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Anxiety & Panic

Anxiety isn't ordinary stress and it isn't something a person can be reasoned out of. The body is running an alarm that the mind cannot switch off, so arguing with the content of the worry almost never works. What helps is lowering the stakes, staying close, and waiting -- panic peaks and falls on its own, usually within about ten minutes.

What helps

• Stay, and be boring — Your calm is the most useful thing in the room. Sit down, lower your voice, slow your own breathing. People match the nervous system nearest them, and they will borrow yours long before they take your advice.
• Say what is happening — "This is a panic attack. It peaks and comes down. I'm not going anywhere." Naming it removes the most frightening part, which is not knowing what this is or whether it stops.
• Give the body something to do — Feet on the floor, something cold to hold, breathing out for longer than they breathe in. Physical instructions land when reassurance doesn't, because they don't require agreeing with you.
• Ask before touching — A hand on the back helps some people and makes others feel trapped. "Do you want me closer or do you want space?" takes two seconds and gets it right.
• Treat avoidance as the thing to chip at, gently — Anxiety shrinks a life one canceled plan at a time. You are not there to push, but going with them to the thing they're dreading is worth more than any amount of encouragement to go alone.

What tends to backfire

None of these are stupid. Most of them are what caring looks like when it is frightened, which is why they are so common.

• "Calm down" or "there's nothing to worry about" — They already know it's out of proportion. Being told confirms that the person they turned to doesn't understand, and adds embarrassment to the panic.
• Debating the worry — Anxiety generates a new worry faster than you can answer the last one. Arguing the content keeps them in their head, which is the place that hurts.
• Reassuring over and over — One reassurance settles; the tenth teaches them they cannot cope without asking you. It feels kind and quietly makes them more dependent and more anxious.
• Helping them avoid everything — Making excuses to get them out of something works today and makes tomorrow harder. Avoidance is what anxiety feeds on.

What you could suggest

Understanding the situation does not tell you what to actually do. These are things you can offer.

• Suggest a GP before a therapist — Anxiety this bad has physical treatments as well as talking ones, and a doctor is an easier first door than finding a therapist alone.
• Name CBT specifically — Cognitive behavioral therapy has the strongest evidence for anxiety of anything available. Asking for it by name gets someone further than "I need counseling".
• Ask about caffeine and sleep — Not a cure, and not a lecture. But heavy coffee and four hours' sleep will hold an anxiety disorder in place no matter what else is being done about it.
• Offer to go with them — The appointment is often the hardest part. Sitting in the waiting room is a concrete, finite thing you can actually do.

Questions that are easier to ask than to invent

• Is this the worry brain, or is something actually happening?
• Do you want help thinking it through, or do you want to think about something else?
• What does it feel like in your body right now?
• Has this one come up before, or is it new?
• Do you want me closer, or do you want some space?
• What normally brings it down?
• Is there anything you've been avoiding that I could come with you for?
• Do you want me to stay on the phone until it passes?

Words you will hear

Panic attack

A sudden surge of intense fear with physical symptoms -- racing heart, breathlessness, tingling. Peaks within about ten minutes and is not dangerous, however much it feels like it.

Avoidance

Steering around whatever triggers the anxiety. It works immediately and makes the anxiety stronger over time, which is why it is so hard to stop.

Reassurance seeking

Repeatedly asking for confirmation that things are fine. Relieves anxiety for a moment and deepens it over time, so answering endlessly does not help.