Someone having a panic attack experiences apprehension or intense fear suddenly when triggered by a stressful situation, or for seemingly no reason. It can last between 20-30 minutes, even though some people also experience it in waves over hours.

Diagnosed with Generalized Anxiety Disorder (GAD), the following is my personal experience and some helpful methods I am using to manage my panic attacks and anxiety.

These tips should not be used as a substitute over professional opinion, and we highly recommend you to consult a doctor if you are experiencing disruptive episodes of panic attacks. The Mental Health Helpline is available 24 hours at 6389 2222, as well as the Emergency Department of the IMH should you require immediate medical attention.

My first vivid memory of a panic attack occurred when I was around 14. I remember feeling an intense fear after being reprimanded by my uncle. I started blaming myself for my mistake, and eventually broke down in tears where my breathing intensified into hyperventilation.

While there was a trigger in one of my earliest memories of an anxiety attack, there have also been instances during my adulthood, when I experienced a panic attack out of the blue.

A panic attack for me begins with a feeling of heaviness on my chest, and I feel unable to breathe. I sometimes also feel nauseated, which intensifies my fear. By the time I am breathing rapidly and feeling numbness on my face and fingertips, I know that I am experiencing a full-fledged panic attack.

There were also more serious instances where I fainted and required medical assistance.

What are the signs of a panic attack?

I have learned to recognize the early signs of an panic attack as mentioned earlier. These signs can vary across individuals, although the symptoms usually are:

• Tightening of chest
• Pounding heart
• Difficulty breathing, choking, or rapid shallow breathing
• Dizziness or feeling light headed
• Nausea
• Fear of going crazy, or losing losing control
• Uncertainty of what is real (distortion of reality)

Fear and Anxiety are common natural responses to a perceived threat.

Learning to identify potential stressful triggers and warning signs of impending panic attack may require some practice initially. However, mastering some coping skills will prove to be helpful in learning to manage fear and anxiety before it escalates.

Stress management and relaxation techniques will also be helpful in reducing one’s risk of stroke and heart attack. If left unmanaged, anxiety has been found to be related to one’s long term risk of stroke.

Focus on one thing

One of the first things I learned during therapy is mindfulness. One way to do this, is to find one thing in my vicinity and focus on it.

For example, if you are in the office, you may notice your coffee mug in front of you. Draw your attention to it with your senses. Reach out to touch it, feel the warmness of the cup, observe its colour(s), hold the mug closer to you and inhale the aroma of your drink, or even take quick sips of it to help regulate your breathing back to normal.

Breathe

Someone having a panic attack may be breathing rapidly and feeling breathless. If you notice that this is happening, learn to perform deep breathing exercises, counting to 3 as you inhale, and counting to 3 as you exhale. Repeat this until you feel like you can breathe normally again, or when the fear has subsided.

Distract Yourself

Fidget spinners are the craze these days as they help distract some individuals by keeping their hands busy. But if you don’t have a fidget spinner, you can distract yourself in other ways like spinning a pen, playing a game on your mobile device, or listening to music. It may also be helpful to change your environment for a while by leaving the room or office, paying attention to the pleasant change of surroundings.

Personal Mantra

Another thing that has helped me cope in overwhelming situations is to mentally recite a personal mantra. Some examples are:

• “I can do this.”
• “I am safe.”
• “I am feeling fear. This is normal. It will pass”
• “I will be okay.”

Imagine a Safe Space

Is there a place you have visited before that makes you feel happy and calm? It could be your home, the beach, or simply a picture you have come across on the internet. Try to picture that in your mind, and think of how it makes you feel – calm, happy, peaceful, excited, safe, etc.

You may also find it helpful to keep a picture of it at your desk or in your phone so that you can look at it.

What can I do to help someone with a panic attack?

If you notice a loved one having a panic attack, remember that it is a scary experience for them. Keep calm, and:

• Stay with them
• Ask them what they need, or how you can help
• Practice some of the coping techniques with them, as described earlier
• Reassure them that help is available

I personally find that what helps me most, is when someone tells me “you are safe.”

When Does a Panic Attack Become a Problem?

• Affects daily functioning in life
• Unable to go to work, attend school, or refusing to get out of bed

I eventually sought help and was diagnosed with GAD when I realized that it was affecting my life.

I was reluctant to get out of bed in the morning, often imagined the worse case scenarios even before arriving at the venue, and would often find excuses not to turn up at social gatherings or events at work and school. And if I did eventually turn up, I would often experience such intense apprehension, that I would have an anxiety attack which worsened my fears of going out.

