Meltdown Management: How to manage and prevent a panic attack
This post is part three and final part of the Crash Course in Meltdown Management Series by Karen Wang.
Part One: How to manage and prevent a Temper Tantrum
Part Two: Sensory Meltdowns: 26 Sensory Integration Tools for Meltdown Management
Part Three: How to manage and prevent a panic attack
This morning someone asked me if I was excited about decorating my family’s new home for the holidays. I shrugged and answered, “I’m not into decorating. I’m into kids not crying.”
Holidays are prime time for meltdowns. I think that different types of meltdowns look and sound different from each other. If you look at the photos accompanying each article in the Crash Course in Meltdown Management, you’ll see what I mean.
A classic temper tantrum is caused by a feeling of powerlessness. Big tears come cascading down in an explosion of frustration, sadness and anger amid cries of “NO!”
A sensory meltdown happens when the human brain has difficulty processing one or more types of sensory input. I hear whining and pained cries, and I see my son’s physical reactions such as covering his ears, hiding his eyes, recoiling from touch or gagging on a food’s texture. He often starts speaking in metaphors or saying things that don’t make logical sense during a sensory meltdown.
When my son has a panic attack, he seems to be incapable of speech and his scream is high-pitched and sharp, like in a horror movie. His eyes are wide with fear. He starts hyperventilating and trembling right away. He will either try to run away or fight.
Today I will define the characteristics of panic attacks, and propose at-home treatments that have been successful for my family. I will conclude the Crash Course in Meltdown Management with guidelines for prevention and communication.
If you or someone you love has a history of panic attacks, I first want to reach out to you in compassion and peace. You will need inner strength to face this issue. I know that the tendency among family, friends and even some professionals is to minimize this emotional experience or to blame the caregiver.
Eventually you will have to seek professional guidance to overcome the chronic anxiety and phobias that lead to panic attacks; the purpose of this article is to provide basic tools for relieving the anxiety enough so that you can seek the outside help that your family needs.
My Son’s First Evaluation
My son had his first evaluation with an early intervention team when he was 19 months old. The school building had a confusing polygonal layout and weird orange fluorescent lights, both of which made my son nervous. We had to wait in the hallway for several minutes before the evaluation, which only increased his anxiety. When I finally carried him into the evaluation room, I quickly scanned the unfamiliar faces and surroundings. Before any introductions were made, I said, “Block the door.” I sat down on the floor with my son. He immediately vomited, then ran screaming to the door. He slipped right past the physical therapist, opened the door by himself, and ran down the hallway before I could catch him. When I carried him back to the room, I told the physical therapist, “You didn’t block the door.”
I held my son tightly and pressed my face to his as I whispered his favorite prayer over and over, since this was the best way to calm him. The team leader gently asked me if this was typical behavior for my son. I almost choked on the word “Yes.” My son qualified for all of the services offered by the early intervention team, except for physical therapy. But it’s not possible to deliver services to a child who has a panic attack at every therapy session; the anxiety must be addressed in a secure environment before moving on to therapeutic services.
In my son’s episode, he experienced a panic attack caused by agoraphobia. Agoraphobia is a common phobia, defined as the fear of being in a situation from which escape is difficult (such as an open public space or a crowded place), or the fear of having a panic attack in such a situation.
A panic attack is an episode of intense fear with a sudden onset, and its symptoms peak within 10 minutes of the start. The episode usually tapers off after about 30 minutes. A panic attack may be caused by a phobia or a build-up of generalized anxiety, or it may come without warning. In her book The Way I See It, autism advocate Temple Grandin reports being awakened from sleep by panic attacks. The Diagnostic and Statistical Manual (DSM-IV), a standard reference for physicians and psychologists in the USA, identifies the following symptoms for panic attacks:
1. Palpitations, pounding heart, or accelerated heart rate
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Feelings of unreality or being detached from oneself
10. Fear of losing control or going crazy
11. Fear of dying
12. Numbness or tingling sensations
13. Chills or hot flushes
The onset of a Panic Attack
I can always tell when my son is about to have a panic attack, because the top of his head will suddenly become very hot. This is caused by the release of the stress hormone norepinephrine into his bloodstream as a direct result of the “fight or flight” response. This response is an instinct that allows an animal to save its life when danger is perceived; but in a panic attack, danger is misinterpreted by the brain, and the “fight or flight” instinct takes over when there is no obvious threat.
Treatments for Panic Attacks
Panic attacks may occur at any age; but according to the Mayo Clinic, they often start in late adolescence or early adulthood, and are more common in women than in men. Panic attacks are associated with increased risk of depression, substance abuse, self-injury or suicide if untreated. That is why it is important to seek medical help as soon as possible.
