QUESTION
My daughter, who is just 15, has always been a bit of a worrier. Just about anything can make her anxious. Recently, things have got a little worse and now she occasionally suffers with panic attacks. Could you please give some tips on how to deal with them?

ANSWER
A Panic attack is an acute onset of anxiety symptoms such as shortness of breath, increased heart rate and dizziness. Essentially, it is a misfiring of the body’s “fight or flight” alarm system when there is no corresponding threat. Usually a panic attack represents a vicious cycle of thoughts, feelings and bodily symptoms that reinforce each other.

For example, an anxious person experiences their heart beating faster and thinks, Something must be wrong with me, which increases their anxiety and thus their heart rate which further reinforces their fear. Panic attacks are common and can be triggered in a variety of contexts and can easily become habitual.

Managing panic attacks
The key to managing panic attacks is learning to break the underlying cycle that reinforces them. The goal is to accept the feelings of anxiety without fuelling them with distressing thoughts, such as Something is wrong and to ensure the anxiety does not stop you doing important things.

Essentially, this means you notice the early signs of anxiety in the body – Oh, I feel a bit nervous – but then get on with what you are doing, letting the anxiety dissipate in its own right. Once you habitually realise that the anxiety passes in its own right then the cycle is broken. Of course, this is all easier said than done.

Increasing body awareness
Helping your daughter tune into her body and the symptoms of anxiety can be really helpful. Away from a bout of anxiety, help your daughter map out the symptoms she experiences and how they start: for example, butterflies in the stomach, leading to increased heart rate. It can also be helpful to induce some of these symptoms so you can show her how they pass in their own right.

When working with teens, I sometimes get them to do some exercise, such as jogging on the spot, before taking time to relax: this allows them to notice their increased heart rate and watch how it quietens when they relax.

Teaching relaxation and mindfulness
There are lots of great relaxation and awareness techniques for tackling panic and anxiety, such as becoming aware of and slowing one’s breathing, progressive muscular relaxation, or learning to be mindful and gently accepting one’s thoughts and feelings.

You may wish to attend a class that teaches some of these techniques, such as yoga, meditation or mindfulness, with your daughter. This would be a good way to support her and to tackle the anxiety together. Once she gets experienced in these techniques, she can apply them when facing a bout of anxiety.

Take time to understand the triggers for your daughter’s anxiety and to problem solve with her to address the underlying issues and thoughts. Seek further help from mental health services if problems persist.

Dr. John Sharry, Irish Times Newspaper, May 2015.  John writes in The Irish Times Health+ every Tuesday.
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