249. what to do during a panic attack (when nothing else works!!)

Feb 11

listen to this episode:

if you struggle with panic attacks and haven’t found a way to stop them, this episode will change that completely! in this solo episode, i share my psychology-backed hack to end 100% of your panic attacks.

by the end of this episode, you’ll have a mental health skill in your toolbox designed for curbing every panic attack– no matter how much anxiety you’re facing.

i talk about:

a dbt skill that stops all panic attacks
why this skill works better than other panic attack hacks
what’s really happening in our bodies during a panic attack
the science behind stopping a panic attack
how to use this panic attack skill wherever you go
other scenarios you can try out this skill in (including helping a loved one!)

mentioned:

dbt tipp skill⁠

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

About She Persisted

She Persisted is THE Gen Z mental health podcast. In each episode, Sadie brings you authentic, accessible, relatable conversations about every aspect of mental wellness. Expect evidence-based, Gen Z-approved resources, coping skills (lots of DBT), insights, and education in each piece of content you consume. She Persisted offers you a safe space to feel validated and understood in your struggle while encouraging you to take ownership of your journey and build your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: [00:00:00] there is a way to stop a panic attack 100% of the time,

when all else fails,

this skill will be there and it will work.

everyone's body panics sometimes, and this is how you get through that crisis.

hello, hello, and welcome back to She Persisted.

Today we are talking about the 100% foolproof way to stop a panic attack at under five minutes.

Most people don't know this, but there is a way to stop a panic attack 100% of the time,

This will calm you down no matter how distressed and overwhelmed you are. And this is the exact skill that they use to stop panic attacks in residential mental health treatment.

And that is the ice dive. This comes from DBT or Dialectical Behavioral Therapy

Within DBT, we have different modules and the ice dive is part of the tip skill, which stands for temperature intense exercise, paced breathing and paired muscle relaxation.

And the thing about distress tolerance skills is that they are made for and meant to be used in crisis. We save these skills in our back pocket when we are at like a seven or an eight or a [00:01:00] nine out of 10 when it comes to emotional distress,

when all else fails,

when nothing else is working, when we just need to get through the moment and survive that crisis, that's when we pull on these distressed tolerance skills or these crisis survival skills.

The reason that's so important is because a lot of the distress tolerance skills push away our distress for a short period of time. Things like distraction can help in the short term, but cause more challenges in the long term.

And self-soothing is absolutely essential in crisis, but isn't a stand in for a hard, direct, challenging conversation and an unhealthy relationship or making changes to our habits and routines And you might be like, yeah, that's great. Like I don't find myself in crisis a lot. I'll use the skills, whatever A lot of the times when you're doing DBT, you find yourself in crisis a lot. I remember pulling from the distress tolerance skills on a daily basis, because I was having panic attacks and massive arguments with family and intense suicidal ideation on a daily basis.

The catch 22 of the distress tolerance [00:02:00] skills is that while they help you survive that crisis, the more we use them and the more we lean on them, they lose their effectiveness. Distracting yourself by watching the office will only work so well until it becomes background noise and you're brought back to that anxiety or panic attack you're having

similarly, if you do 20 jumping jacks, when you're starting to have a panic attack, at some point your body gets into better shape and you're still having the panic attack symptoms, you can do the jumping jacks while still being in that thought spiral. But the ice dive never loses its effectiveness because it's tapping into a physiological response.

That never goes away,

I find at least that

that gives me a lot of comfort and reassurance that if I have the worst panic attack of my life, no matter what, this skill will be there and it will work. It doesn't matter where I am or what I'm doing, or what's going on or what I'm stressed about a hundred percent of the time, this skill will lower my heart rate and lower my breathing rate, and

take me out of the physical stress enough to be able to talk myself out of the spiral.

So let's talk about what happens when we're having a panic attack.

For a [00:03:00] lot of people, the most distressing and overwhelming part of a panic attack is the physical symptoms. People describe it as dying. They describe it as feeling like they're having a heart attack. They can't breathe. It feels like your body is no longer listening to your brain.

