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SYMPTOMS CAUSES DIAGNOSIS TIPS TREATMENT TAKEAWAY

ANXIETY BEHIND THE WHEEL

Panic attacks, or brief periods of extreme fear, can be terrifying no matter when they happen, but they can be especially troubling if they happen when you're driving. While you might experience panic attacks more often if you have an anxiety disorder or panic disorder, they can occur even if you don't. But there's hope. Panic attacks are treatable, and there are steps you can take to help relieve a panic attack that strikes while you're behind the wheel.

How do you know if it's a panic attack?

Panic attacks and panic disorder belong to the broader category of anxiety disorders, but panic attacks and anxiety attacks aren't the same. Panic attacks often involve primarily physical symptoms that can completely disrupt what you're doing for a short period of time. They might make you feel detached or separate from yourself or the world around you. Unlike anxiety, panic attacks often seem to happen for no apparent reason. Learn more about what a panic attack might feel like here.

Worried woman driving in car

SYMPTOMS OF A PANIC ATTACK

  • a sudden feeling of extreme fear
  • pounding heart or very rapid heartbeat
  • tingling and dizziness
  • feeling like you might faint
  • trouble breathing or feeling as if you're choking
  • nausea
  • sweating and chills
  • head, chest, or stomach pain
  • feeling like you might lose control
  • feeling like you're going to die

Intense anxiety can involve some of the same symptoms. In fact, you might still feel like you're having a panic attack. Anxiety may develop more slowly and involve emotional symptoms as well, such as worry, nervousness, or general distress. It might also persist longer than a panic attack. Anxiety often causes distress, but it doesn't always completely overwhelm you. Having even one panic attack can make you worry about having another. It's not uncommon to become so concerned about having more panic attacks that you alter your daily routine to prevent them.

What causes panic attacks while driving?

You could have a panic attack while you're driving for many different reasons. Sometimes, panic attacks happen with no clear cause. However, certain factors can make panic attacks more likely, such as:
• a family history of panic disorder
• significant stress or life changes
• a recent accident or trauma, even one that's not related to driving

If you get panic attacks from time to time, you might worry about having one again, particularly in a situation or place where you might put yourself or others in danger. Panic attacks often stem from a fear of losing control, but having this worry may actually make it more likely you'll experience one. Feeling anxious, panicky, or stressed for any reason while driving doesn't necessarily mean you'll panic, but these factors could make an attack more likely as well. Panic attacks can also occur in response to fear or when you're exposed to a trigger, such as an event, sight, smell, sound, or feeling that reminds you of your fear or of a time you had a panic attack. If you have a phobia you may be more likely to have a panic attack. For example, encountering what you're afraid of could cause a panic attack. This might occur with driving anxiety or a phobia of driving, or things you might encounter while driving, like bridges, tunnels, large bodies of water, or bees and other insects that you suspect could get inside your car.

How are panic attacks diagnosed?

To diagnose a panic attack, a mental health professional — such as a therapist, psychologist, or psychiatrist — will ask you to describe what you experienced, when it happened, what you were doing, and where you were. Mental health professionals compare the symptoms you describe to those listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to help identify panic attacks. A panic attack itself isn't a mental health condition, but it can happen as part of another condition, such as anxiety, social anxiety, post-traumatic stress disorder (PTSD), depression, and panic disorder, to name a few. It's also considered to be a specifier for some mental health conditions, including depression, PTSD, and substance misuse disorder. If you have regular panic attacks, worry about having more, and change your daily life or behavior in order to avoid having them, you could have panic disorder. This condition is classified as an anxiety disorders in the DSM-5. Panic disorder is very treatable, but you'll need to see a mental health professional for an accurate diagnosis and to determine the best treatment for you.

Tips for coping with panic attacks

Panic attacks can cause fear and physical symptoms. It's not uncommon to feel like you could die, along with other unpleasant sensations. You might have a hard time staying calm when you feel dizzy, lightheaded, or can't catch your breath. You may need to pull over and get out of your car right away. If you're in a safe place, getting out of the car may help you feel less panicked in the moment, but it won't help you address what's causing your panic. But what do you do if it's not safe or possible to pull over and get out of your car?
Here are several tips to help you cope with panic attacks while driving:

Use safe distractions
If you're accustomed to driving, listening to music, podcasts, or the radio while you drive can help you focus on something besides your stressful thoughts. If you live with anxiety or another mental health condition, music can often help you cope with distressing thoughts and emotions, and prevent panic attacks. Try making a playlist of your favorite calming, relaxing songs or "chill" music. A lighthearted or humorous podcast or radio show can also help keep your mind off thoughts that might cause anxiety or stress.

Engage your senses
Take sour or spicy candies, gum, or something cold to drink with you when you drive somewhere. If you start to feel panicked, suck on a candy or sip your drink. The cold liquid or sharp taste of the candy can help you regain your senses and focus on something besides your panic. Chewing gum can also help.

Cool off
If you begin to feel dizzy, lightheaded, or sweaty, turn on the air conditioning or roll down your windows. The cold air on your face and hands can help ease your symptoms, and you may feel calmer.

