Alberta Lawyers' Assistance Society

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Panic Attacks: Helping Yourself and Others

The first time I had a panic attack, I thought I was dying.

I was on mat leave after the birth of my third child, and my older two (ages 5 and 3) had dental appointments. I was feeling rather run down and had had a sore throat for a couple of weeks that was hanging on, and my sister agreed to look after my 4-month-old baby so that I wouldn’t have to tote him and his car seat along. Parenthood. They never said it would be easy. And it wasn’t,

Driving home from the dentist’s office, everything in front of me started shifting and moving. I couldn’t focus my eyes and I couldn’t make it stop. I was on a four-lane road, but traffic was moving slowly. I managed to turn onto a side street and the sensation of spinning continued. I had to do something to get help—my children were safely locked into their car seats in the backseat--so I put my hand on the horn and kept pressing until a kind taxi driver came to my aid, calling my husband.

Then things got worse. I began to feel pressure on my chest, and I had trouble breathing. I was gulping for air, convinced that no oxygen was getting through to my lungs. I then asked the helpful taxi driver to call an ambulance because I was sure I was having a severe medical emergency—I couldn’t see properly and now I couldn’t breathe.

The paramedics arrived a few minutes later and I told them what I was experiencing. They gave me a paper bag to breathe into, explaining that I was having a panic attack and was hyperventilating. That’s how I learned what a panic attack was.

At the ER, medical staff quickly diagnosed me with labyrinthitis, an inner ear infection that causes extreme vertigo, and after a couple of hours with a steroid IV, the vertigo stopped. I was worried about labyrinthitis recurring while I was driving, but it has been almost 25 years and it has not happened again.

Not so with the panic attacks.

The second panic attack didn’t strike for a few years. I don’t remember what I was doing when it hit—something inconsequential—and once I recognized that no one was standing on my chest and that I was hyperventilating, I realized it was a panic attack. While the first one had clear causation, this one came out of the blue, and then more followed.

Ultimately, I developed strategies through counselling, and I had a hard-hitting anti-anxiety medication for bad ones. I learned that while sometimes there was an identifiable stress trigger like a disturbing event or a fear about something specific in the future—or having a medical emergency while driving-- sometimes I was not consciously aware of what triggered the panic attack.

Even when you know that you are having a panic attack and you work through it using helpful techniques, the feeling of crisis and being unable to breathe is real. But I realized that I had to address, and deal with, my lifetime anxiety issues, and it has now been some time since I last had a full-blown panic attack.

So, let’s talk panic attacks. What are they, what can we do and how can we help someone else?

We use mental health terminology loosely in casual conversation—“I had a panic attack when I realized I had slept in.” However, panic attacks are a DSM-5 condition, within the anxiety disorders category.

Here is the DSM-5 definition:

An abrupt surge of intense fear or discomfort that reaches a peak within minutes and during which time four or more of the following symptoms occur.

The listed symptoms include:

  • Palpitations, pounding heart rate, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control or “going crazy”
  • Fear of dying
  • Paresthesia (numbness or tingling sensation)
  • Chills or hot flashes

Does this list of symptoms remind you of how you felt heading into law school exams? Your heart was racing, you might have a slight tremble (but maybe that was the caffeine), and nausea was common. We joked that these feelings of extreme stress would help us perform our best, and then we carried this normalized anxiety into our trials, closings, and interactions with other lawyers, and with our families.

Many years later, when I heard that Supreme Court of Canada Justice Clement Gascon had experienced a panic attack that led to his public disclosure about anxiety and depression, my heart went out to him, but I also realized that if someone who rises to the very top of our profession struggles with anxiety and depression, too, then why do we, as lawyers, assign stigma to lawyers dealing with this issue?

If you suffer from panic attacks, or any other manifestations of anxiety, you do not have to accept that they are a fact of your life—help is available. First, please consider meeting with an Assist counsellor. Cognitive Behavioural Therapy (CBT) with a qualified counsellor can help you overcome thinking patterns connected with panic attacks. Assist’s counsellors are registered psychologists with depth of experience in this modality.

Many people also find eye movement desensitization and reprocessing (EMDR) helpful, particularly post-trauma. We have counsellors who employ EMDR as well.

