How can I help myself?

Your panic attacks are likely to make you feel out of control and dependent; the victim of your bodily reactions and outside circumstances. The first step along the road to recovery is recognising that you have the power to control your symptoms.

Take control
Start by really looking, in detail, at your panic attacks. When did they happen? Where were you? What were you thinking? See if you can identify particular thoughts that trigger a panic reaction.

A number of experts have emphasised the need to accept the panic attacks when they occur and that it may in fact be most helpful if you try and ride out the attacks to learn that no harm will come to you. This may sound strange, but fighting them only increases your level of fear and allows your panic to take on tremendous proportions. Accept that a panic attack is unpleasant and embarrassing, but that it isn't life-threatening or the end of the world. By going with the panic, you are reducing its power to terrify you.

Creative visualisation and affirmations
Creative visualisation and affirmations are techniques that may be helpful. You can use them to re-train your imagination and to get yourself moving in a more positive direction.

Many people who suffer panic attacks have a vivid imagination, which they use to conjure up disaster, illness and death. You can train your imagination to focus on situations that give you a sense of wellbeing. You can imagine you are in a place that symbolises peace and relaxation for you, such as drifting on a lake. You can practise this anywhere but, until you have got used to doing this, try sitting in a chair with your limbs as floppy as possible, and think of calming images.

You can use visualisation to focus on situations that you fear. Imagine the situation and speak positively to yourself: 'I am doing well', 'This is easy'. These simple, positive, present-tense affirmations are messages that you can say silently or out loud. These techniques do not provide a quick fix. If you have been used to thinking negatively, over a long period of time, you will need to practise every day. You may then gradually notice positive changes in the way you think of yourself and others.

Assertiveness
You may be having panic attacks because there are aspects of your life that are undermining your confidence. It may be useful to look at your family life, your job, and so on, and identify changes you would like to make. If you feel trapped in a situation, and find it very difficult to express your true feelings (to say 'no' or to set proper limits in relationships, for example), you may find assertiveness training helpful.

Learn a relaxation technique
If you habitually clench your jaw, and your shoulders are up around your ears, this will generate further tension. Relaxation techniques focus on easing muscle tension and slowing down your breathing. It helps your mind to relax. (See The Mind guide to relaxation.)

Breathing
Hyperventilation (over-breathing) commonly leads to panic attacks. Many people get into the habit of breathing shallowly, from the upper chest, rather than more slowly from the abdomen. Put one hand on your upper chest and the other on your stomach. Notice which hand moves as you breathe. The hand on your chest should hardly move, if you are breathing correctly from the diaphragm, but the hand on your stomach should rise and fall. Practise this breathing, slowly and calmly, every day.

Diet
Unstable blood sugar levels can contribute to symptoms of panic. Eat regularly and avoid sugary foods and drinks, white flour and junk food. Instead, choose complex carbohydrates, such as potatoes, rice and pasta. Caffeine, alcohol and smoking all contribute to panic attacks and are best avoided.

First aid
If you are having a panic attack, try cupping your hands over your nose and mouth, or holding a paper bag (not plastic!) and breathing into it, for about 10 minutes. This should raise the level of carbon-dioxide in the bloodstream and relieve symptoms.

Other first-aid tips include running on the spot during a panic attack. If you feel unreal, carry an object, such as the photograph of a loved one, to anchor you in reality, or finger a heavily textured object, such as a strip of sandpaper. You could also distract yourself, by trying to focus on what is going on around you.