If you notice yourself having panic attacks as frequently as several times a week, intensifying with every subsequent episode, or to the point where life has been disrupted, it may be time to reach out for help.

Help is available.

Consult your family doctor and if possible, make a list of physical symptoms that you have experienced.

With counselling and medications, I am now more mindful of stressors and warning signs to a potential panic attack, as well as equipped with techniques to manage my intense fear and anxiety.

Experiencing panic attacks frequently is also an indication that one is undergoing a stressful period, which should be assessed by a professional since this can also increase one’s risk of stroke or heart attacks. In addition, anxiety may sometimes manifest as emotional or aggressive outbursts that may cause harm to your loved ones and hurt relationships.

When in doubt, it is recommended to err on the side of caution and seek the opinion of your family doctor.

You are safe.

References

1. Institute of Mental Health (2012). Managing Panic Disorder. Retrieved from https://www.imh.com.sg/wellness/page.aspx?id=555.
2. Anxiety and Depression Association of America (2018). Panic Attack Symptoms. Retrieved from https://adaa.org/understanding-anxiety/panic-disorder-agoraphobia/symptoms.
3. Better Help Online (2018, December 14). Learn How to Stop a Panic Attack in Its Tracks. Retrieved from https://www.betterhelp.com/advice/panic-attacks/learn-how-to-stop-a-panic-attack-in-its-tracks/.
4. American Heart Association (2019). Anxiety Linked to Long Term Stroke Risk. Retrieved from https://www.goredforwomen.org/en/about-heart-disease-in-women/latest-research/anxiety-linked-to-long-term-stroke-risk.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

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Initially, I felt intimidated that I had to reveal my personal self (inner thoughts and feelings) to a stranger. I was afraid of being judged and shamed for my suicidal thoughts and self-harm tendencies. I was concerned that whatever was shared during these sessions would be disclosed to my family.

Seeing a therapist can be rather expensive

During the initial period, visits with my psychiatrist ranged between 6 weeks to 6 months.. Currently, my psychotherapy sessions are scheduled on a fortnightly basis.

Thanks to the Chronic Disease Management Programme (CDMP) which can be assessed at more than 700 GP clinics and GP groups, I am able to manage the costs of my visits at Changi General Hospital (CGH). With that, I can use my MediSave to pay for treatments, on top of the existing government subsidies.

Other mental conditions eligible for this programme include schizophrenia, major depression and bipolar disorder.

Will my therapist disclose my personal details shared during the therapy?

While my family was aware that I was seeking treatment for my mental illness, I was not comfortable with them knowing about the details. I did not want them to feel hurt or guilty in knowing that their actions have contributed to my intense anxiety and panic attacks.

Protecting your privacy: Understanding confidentiality

I have been assured that in almost every instance, my therapy is absolutely confidential.

I have also learned that therapy sessions would only be fruitful when I begin to trust my therapist. Our sessions were critical to my recovery, as my willingness to be honest would in turn help my therapist to understand my struggles better, and suggest suitable coping strategies.

Research has shown that therapy is more effective than medication in the long-term, although they have been working well together for me.

My medications were aimed to stabilise my moods, calm my headspace so that I could effectively assess a triggering situation. Consequently, I am able to practice the coping techniques such as breathing exercises, being mindful, or re-evaluating my thought process before I responded.

I cried in front of my therapist

It took about 2-3 sessions before I was willing to open myself up and dive deeper into the reasons behind my emotional reactions. We were then able to identify patterns of thought and behaviour.

It was painful to confront repressed memories. I felt ashamed even when I felt like crying, although I eventually accepted that I was in a safe space to express myself however I wanted. Sometimes, I became angry because I felt like I was being provoked, and I questioned if I was able to continue to trust my therapist.

I gradually learned that this was a necessary evil, especially since I no longer wanted to feel weighed down by my emotions and panic attacks.

The hardest part was learning to accept that my past was now a part of me, even if they were unpleasant.

Recovery has not been straightforward, and even with the good rapport I build with my therapist over many sessions, there were instances of regression. My self-harming behaviour and suicidal thoughts would become more intense and frequent, and this made me feel discouraged.

There were also sessions that did not feel fruitful, with issues discussed that remained unresolved. I also found myself unable to practice the coping techniques when I was caught in a similar triggering situation, which made me feel dismayed and sometimes even made me feel worse than before.