And that loss of control is incredibly distressing. Even if you know that the threat isn't real or that you need to calm down, it can be incredibly challenging to talk your brain off that ledge.

And what's happening when you're in this state of panic, is that your sympathetic nervous system has taken over, you're no longer operating from a logical place. You're no longer deciding how to navigate and approach the situation you are in, fight or flight. So your heart rate is spiking, your breathing rate is increasing, and you aren't able to think about the situation logically.

This is because your body is preparing to fight or flee from a situation and to fight or flee a situation, you need to be physically at your best, which means a fast heart rate and a fast breathing rate. You can't physically fight someone. If [00:04:00] you're completely calm.

You can't run away and maintain a 60 beats per minute heart rate. You also can't effectively run away or fight someone and also be thinking through the pros and cons of a situation in extensive detail. So your brain focuses on what will keep you alive, which is increasing your heart rate, increasing your breathing rate, getting ready to fight or flee Devoting all of its brain power to getting outta the situation alive, not thinking about it, not unpacking it, not looking at the detailed nuance of why this isn't actually stressful. You lose that capacity when the sympathetic nervous system takes over

And anyone who's had a panic attack has probably experienced this. You cannot talk your body out of panic. You have to change the physical before you can address the mental.

And this is where the ice dive comes in.

So let's talk about how this works. The ice dive activates something called your mammalian diving reflex. So to understand how this works, you have to understand what happens when you're drowning, which is not something that I understood before learning this skill

apparently,

our bodies know that the faster our heart is [00:05:00] beating, the faster we're using oxygen and if we find ourselves drowning under water. We don't know when we'll next have access to additional oxygen. So our body has a built-in fail safe to slow our heart rate as fast as possible to conserve our oxygen supply until we hopefully come up for air.

So your body has a thing called the vagus nerve. It runs from your brain down to your intestines, and one place that it extends to is underneath your eyes. And when the vagus nerve detects cold ice water come into contact with your cheeks below your eyes, it tells your brain that you're at risk of drowning, which sounds really stressful and really overwhelming, especially if you're trying not to have a panic attack.

But this is actually a good thing, which it sounds counterintuitive to tell your brain that you're drowning if you're already having a panic attack. But I promise this is actually good and will help because when the vagus nerve tells your brain, we're at risk of drowning use the emergency system, pull the fail safe your brain immediately starts to lower your heart rate and lower your breathing rate.

A hundred percent of the time, no matter how old you are, no matter where you are, no [00:06:00] matter what you're stressed about, when your vagus nerve detects ice water underneath the eyes, it will lower your heart rate and lower your breathing rate.

So now that we understand how it works and why it works, let's talk about ways that you can use an ice dive. So the first and most effective way is the bowl of ice water. You fill a large bowl with ice and cold water, you hold your breath and you submerge your face for 15 to 30 seconds at a time.

You repeat as needed until you feel that your breathing rate and your heart rate have calmed down for you to then mentally navigate yourself out of the situation. Maybe you do deep breathing, maybe you ask for help. Maybe you start distracting.

Maybe you take a shower, whatever your other coping skills are, but this first step gets you to the point where you can even comprehend what to do next. This is gonna be the most effective way to activate the mammalian diving reflex. It's what they use in intensive treatment.

It's what I use. If I have a family or friend who is having a panic attack. It's what I will use on myself if I have another extremely bad panic attack, which [00:07:00] thankfully I haven't had in years. But this is the most effective way because it most closely simulates diving into cold water and is the most convincing way to get your brain to believe you're drowning, which again, is a good thing in this situation. But if you are in class having a panic attack about the speech you have to give, you can't pull out your handy bowl of ice water and do an ice dive.

If you are on a plane and you are having a panic attack about your fear of flying, you can't pull out your handy dandy ice and two gowns of water that you brought through TSA. If you are in a crowd, in a public situation. At a concert, you cannot pull out your six gallons of ice water in your bucket into your ice dive.