Breathe
Panic attacks can cause shortness of breath and make you feel like you're choking. This can be scary, but try to take slow, deep breaths. Focus on breathing in and out, not on the possibility of choking. Thinking about not being able to breathe can make it harder to catch your breath. These breathing exercises can help.

Focus on your symptoms, not the thoughts behind them
Take slow deep breaths, shake out your hands if they're trembling, and turn on the AC if you feel hot or sweaty — or the heater if you have a chill. Remind yourself that the physical symptoms aren't serious and that they'll go away in a few minutes. Try not to think about your fear. It can help to give yourself something to focus on, such as a building in the distance or a sign to look for.

Keep driving, if you can safely continue
Pushing through the fear that accompanies a panic attack can help you overcome it. Treating panic often involves the realization that however scary they seem, panic attacks don't actually hurt you. Driving through your panic attack can help you realize it doesn't control you and reassure you that you can manage it without anything bad happening. This may help you feel more able to address a panic attack if you have another one.

What's the treatment for panic attacks while driving?

Many people who have a panic attack never have a second one. If you do have more than one panic attack, you may want to consider reaching out to a mental health professional. Therapy can help you learn how to deal with panic attacks and address any underlying causes. If you have repeated panic attacks, spend a lot of time worrying about having another panic attack, and begin to avoid work, school, or other places you'd usually go, you might have panic disorder. About a third of people with panic disorder also develop agoraphobia. This condition involves an intense fear of having another panic attack and not being able to get away safely. These conditions can eventually affect your quality of life and make it difficult for you to even leave your house.
Therapy can help treat both panic disorder and agoraphobia. Here are the most common types of therapy:

Cognitive behavioral therapy (CBT)
CBT is the primary treatment for panic disorder, but adding skills training could have even more benefit. A 2019 study looking at 100 people found evidence to suggest that people who received resilience and coping skills training in addition to standard CBT experienced greater resilience and had improved quality of life.

Exposure therapy
Exposure therapy can also help you deal with panic attacks that happen because of a phobia or other feared situation. This approach involves slowly exposing yourself to what you're afraid of with the help of a therapist. If you fear driving, or things you might encounter while driving, such as bridges or tunnels, exposure therapy can help you learn to overcome your fear. This can reduce or eliminate panic attacks.

Online therapy
Online therapy may also help with panic disorder and panic attacks. A 2008 study found one type of internet-based CBT, called Panic Online, had about the same benefits for participants as face-to-face therapy.

Medication
Some medications can also help with panic attack symptoms, though they don't address any underlying causes of panic attacks. Medications a psychiatrist might prescribe include:
• selective serotonin reuptake inhibitors (SSRIs)
• serotonin-norepinephrine reuptake inhibitors (SNRIs)
• benzodiazepines
Benzodiazepines can be addictive, so you'll generally only use them for a short time. For example, they might help you manage symptoms of severe panic attacks in order to feel able to work on their underlying cause in therapy.

What's the outlook if you have panic attacks?

Panic attacks and panic disorder generally improve with treatment, and a mental health professional can help you find the treatment that works best for you. While you're in therapy, it's a good idea to try and keep doing things you'd normally do, including driving. If you avoid driving out of fear of having a panic attack, you may find it even more difficult to eventually begin driving again. Try driving short distances or on quiet roads where you can safely practice deep breathing or other relaxation techniques if you begin feeling panic symptoms. It might also help to take a trusted friend or family member with you when you drive.

The takeaway

Many people feel fearful or anxious when driving. If you find yourself feeling extreme fear and having physical symptoms, you may be having a panic attack. If you've had a panic attack behind the wheel or worry about having one, consider talking to a therapist. Therapy can help prevent panic attacks while driving and help you develop strategies for coping with your fear about driving.

12 Ways to Stop a Panic Attack

12 WAYS TO STOP A PANICK ATTACK WHAT IS A PANICK ATTACK PREVENTION WHEN TO SEE A DOCTOR SUMMARY

If you're having a panic attack, you can manage your symptoms in the moment with strategies like deep breathing, mindfulness exercises, muscle relaxation, and more. Working with a therapist may help prevent future panic attacks.

How to stop a panic attack

Panic attacks can be scary and may hit you quickly. Here are 12 strategies you can use to try to stop or manage panic attacks. Some may help you in the moment, while others can help in the longer term.