Besides learning to trust my therapist, I also had to trust myself and be patient with myself during the process. I needed to learn to forgive myself in moments when I faltered and continue to attend my therapy sessions. Celebrating my milestones and small achievements also helped to keep me going.

I am still attending regular psychotherapy sessions, and am in the process of tapering off the medications that I was once largely dependent on to function. I know that more work needs to be done, but I have also come a long way in my mental health journey.

Reaching out for help was one of the best things I did for myself.

References:

1. American Psychological Association (2011, October). Psychotherapy is effective and here’s why. Retrieved from https://www.apa.org/monitor/2011/10/psychotherapy
2. Ministry of Health (2019, February 19). Outpatient Cost for Chronic Disease (How to Reduce Cost). Retrieved from https://www.healthhub.sg/a-z/costs-and-financing/20/medisave_chronic_disease_management

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Anxiety a risk factor for Stroke?

Many patients with stress induced anxiety are shown to have an effect on their high blood pressure due to lack of proper rest, sleep deprivation and unhealthy eating habits. High Blood Pressure is a strong risk factor to Ischemic Stroke.

Stroke due to stress at work

In 2016, then Finance Minister Mr Heng Swee Keat collapsed from a stroke during a Cabinet meeting. According to Law & Home Affairs Minister K. Shanmugam, “[Mr Heng] was carrying an incredible load – handling the Financial Ministry, various projects, SG50 celebrations and the Committee for Future Economy”.

“I could see that he was very tired. I have been telling him that he was overworking so much that it will affect his health.”

Law & Home Affairs Minister K.Shanmugam

How can I manage my anxiety or stress?

Feelings of being overwhelmed with constant demands, lack of motivation, low energy levels and low productivity are signs of burnout. It is important to know how to manage anxiety and stress. It is also crucial to recognise the need to seek help if your anxiety interrupts your daily routines.

Exercise

Find time to exercise every day for at least 20 minutes. Take time to brisk walk around your neighbourhood park or find a friend to exercise with you. Exercise is known to release endorphins, which are chemicals in our brain that helps improve our overall mood.

Sleep

With exercise, you can sleep better at night. With better sleep, your overall mood will be improved significantly in the day.

Try Journalling

Consider writing down your thoughts and what you are stressed or anxious about. You can write down your feelings or what you are grateful for the day – the little things make a difference.

Spend more time with your family and friends

Make the effort to find time with your friends and family. Talking about your anxieties and stresses can help you to process your feeling better.

Even though there is no direct link between anxiety and stroke, however, the physical effects anxiety has on an individual’s lifestyle may be risk factors of stroke. Taking care of your mental and emotional well-being is as important as your physical well-being.

References:

1. HealthXchange Singapore (n.d.) Anxiety in Singapore: Stats, Types and Who’s At Risk. Retrieved from  https://www.healthxchange.sg/wellness/mental-health/anxiety-singapore-stats-types-risk
2. The Straits Times (24 May 2016). Stressed at Work? Beware of Stroke. Retrieved from https://www.straitstimes.com/singapore/health/stressed-at-work-beware-of-stroke
3. American Heart Association (n.d.) Anxiety Linked to Long Term Stroke Risk. Retrieved from https://www.goredforwomen.org/en/about-heart-disease-in-women/latest-research/anxiety-linked-to-long-term-stroke-risk
4. Pérez-Piñar, M., Ayerbe, L., González, E., Mathur, R., Foguet-Boreu, Q., & Ayis, S. (2017). Anxiety disorders and risk of stroke: a systematic review and meta-analysis. European Psychiatry, 41, 102-108.
5. Today Online (12 May 2016). Heng Swee Keat appeared ‘very tired’ at Cabinet meeting before he collapsed. Retrieved from https://www.todayonline.com/singapore/heng-swee-keat-appeared-very-tired-cabinet-meeting-he-collapsed
6. Healthline (n.d.) 16 Simple Ways to Relieve Stress and Anxiety. Retrieved from https://www.healthline.com/nutrition/16-ways-relieve-stress-anxiety
7. Institute of Mental Health (n.d.) Generalised Anxiety Disorder. Retrieved from https://www.imh.com.sg/clinical/page.aspx?id=254

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

My body is physically tired. I have after all, had a trying day at work. I feel sore from the neck down to my feet, and it feels like I have run for miles today. For many people, it shouldn’t take too long to fall asleep from the fatigue.

But there is one thing that isn’t stopping for a rest – my mind.

Dilemma and Social Stigma

Did my colleague take offence when I explained why his suggestion would not be feasible for the project? Was my boss frowning a sign that she didn’t like me? Should I have been more mindful of how I brought my point across to the client. Is it my fault that we couldn’t close the deal there and then? Will the team be better off without me?

