "mission accomplished" is more important than keeping everybody alive. In many military missions, it is known that you will probably die. Consider, for example, the storming of the beaches of Normandy. If a person's objective was to stay alive, then the correct thing to do would be not to get off the boat, not to go on the mission, or not to be in the military at all.

It would be advantageous for the military to ELIMINATE fear entirely from a soldier if they could. So, they train to do so as best as they can. In contrast, for a survival situation, where the objective is to stay alive, eliminating fear entirely would be a bad thing. It's an important distinction.

regular people don't have millitary to manage panic attacks.

I'll let you know if I ever get there!

At work, my job can be very stressful since I tend to get the worst crap thrown at me and often all at once. So it is a matter of learning to dance, box and swim at the same time. The last 3 weeks of work just before my current vacation was just that. Although there was no outright panic attack the stress was extremely weary. Each day would knock me down so by 6:00 I headed home to relax. However, one afternoon it came to a head and I just had to bail. (The final trigger was something so minor and unexpected - I dumped my food in my lap!) I told people I needed some space and took off for the rest of the afternoon before I blew up at someone.

Later my supervisor recognized that I did the right thing in that moment and encouraged me to take it easy during my well deserved time off.

There are few times when someone is going to come face to face with a life crisis like a vehicle accident or natural disaster or whatever. You will handle it they way will handle it. Although some mental preparation and training is helpful, when you are out of your element you will just have to adapt and deal with things OR you will panic.

That said, I think the idea of panic is overblown especially in the movies and the media. Studies have shown that in fires, etc that people tend to just react fairly calmly and even rationally. What is the first thing most people think of in a crisis? -- Where are my loved ones? How can I get to them and protect them? So in spite of sirens and commands from others most people will seek out those they are separated from. Its instinctive. During my Wilderness FA training, the instructor related several stories of people had instant recall of their training after a moment or two of hesitation and were able to perform first aid with clarity.

A couple of months ago I posted a link on the forums about some kids who stayed calm and took control of their school bus when their driver suffered from a heart attack while driving. Students too young to really have much training evidently were calm enough to control the situation. http://forums.equipped.org/ubbthreads.php?ubb=showflat&Main=17454&Number=244761#Post244761

You don't need military training, you just need training. Often that just involves going through the motions and getting your head around whatever the problem might be. Much fear and panic is based on the unknown -- "I've never been there before, what do I do now?". Get comfortable with the emergency procedures; go through the motions, find the emergency exits and if they aren't alarmed, walk through and take the stairs.

A lot of military boot camp is focused on physical conditioning, you don't need military boot camp to work out and get in shape -- find a gym. Your mind and your body are connected. Mental stress can be mitigated with physical stress; working out is a stress release.

When I took my last (hopefully it will be my last) water survival qualification swim the instructors were testing survival techniques -- pass/fail. It was a one hour work-out that started with simple swimming and swimming underwater, then progressed to putting on the gear and swimming while fully suited. At the end of the hour I felt like I'd had a pretty good work-out. You don't get to that point if you aren't in shape to begin with. That's just a qual and a re-familiarization with survival gear.

In the real world where you aren't in a heated pool but in a cold ocean, the stress (mental and physical) is much higher. The only way to deal with that real world threat is to be physically fit and mentally prepared. Otherwise you become a statistic.

But you aren't in the ocean, you're in a office building. The same principle applies. Get in shape now so the physical stress of the emergency is not a factor and then train with whatever procedures you feel appropriate to get around the mental stress component NOW, before it's real. Train yourself with your evacuation plan now and you won't have to figure it out in real-time when you don't have time to ponder.

$.02

It has been my experience that training is one of the most effective mechanisms to overcome panic. Both muscle memory and removing “what do I do” from the equation helps to focus one in on performing a function or task at hand. When training for rescues, many people do not know how they will react since they have not been in the situation before or even if they have; the “wave of panic” can hit anyone. Understanding that this is a normal reaction to being in a stressful situation will often allow one to stop, slow one’s breathing down, take a moment to access the situation, formulate a mental plan of action and put it into action. For many First Responders, this could be during their first blindfolded run through the fire maze on air, the first time in the burn building, in an narrow tunnel during confined space training, first time repel or their first call. Your training kicks in and you learn to focus (hopefully not with tunnel vision) on the task at hand. It is after, when you have time to reflect on the experience, you sometimes react almost panic like to the event.