There are many treatments for panic attacks, including:
- prescription medication
- nutritional supplements
- family counseling
- individual psychotherapy
- relaxation training
- cognitive-behavioral therapy
Cognitive-behavioral therapy is the type that I’ve seen most widely recommended by physicians. It addresses the thought processes behind the emotions and teaches adaptability in the face of adversity. The book Your Anxious Child by John Dacey and Lisa Fiore offers a practical, flexible method based on cognitive-behavioral therapy.
Here I will summarize the co-authors’ four-step approach with some of my own variations:
1. Calm the nervous system
Practice your favorite calming method until it comes automatically to you. Then the method will be available to you in your moment of need.
- Learn how to relax using breathing techniques such as Diaphragmatic Breathing or yoga breathing exercises.
- Use sensory integration to soothe the nervous system.
- Get plenty of aerobic exercise. I’m not talking about doing 10 sit-ups before breakfast. Work your way up to an intensive 30 or 45 minute workout four times per week. I love to tell the story of the day my son and I completed a 5K run/walk, and as soon as we arrived home, my son headed straight for our mini-trampoline for several minutes of vigorous jumping. The 5K was not enough to burn off his excess adrenaline!
- Massage therapy
- Take turns with your child to imagine the worst anxiety-provoking situations. Let the hypothetical situations become as silly as possible.
- Journal about fear and anxiety. See this article for some creative writing ideas.
- Visualization of positive imagery works best with children over the age of 3 or adults. Maureen Garth’s books Starbright, Moonbeamand Earthlight are packed with simple, beautiful visualizations for children.
- Meditation, prayer, chanting and singing are all well-documented methods for calming the nervous system. My son used to request long, repetitive prayers whenever he was upset.
2. Create an imaginative plan
- Recognize other points of view and look at the problem from a different perspective. When my son had a phobia of bells, I bought him several different types of bells to play with. He was able to handle these without fear on his own terms and to control their sound or lack of sound. This casual exploration of another perspective was what helped him overcome that phobia.
- Be honest with yourself about your abilities and limitations.
- Push yourself to try new experiences to gain new insights, even if it is frightening. My son developed a phobia of school buildings after a negative preschool experience. I started taking him to various school playgrounds on days when the schools were closed. I took him to help me vote in every local election, because the neighborhood elementary school was our polling place. When we enrolled him at a different preschool, I started him in school for only 10 minutes on the first day while I stood just outside the classroom door where he could see me. I added 5 minutes to the length of time he spent in preschool every day, and I gradually removed myself. I was providing him with emotional security while he faced his fears — and it worked! No tears were shed.
- Develop family rituals to relieve anxiety. A ritual is any procedure that is deliberately and regularly performed, such as mealtimes, birthdays or Saturday morning routines. The whole family will benefit.
3. Persist in the face of obstacles and failure
The biggest obstacle in overcoming anxiety is that it usually gets worse before it gets better. Dacey and Fiore affirm that our creative imaginations will triumph if we persist.
4. Evaluate and adjust the plan
Keep track of emotions during the treatment process. If something is not working, find another way.
My son is ten years old now, and he still struggles with some types of anxiety. But he has worked through all of his phobias, except for his fear of dogs, and he rarely has panic attacks now. He’s in a typical fifth grade class with 28 other students, and he’s a fun-loving, hard-working, deeply spiritual child. He doesn’t realize that he is an inspiration to those who know and love him. The point of treating panic attacks is to increase a person’s quality of life and ability to function in everyday life. In this respect my son is a success. I pray that others may know this success, too.
Preventing meltdowns is a heck of a lot easier than trying to stop one after it starts.
Preventing Temper Tantrums
To prevent temper tantrums, give some control over small matters to the child. For example, my 4 year old used to resist putting on pajamas at bedtime. I discovered that if I allowed him to choose his own pajamas, he was much more cooperative. He often selects deliberately mismatched pajama shirts and pants, which is fine with me! Stating expectations and family rules at the beginning of the day is another way to prevent tantrums. After all, everyone needs limits. Because temper tantrums are an important part of emotional development, writing personalized “emotion stories” about tantrums – and reading those stories often! – can be another prevention method.
Preventing Sensory Meltdowns
Sensory meltdowns can be prevented by creating a sensory-friendly environment at home, and carrying a sensory toolkit whenever you are away from home. This will help a sensitive person develop tolerance for new types of sensory input and learn how to self-regulate.
Preventing Panic Attacks
Panic attacks can be prevented by identifying the triggers for anxiety as well as helpful lifestyle changes, such as habitual exercise. Calming routines, such as diaphragmatic breathing, prayer, guided imagery or exercise, can be built into everyday life so that they are available when a panic attack is imminent. Review and adapt your strategy as necessary.
Behavior is communication, and communication is a two-way street. Being responsive to all communication attempts is the only way to maintain a constant flow of feedback. Therefore, communication is a type of prevention. Prevention is the key to meltdown management.
Take a few minutes to calm yourself and fulfill your emotional needs. Then re-schedule that playdate.