Your kid tells you that they've had a panic attack. Maybe you completely understand because you've had them yourself, or perhaps this a new and foreign idea to you. Maybe you empathize with them, or you feel like they are being "overdramatic". Either way, it's hard to watch your child suffer with these seemingly unpredictable episodes. I've included some psychoeducational information in this article so that parents can have a better understanding of what panic attacks are, and how to support your child who experiences panic attacks, or even, how to have a better understanding of yourself, as a parent if you are someone who has panic attacks.
Signs and Symptoms of Panic Attacks
Shaking
Sweating
Heart racing
Heart pounding
Vision narrowing
And dizziness, are among a few of the physiological presentations of panic attacks - keep in mind that everyone is different
The overall state of being when someone is having a panic attack is a feeling of overwhelm, dread, and doom.
Why do panic attacks happen?
Panic attacks are learned patterns of behaviour. It goes like this:
Underlying fears - innate
Triggers - unique to the individual based on family of origin (nature and nurture) as well as history, trauma, and life experience as well as protective factors toward resiliency
Neurochemical response - some people might have a chemical stress response to dropping a plate in the kitchen, while other might react only to stubbing their toe - again, unique to each individual
Physiological response - the body responds by redistributing energy. Blood flow prioritized toward limbs for fight/flight response. Can lead to gastrointestinal difficulties, etc. when under chronic stress - blood flow directed away from internal organs. Shallow breathing versus deep diaphragmatic breaths. Autonomic nervous system switches from Parasympathetic (rest and digest) to Sympathetic (fight or flight)
Cognitive response - thoughts, we have more than 80,000 thoughts per day and 95% of them are the same, overwhelming, racing, looping, ruminating thoughts
Emotional response - associating feelings with the event - if you've seen the movie "Inside Out", you'll notice that some of the experiences and memories that the main character has are joyful, some are sad, some are linked with feelings of disgust like when the main character eats broccoli
Behavioural response - aimed at decreasing the experience of stress, attack, or threat (remember, something even as seemingly simple test at school can feel like a threat to our safety based on our innate fears)
Neurochemical response - the brain responds with "good feelings"/reward when we feel that we have escaped or managed the stressor. We are rewarded when we feel safe, calm, and content
Belief systems - Everything that precedes this reinforces what we believe about ourselves, our ability to handle or not handle stress, our beliefs about others, and about the world around us. If someone believes "I'm no good at taking tests" then they have a panic attack, use their phone as a distraction (behaviour), then the brain rewards them with dopamine, and then the outcome is that they fail the test because they didn't study - this will then reinforce the belief that "I'm no good at taking tests."
To the person experiencing panic attacks, it feels out of their control. Perhaps they're able to identify a trigger/hot button, but then they aren't sure how to de-escalate when their body takes over and begin to go through the whole range of anxious response symptoms.
As a therapist, I would ask, how is this serving you?
People would typically answer with, it's not, I hate it. But, there is some reason, there is always a reason why humans engage in behaviours. We are highly intelligent and highly instinctual beings. There is a reason why our bodies respond in this way.
Panic attacks are a trauma response, and if you don't resonate with the word trauma, then think of it as stress, or chronic stress.
At some point, the panic served as useful. Perhaps it was after doing poorly on a test and the next time it was time to study for a test, the stress of possible failure was a motivator for the person to do well. But, as you see in the above image, we keep looping on the same patterns. Here's an example of how a panic attack might be useful to decrease the stress associated with underlying fears and triggers.
Underlying fears - "I might fail"
Triggers - "high school exam time"
Neurochemical response "cortisol, adrenaline, norepinephrine"
Physiological response - when sitting down to study "shaking, sweating, heart racing, difficulty focusing"
Cognitive response - "I suck at studying, no wonder I'm failing my courses"
Emotional response - "Sadness, anxiety, worry, fear"
Behavioural response - "Distraction, scroll on phone, watch TikTok and YouTube, spend time with friends, lashing out/irritability toward parents for encouraging studying which is the current trigger/hot button"
Neurochemical response - "Dopamine released when enjoying time on phone or avoiding work by creating an argument about it"
Belief systems - "I can't study, I can't focus, I'm not good at school work, I'm failing, I may as well scroll on my phone"
We just keep looping and these same neuropathways continue being carved out, strengthened, and reinforced. This is what it means when people in the therapy, wellness, and healing world talk about "rewiring your brain" they mean, disrupting this fear-trigger-reward cycle, somewhere along the way.
This cycle isn't all negative or all related to panic symptoms specifically. It's everything. It's what they call in the world of psychology "Bio-Psycho-Social". How we relate as biological organisms, with our innate and natural characteristics, to our social and emotional nurtured environment.
Look at the above diagram and run through different kinds of learned behaviours, everything from walking, to skating, to driving, to exercise habits, addiction, to conflict resolution styles. This neurofeedback loop is how we engage with our world.
First steps to navigating panic attacks
Bring awareness to the above cycle - it's useful for someone who feels out of control to be able to identify "Oh, I'm having a physiological response to my stress chemicals right now, I'm feeling really dysregulated" Knowing the science behind why we are reacting in the ways that we react is empowering. Knowledge is power.
Begin creating resources - what do you need when you feel dysregulated?
Reflect - what do you wish you had done last time?
Cognitive Rehearsal - what will you do next time?
That's cool, I wasn't planning to create that, above, but let's call it the 4 R's. To recap:
Regulate
Resources
Reflect
Rehearsal
Regulating is about recognizing that humans go from trigger to behaviour real quick, like 0-100. Noticing this creates space. Space for you to notice how your body is reacting, notice what thoughts and feelings you're having, and then in time, you will be able to be more thoughtful and strategic about choosing what behaviours you want to engage in. Regulating your emotions gives you choice and options. It liberates you and gives you freedom. Scared rabbits don't have much choice; they either sit on the lawn frozen in their tracks, or they have to hop away really quick to escape. Humans have options.
Resources is about identifying your needs, this is the part where you get to engage with new options. Do you need to talk to someone, do some journaling, go for a run, have some water, take a quick nap, have music on in the background, do you need to adjust the expectations that you have for yourself? What do you need? The trigger/hot button will always be there. Sometimes it's a matter of setting boundaries, like say there's a friend who likes to gossip and that's triggering, but other things, like tests or job interviews, etc. will always be a part of life. Knowing your needs and resourcing them will help you to navigate stressful situations in life.
Reflection is not about beating yourself up, just take responsibility. It's not about ruminating over your mistakes. Just acknowledge it and move on.
Example: "I had difficulty studying, I scrolled on my phone, my screen time was 12 hours, I failed my test, mom and dad were upset"
Rehearsal is a tool that I use daily. It's not about obsessing over what you need to do, it's about seeing the potential in yourself and knowing that you may not have reacted in a way that you wanted to that time, but that you will practice in your mind and create a script for what you will do next time.
Example: "When I start to feel sweaty and can't focus on my laptop when studying, I will take a walk, listen to music, get my favourite snack, and then sit back down and study only a small amount for one hour".
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