Pete

"People don't rise to the occasion. They default to their training."
This quote has been attributed to Rick Rescorla, the soldier-turned-security officer who saved the lives of all but six of the 2,700 Morgan Stanley employees in the World Trade Center on Sept. 11, 2001. Other firms that hadn't conducted the disaster drills Morgan Stanley had, lost scores of employees in the terrorist attacks.

A real "panic attack" is an organic form of an anxiety disorder recognized by the professional mental health associates. Under normal circumstances, the brain and body work together to identify a perceived or real threat. Hormones stimulate the adrenal gland to produce adrenalin. With an anxiety disorder, the body produces the hormones that stimulate the production of adrenaline without any real or perceived threat, but the body's "fight or flight" instincts/reflexes are instantly kicked into gear. There is really no way to control the panic attack after it has begun, other than to just sit still, bear it and wait it out. The oversupply of adrenaline essentially overcomes the body's fine motor and critical thinking skills. This is the "flight" part of the disorder. The flip side of the coin is the "fight". This is essentially a rage of a magnitude that most people never experience in a lifetime of getting angry and those who have experienced rage of this order usually experience it only once or twice in a lifetime. For a person with this version of the anxiety disorder, such rage is experienced much more often - as often as weekly. These people are capable of as much destruction of physical objects, including other people, as any adrenalized individual. Treatment of both manifestations of this anxiety disorder is permanent maintenance of daily doses of tranquilizers. As with the "flight" or panic attack malaise, it can be controlled, once started, only by an extreme exertion of will power. In either case, the exertion of will power is only sufficient to essentially self-immobilize the individual. The feeling of panic or rage eventually dissipates as the adrenaline if burned up by the body.

My training helps. As does shutting down all emotions and doing what needs to be done.

The military does not try to eliminate fear but rather attempts to train you to work through the fear. Fear causes normal and predictable reactions in all of us. Knowing what these reactions are combined with constant muscle memory drills allows a person to cope with the fear rather than be crippled by it.

If you are really interested, check out a book called "on killing" written by an American colonel (grossman) If I recal correctly. Extensive research was done on the subject. I didnt read the book myself, but I had to attend his seminar on a few occasions.

With respect, I disagree with some of what Saniterra posted:
" The flip side of the coin is the "fight". This is essentially a rage of a magnitude that most people never experience in a lifetime of getting angry and those who have experienced rage of this order usually experience it only once or twice in a lifetime. For a person with this version of the anxiety disorder, such rage is experienced much more often - as often as weekly. These people are capable of as much destruction of physical objects, including other people, as any adrenalized individual."

Individuals with Panic Disorder (Panic attacks) are less, not more, likely to act out in violent ways. Those who do get violent probably have Intermittent Explosive Disorder(IED) or some other cause of the violent behavior. This disoder (IED) can be comorbid with panic disorder (People with other mental illnesses such as mood or anxiety disorders may be more likely to also have intermittent explosive disorder.) But I'm not aware of any good studies that show that Panic Attacks increment risk of violence, and would be interested in being directed to any studies that show that.

"There is really no way to control the panic attack after it has begun, other than to just sit still, bear it and wait it out."....."Treatment of both manifestations of this anxiety disorder is permanent maintenance of daily doses of tranquilizers."......" As with the "flight" or panic attack malaise, it can be controlled, once started, only by an extreme exertion of will power. In either case, the exertion of will power is only sufficient to essentially self-immobilize the individual."

The use of daily doses of tranquilizers (alprazolam or clonazepam are the typical choices) can be problematic and is not an unchallenged treatment of choice. SSRI and SNRI antidepressant medications are apt to be equally effective, or even more effective if prolonged use of medication is needed.
HOWEVER, the use of medications for Panic Disorder is by no means unchallenged in the scientific literature. Behavioral techniques (some published by Gayle Beck, Ph.D.), Cognitive-Behavioral treatments (David Barlow, Ph.D.), ACT techniques (e.g. Kelly Wilson, Ph.D.), and Stress Innoculation Training (Donald Meichenbaum, Ph.D.) are thought to be at least equally effective and likely more effective (than drugs) in the long run at reducing the severity, frequency, and duration of Panic Attacks.

So...if you have panic attacks with enough severity or frequency to be a problem for you...IMHO you should start with a well trained Cognitive-Behavioral Psychologist and give that approach a good try. More likely than not this will be markedly effective; more likely than not in fewer than 14-15 sessions. Only if this isn't effective would I then consider medications.

