A panic attack is a sudden feeling of intense fear or anxiety that is accompanied by physical symptoms such as heart palpitations, nausea, or dizziness. Panic attacks reach their peak within ten minutes, but they can last hours in extreme cases. Recurrent panic attacks may be associated with psychological conditions such as panic disorder or post-traumatic stress disorder or with medical conditions such as hyperthyroidism or mitral valve prolapse. By their nature, panic attacks are overwhelming. You may feel as though you are having a heart attack, suffocating, or even that you are about to die. Hyperventilating can increase these sensations. There are ways, however, that you can learn to manage your panic attacks and regain control. Recognize the Symptoms The first step in overcoming panic attacks is recognizing when one is coming on. Your panic attacks may or may not be associated with triggers. Common triggers include: \tSituations. Situational triggers are circumstances that induce panic attacks. They might include stressful situations such as speaking in front of a group, eating in front of other people, or interviewing for a job. Situational triggers are common for those with phobias, such as fear of heights or public speaking. \tAnticipation. Anticipatory anxiety is fear of a situation before it happens. Anticipation in the days or weeks leading up to an event can be marked by panic attacks. Fear of having an attack can, itself, also lead to anticipatory attacks. \tStimulation. Caffeine, nicotine, and other stimulants worsen anxiety because they act on the nervous system. Treatments There are two main types of treatment for panic attacks: psychotherapy and medications. The most effective type of therapy for panic attacks is cognitive-behavior therapy (CBT). Cognitive therapy addresses the distorted thought processes that contribute to anxiety. Behavioral therapy works through desensitization of the trigger. Medications may be used to treat an underlying medical cause of panic attacks, such as hyperthyroidism. When underlying medical conditions are brought under control, panic attacks often resolve on their own. Medicine may also be employed to treat panic attacks directly. The medications most commonly prescribed to treat panic attacks are selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Zoloft and benzodiazepines such as Xanax and Klonopin. Some people also find the herbal supplement valerian to be a good alternative to benzodiazepines. Valerian is most commonly used to treat insomnia, but is believed to also help anxiety. Although there is not yet enough data to definitively determine whether valerian reduces anxiety, it is a popular herbal remedy that is thought to cause few side effects. Coping Techniques One of the best ways to prepare yourself for the onset of a panic attack is to practice breathing techniques for five to fifteen minutes a day. Hyperventilation or shallow breathing can cause dizziness, chest pain, and fainting. The sensation of not getting enough air also increases feelings of panic. Controlled breathing is one of the easiest and most useful skills you can learn to help you manage panic attacks. \tSit or lie comfortably with one hand on your chest and the other on your belly. \tBreathe in slowly and deeply through your nose. Fill your stomach, not your chest. Notice how your stomach expands as you breathe, and observe the simple fact that you are taking in air. When you are having a panic attack, this observation will help you to stay grounded and recognize that you are not suffocating. \tSlowly release your breath through your mouth. Feel the tension leave your body along with your breath. Pause briefly after you exhale. This pause will slow your breathing process and ensure that you have expelled enough air so that you can get another nice, deep breath. \tRepeat. You may want your spouse or partner to talk you through this breathing exercise by timing your breaths and instructing you to inhale or exhale every five seconds. This can teach him or her how to help you through a panic attack when the real thing occurs. Combine your breathing exercises with progressive muscle relaxation. Progressive muscle relaxation involves systematically tensing and relaxing your muscles from your toes to your head. As you go through this exercise, keep your mind focused on the muscle that you are working. It is normal for the mind to wander, but gently bring yourself back to awareness of the tension leaving your body. \tStart with your toes. Curl your toes as tightly as you can for five seconds as you inhale. \tRelax for fifteen seconds. Think about the tension that is draining from that part of your body. \tAs you inhale again, flex your feet towards your calves as hard as you can for five seconds. \tRelax. \tContinue working your way up your body, repeating the cycle of contraction and release for each muscle group. If you feel a panic attack coming on, don't try to fight it. Anticipation increases anxiety, compounding the problem. Accept that you are having a panic attack and face your fear. If you find yourself indulging self-defeating thoughts, tell yourself, "Stop! This will pass." Stay in the moment and realize that you are not dying, having a heart attack, or suffocating. Initiate the breathing and relaxation techniques that you have practiced. Over time, you will find that you are able to better control your panic attacks or avert them altogether.