I get it. And this is one of the biggest pieces of pushback that people have about this skill, but there are ways that we can adapt it to still get some of the benefits, even if we're on the go, cool water underneath the eyes is gonna be beneficial even if it doesn't have as extreme of an effect. So if you are in a bathroom and you have access to paper towels, wetting those paper towels with cool water, putting themselves under the eyes, even [00:08:00] if it doesn't fully activate the mammalian diving reflex, it's a physical sensation that can help distract from the intense panic you're experiencing.

Similarly, splashing cool water on your face from a sink. can help activate the mammalian diving reflex and also helps you get out of your brain and back into your body.

If you are someone who is prone to anxiety or has a family member who's prone to anxiety, one of the best ways to bring this skill on the go is those first aid ice packs, the one you pop and it immediately turns cold.

If you keep one of those in your bag, regardless of where you go, where you're at, what situation you're in, you have access to cold ice if you have a panic attack.

A couple notes here, regardless of what way you choose to activate the mammalian diving reflex, the goal here is not for it to be painful. If you're like, oh, my face is getting numb, you're doing it too long. It will not take you 20 minutes to activate the mammalian diving reflex.

After a couple of cycles of taking a breath emerging your face, your heart rate and your breathing rate will decrease, and you can feel your [00:09:00] pulse and count your breaths to see how many you're starting with and watching that slow down, that can be really calming and give you something to focus on It also is self-reinforcing as you see it actually working. The goal here is not to cause yourself like pain or challenge your mental toughness. How long can I keep my face emerge in this bowl of ice water? No, it's a couple minutes.

It lowers the heart rate. It lowers the breathing rate, and then you're able to implement other skills

To cope through the panic attack.

So if you clicked on this episode, 'cause who doesn't wanna know the best way to stop a panic attack, but you're still not really sure when and why you would use this? You can use it, like I said, for panic attacks.

You can use it when you're having intense anxiety, even if you're not quite at the point of a panic attack. You can use it for any emotionally overwhelming situation if you're feeling incredibly depressed and need to

kind of like

shock yourself back into the body if you're feeling really angry, it's a great way to decrease the intensity of that emotion.

If you're feeling a lot of shame and need to get out of that thought spiral and back into your physical self. [00:10:00] If you struggle with disassociating, this is a great way to

kind of

shock yourself back into the present. Or if a loved one has a panic or anxiety attack from personal experience, they may be confused.

They may be a little bit what is happening? Why are you telling me to put my face in ice water when I like cannot breathe and I'm crying and freaking out? However, if they trust you, if there's that established relationship, people are looking for something that will help them.

And again, it's self-reinforcing. It works very quickly. It takes you out of your brain and back into your body. So if you can be the one to get the water, to get the ice, to set it up, get a towel, and just have them go through the ice dive while you are there to support them.

Will thank you later.

I absolutely don't recommend trying to explain the mammalian diving reflex to them.

most people are aware that drinking a cold glass of water or like a cool paper towel will be helpful when they're in a state of anxiety. So it's not so foreign. It's not like you're like handing them a banana and telling them to have a snack. That would probably not be something they would do.

But don't try and argue with them or reason or explain why it would [00:11:00] work. Don't ask them questions about, is this helpful? Will you blah, blah blah. Just focus on changing that physiological stress. So say something like, we're just gonna focus on cooling down your face. It's gonna help calm your nervous system.

Or we're gonna try and ice dive. This is gonna slow down that breathing rate that is really distressing to you right now. Don't shove them in the ice water. That would probably make the panic attack worse. So remember, you're giving someone relief, not advice in this situation.

And like I said in the beginning, the reason this is probably my favorite mental health coping skill ever is because no one can ever say it doesn't work. That's like the number one excuse people give when it comes to trying things for their mental health.

Like, That doesn't work for me. I tried that. This will work. No matter who you are, no matter what your beliefs are, no matter what your lived experience, if you are in a state of panic, an ice dive will slow down your breathing rate and slow down your heart rate and help alleviate the physical so you can address the mental.

So we hope this was helpful. Like I said, ice dives are a skill that everyone should know. Not because you're [00:12:00] broken, but because everyone's body panics sometimes, and this is how you get through that crisis.

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