During my commute home from work, I texted a friend to confide in, and was told that I was “thinking too much,” even though I was quite convinced that I messed up at work. Perhaps it was a bad idea to reach out and trouble her in the first place.

Its a struggle with myself on many nights – my Anxiety versus my desperate desire to calm down and be rational.

While the day is over and that I can no longer change what has happened, another part of me is tearing through the events of the day. I toss and turn in bed in frustration, worried that I will not be getting enough sleep to function the following day.

The tightening of my chest and throbbing headache is telling me to take my doctor’s prescribed Anxiety medication to help me relax and soothe myself to sleep.

I know shouldn’t rely too much on these medications, they become less effective over time. Once, a colleague saw me taking them, which I explained was for my Anxiety, and I felt like I was being judged. My way of coping with stress at work was met with a nonchalant comment, “what’s there to be stressed about? Relax lah!”

For the entire year, my family was clueless that I was seeking help for my Anxiety and depression – triggered by a combination of work, family, relationships, and amplified by my own imagination of worse-case scenarios which I fought to manage.

When I plucked up enough courage to let my loved ones know that I was seeking help, I was told to “snap out of it,” and that “too much medication is not good.”

I know that I am not the only one challenged by this dilemma and social stigma. Too many times, I have sat at the psychology clinic where many have turned up alone. I wonder if they too, have been led to feel ashamed of their Mental Health struggles, yet silently I applaud their courage to seek help.

Raising Awareness

It can be scary to reach out and ask for help – we may not know how people will see us once they know that we are challenged by a Mental Health condition(s). It was scary for me – because I was afraid that my loved ones would leave me thinking that I was “crazy.”

Do reach out – even if it means making up an anonymous call to any of the helplines in Singapore. Send a text to someone you trust. It can also mean walking into the Accident and Emergency (A&E) department of any hospital and just saying “I am breaking down.”

It is scary, but it is a step worth taking. I never regretted stepping into the A&E of the Institute of Mental Health (IMH) when i really needed help.

Find out more about Subsidies and Helplines available to those with Mental Health conditions.

In my journey, I have also realized that loved ones want to help, but are often uncertain of how to, as they are afraid of making things worse.

Part of raising awareness about Mental Health in Singapore needs to also come from us who are diagnosed with a condition(s). Let your friends and family know what you are going through and tell them what you need – time alone, hugs, words of assurance, company to doctor appointments, or just being present.

I hope that one day, Singapore will not be on the map for one of the highest rates of depression in the region by population according to a 2015 WHO report. Rather, we shall be known as a country with one of the most supportive mental healthcare networks.

For tonight, I will cave in to my medication to survive another day at work, in hopes that one day, this will become a reality and that I will eventually be able to cope better with my Anxiety.

I am not crazy and I am not alone. Neither are you.

Seek help

If you know of someone, or are in need of help yourself, do know that there are many opportunities for you to seek help. We have curated some resources where you can seek help and relevant self-care.  

Mental Health Helpline
Manned by trained counsellors from the Institute of Mental Health for those requiring advice on mental health issues.

24 hours
+65 6389 2222

Samaritans of Singapore (SOS)
Provides confidential emotional support for those in crisis, thinking of suicide or affected by suicide.

24 hours
1800-221 4444

Tinkle Friend Helpline by Singapore Children’s Society
Provides support, advice and information to primary school children in distress, especially in situations when their parents or main caregivers are unavailable.

Monday to Friday; 2.30pm to 6pm
1800-274 4788

Touchline by Touch Youth Services
Renders emotional support and practical advice to youth.

Monday to Friday; 9am to 6pm
1800-377 2252

National Addictions Management Service (NAMS) All Addictions Helpline
Provides a range of services to assist those who are dealing with addiction problems.

Monday to Friday; 8.30am to 6pm
+65 6732 6837

Dementia InfoLine by Health Promotion Board
For advice and information on dementia-related queries (available in all 4 languages – English, Chinese, Malay and Tamil.)

Monday to Friday; 8.30am to 5pm and Saturday; 8:30am to 1pm
1800-223 1123

Caregivers Alliance Limited
Supports caregivers of persons with mental health issues.

+65 6460 4400 (Main Line)
+65 6388 2686 (Caregivers Support Centre)

If you found this article helpful, we recommend reading The Focus on Mental Health in 2019 and Nutrition in Parkinson’s disease.

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