Other activities, done on your own, can help:

  • Reducing caffeine, nicotine, alcohol, and cannabis consumption
  • Physical exercise—you can start small by walking when you need a break or taking the stairs instead of the elevator
  • Learning about stress, anxiety, and panic attacks generally, and that your physiological responses to a panic attack (fight or flight, essentially) are normal
  • Self-calming techniques, like deep breathing exercises which can allow you to slow down stress-induced rapid breathing
  • Relaxation activities like mindfulness, yoga, and progressive muscle relaxation
  • Reading for pleasure
  • Getting enough sleep

If someone else is experiencing a panic attack, you can provide support and help them get through it. Many panic attacks are as short as ten minutes, but others can last up to an hour or more.

Telling your friend, or co-worker or family member, that they aren’t in any danger is unlikely to change their sense of panic. Instead, stay calm and withhold judgment. Help them to catch the rhythm of their breathing and then work to slow it down. Breathe and count with them. Physical movement can help dissipate the attack, so encourage them to move their arms or legs (if it is safe to do so). Or encourage them to focus on feeling where their body touches surfaces and building on that awareness that they are securely anchored to terra firma.

One other technique is 5-4-3-2-1 grounding, which I also use for high-intensity situations. Guide your friend to identify five things they can see, four things they can touch, three things they can hear, two things they can smell and one thing they can taste. By engaging each of the five senses, we can interrupt the vicious circle of anxious thinking: if I don’t get over this soon, I won’t be able to complete my work, and if I don’t complete my work, I am going to be in trouble, which is causing me to panic even more.

While many people experience occasional panic attacks, others can develop panic disorder. The DSM 5 criteria for panic disorder is:

  • Recurrent and unexpected panic attacks
  • More than 1 attack has been followed by 1 month or more of 1 or both of the following
    • Persistent concern about additional attacks or their consequences
    • A significant maladaptive change in behavior related to the attacks

Panic attacks can be disabling in and of themselves, but when we change our behaviours—like avoiding places where we experienced panic attacks—they can be even more serious. This is what panic disorder is. Lawyers have had panic attacks in the courthouse and in courtrooms—this happens! But if you start to avoid the courthouse or court appearances due to fear of having a panic attack, please discuss this issue with your physician or an Assist counsellor.

Anxiety is common among lawyers. It has been argued that some of the traits that make us good lawyers—being able to anticipate negative outcomes through pessimistic thinking, perfectionism, and being self-critical—also lead to increased rates of anxiety and depression in our profession. See, for example, Brook Greenberg’s Perfectionism Self-Doubt and Mental Health in the Legal Profession. Letting go of perfectionism can help generally, and we can learn to think positively in non-law aspects of our lives. We can also cross-examine the negative, critical voice that plays too readily in our heads.

There are many ways and forums for practicing law, and they are not all the same. If you are in a workplace that feels inherently stressful, causing you to be in a near-constant state of anxiety, please remember that there is nothing wrong with changing jobs, whether it be from moving from one firm to another, changing practice areas, moving to a government or inhouse setting, or setting up your own firm. Assist’s peer support volunteers can help you consider what other options may look like and to reassure you that a more positive workplace is possible. Our volunteers can share their experiences and help you map your way to a change for the better.

And while we tend to associate our stress and anxiety with our work environments, we also experience stress and anxiety in our personal lives. Professional counselling can help you develop insight into how stressors in your life—not just from practicing law--are impacting you. Assist pays for four counselling appointments per issue. Investing in yourself with these sessions and a few hours of your time will pay dividends in the long run.

Your spouse and dependent children are also entitled to free professional counselling through Assist—four sessions per person per issue per year. Please let your family know that this service is here for them and that they can call us directly at 1-877-498-6898. Usage of our programs by your family members is confidential. We do not report usage to you. If you perceive that someone in your family is struggling with an issue, please let them know that even if they are uncomfortable discussing it with you, we have people for them to talk to.

Panic attacks are real, and they are debilitating. I always found that even after the acute symptoms passed, I felt drained. I was not at my best, to put it mildly. Please do not accept that panic attacks are a fact of life. While you may not be able to banish them entirely, you can learn to breathe through them and connect more firmly with the physical environment which may help your panic attacks from escalating into panic disorder. Don’t suffer alone—help is available. Call our counselling office (1-877-498-6898) or call me at 587-779-7205 if you would like another lawyer’s perspective. Conversations with me are confidential as well.

Have a wonderful long weekend,