As to Panic Attacks causing you a problem during a survival situation, I have only anectdotal and not published data, so this is a big FWIW: I've never heard of a person having a panic attack during the actual index event, but rather in the aftermath (typically after the danger is past).

Find a NLP (Neuro Linguistic Programming) practitioner. They use hypnosis to teach patients other responses to the stimulus. Panicking is just one of many responses to a stimulus. The reason NLP practitions are successful in curing panic attacks so fast and for good (like during the first session) is that they quickly gain access to the part of the brain which forms panic responses and they teach the panicker to re-frame those experiences into harmless memories.

Doctors are about as good at curing panic attacks as they are at getting their patients to lose weight.

Personal reports of successful treatments are nice...and one can't "prove" that something doesn't work, but I'd go with the science if I wanted treatment for panic disorder.

There is a strong body of scientific literature (well-designed studies, blind-reviewed research, respected professional journals and publications) that disagrees with you, Grady. Practitioners using evidence-based treatments are effective in treating panic disorder in more cases than not. [I have no idea what the data is for doctors getting patients to lose weight.]

As to NLP.... well, if it helped someone you know, that's great. But NLP is not an evidence based treatment for panic disorder. It has been around since the late 1970's, has somewhat morphed into EMDR techniques, and has been studied fairly extensively. With insufficient sound data to support its use for the treatment of Panic Disorder.

NLP treatment (or its equivalent) for panic disorders does have occasional undesired side effects in that patients are completely cured of having panic attacks, but the underlying disorder reappears as, for instance, mild loose bowels. But even those panic attack patients will tell you to the person that they much prefer having the symptoms of mild gastrointestinal problems rather than severe panic attacks which can happen at any time and at any place, such as while driving over a bridge. Does that paint the picture?

Doctors use, as their remedy of choice in treating panic disorders, hepato-toxic drugs (mood enhancing drugs that can and do kill the liver). Go to any dialysis center and ask how many there were taking anti-depressants, anti-anxiety and anti-psychotic drugs before their liver, kidneys, etc. became so inflamed so as to quit functioning — to the end that they require dialysis or die. Some drugs doctors prescribe for panic attacks can make you want to kill others.

And how many formerly panic disordered patients successfully cured using NLP have died or required dialysis?

If you study the statistics you’ll find that doctors consider having their panic attack patients live the rest of their lives in the drug induced twilight zone - as a success relative to their aggregation of “sound” statistical data.

Some doctors don’t like NLP because it works. Permanently.

Other doctors applaud their patients’ initiative and determination in solving their problem with NLP.

Of course there are various skill levels and competency levels among all NLP practitioners just as there are various skill levels and competency levels among all MDs (medical doctors). Locate a NLP practitioner (or the equivalent) who has a booming practice teaching panic disorder patients to re-frame panic inducing thoughts. With the internet, such a task is no longer impossible.

Grady

O.K.
Looks like you and I aren't going to agree, Grady. Here we have two strongly held but different opinions. One of the things I kind of like about ETS is that this kind of disagreement can be respectful. But I don't want to hijack the OP's thread with our debate, so I've no more to add on the treatment of Panic Disorder right now.

NAro,

I very much appreciate your civility, objectivity and especially your sharing of your insight on critical topics throughout this forum (all of which I hold in high regard). I agree to keep my powder dry as to this thread for the same reason you expressed.

Grady

In response to the OP, there's three ways I've found to deal with potentially panic inducing situations. The first is accepting that there will be problems. The biggest situational stressor's I've experienced are a "now what do I do?" when things did not go according to plan. Things WILL go wrong. That's what adaptability and contingency plans are for.

The second comes from (I think) shooting disciplines: "Slow is smooth and smooth is fast". Taking a couple of seconds to compose yourself before making a decision (STOP, THINK, OBSERVE, PLAN), slow down when taking action.

Lastly, make practice runs. I know this is going to sound cliché, but the more you do it, the less stressful it is. My first time up on stage, I was freaking out. The last time, I just ignored the audience.
*********************************************
EDIT: I know that the panic attack offshoot is being shut down, but I had to add my $.02.
Been there, done that. You're shaking, sweating, gasping for breath, and feel like there's no room in your chest for your lungs to expand. You just have to wait it out. Find a relatively low stimulation location and just concentrate on breathing. It takes about 1/2 hour to completely ride it out. Qi Gong breathing helps.