Cognitive-behavioral therapy (CBT) and other types of counseling can often help people who have panic attacks and who have panic disorders. CBT aims to help you change the way you see challenging or frightening situations and to help you find new ways to approach these challenges as they arise.
You can find CBT for individuals or groups, online or face-to-face, and the length of treatment can also vary. In exposure-based CBT, your therapist will expose you to something that can trigger a panic attack and help you work your way through it.
As well as changing behavior, there is some evidence that CBT might affect structures in your brain that are responsible for panic symptoms.
In 2018, some researchers found evidence that people who attended four weekly sessions of exposure-based CBT experienced changes in the neural pathways involved in panic symptoms. However, this was an early study, and more research is needed.
In 2018, 37 people in Korea attended a mindfulness-based program once a week for 4 weeks, to see if brief treatment would help reduce symptoms of panic disorder. One aspect of the treatment was to focus on their heart rate, as some people experience cardiovascular symptoms during a panic attack.
The findings suggested that the participants could better manage their symptoms using their own thought processes after the treatment. However, this was a small study, and there was no control group. More research is needed to find out how effective short-term therapy can be.
Benzodiazepines, such as alprazolam (Xanax), can help treat the symptoms of panic when they occur.
However, they won’t help treat an underlying anxiety disorder and can quickly lead to dependence. For this reason, doctors only recommend them for short-term use during a crisis.
Because benzodiazepines are a prescription medication, you’ll likely need a panic disorder diagnosis to have the medication on hand.
In some cases, a doctor may prescribe anti-depressants for long-term use. Examples include:
  • selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro) or fluoxetine (Prozac)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta)
  • anti-anxiety drugs, for instance, azapirone (Buspirone)
Some anti-seizure medications, such as pregabalin or clonazepam, can also help treat anxiety.
While hyperventilating is a symptom of panic attacks that can increase fear, deep breathing can reduce symptoms of panic during an attack.
In one study, published in 2017, 40 people joined either a therapy group that involved deep or diaphragmatic breathing or a control group. After 20 intensive training sessions, those who practiced deep breathing saw improvements in their attention levels and emotional well-being.
Blood tests also showed lower cortisol levels in this group, suggesting lower levels of stress. The participants did not have panic disorder, but the strategies could help people who have panic attacks.
Another group of scientists found that slow breathing could have similar effects. They suggested it could also improve feelings of relaxation, comfort, and alertness and reduce symptoms of arousal anxiety, depression, anger, and confusion.
If you’re able to control your breathing, you’re less likely to experience the hyperventilating that can make other symptoms — and the panic attack itself — worse.
Focus on taking a deep breath in through your nose, feeling the air slowly fill your chest and belly. Then slowly exhale through your mouth and feel the air leave your body. Breathe in through your nose for a count of four, hold for a second, and then breathe out through your nose for a count of four.
By recognizing that you’re having a panic attack instead of a heart attack, you can remind yourself that this is temporary, it will pass, and that you’re OK.
Take away the fear that you may be dying or that impending doom is looming, both symptoms of panic attacks. This can allow you to focus on other techniques to reduce your symptoms.
It is not always possible to avoid triggers for a panic attack, but if you know what triggers it, this can help you understand that it is a panic attack and not something else.
Some panic attacks come from triggers that overwhelm you. If you’re in a fast-paced environment with a lot of stimuli, this can feed your panic attack.
To reduce the stimuli, close your eyes during your panic attack. This can block out any extra stimuli and make it easier to focus on your breathing.
Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening.
Mindfulness involves:
  • focusing your attention on the present
  • recognizing the emotional state you’re in
  • meditating to reduce stress and help you relax
Focus on the physical sensations you are familiar with, like digging your feet into the ground or feeling the texture of your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to focus on.
Experts say that mindfulness strategies, such as meditation, can help manage anxiety symptoms, although it’s not clear they can treat an underlying anxiety disorder.
American Family Physician recommended mindfulness as a strategy for dealing with panic and anxiety in 2015, saying it can be as helpful for reducing stress as CBT and other behavioral therapies.
Some research has suggested that mindfulness-based cognitive therapy could help people with anxiety disorders who are receiving medical treatment but haven’t found drug treatment helpful.
Some people find it helpful to find something to focus all their attention on during a panic attack. Pick one object in clear sight and consciously note everything about it possible.
For example, you may notice how the hand on the clock jerks when it ticks, and that it’s slightly lopsided. Describe the patterns, color, shapes, and size of the object to yourself. Focus all your energy on this object, and your panic symptoms may subside.
Muscle tension is a symptom of anxiety, and muscle relaxation techniques can help reduce tension and promote relaxation during an attack. Progressive muscle relaxation aims to release tension in one group of muscles at a time to relax the whole body.
Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible.
If you attend muscle relaxation therapy, your therapist might take you through the following steps:
  • First, you may learn how to tense the muscles before releasing the tension.
  • Then, you will learn how to relax the muscles without tensing them first.
  • You may also learn how to relax specific sets of muscles, for example, in the shoulders, for practical use in everyday situations.
  • Finally, you may learn how to practice rapid relaxation, when you can identify any areas of tension and release it as needed.
To start relaxing your muscles at home, consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body.
Muscle relaxation techniques will be most effective when you’ve practiced them beforehand.
Guided imagery techniques can help reduce stress and anxiety. Research suggests that both spending time in nature and visualizing nature can help treat and manage anxiety.
What’s the most relaxing place in the world that you can think of? A sunny beach with gently rolling waves? A cabin in the mountains?
Picture yourself there and try to focus on the details as much as possible. Imagine digging your toes into the warm sand, or smelling the sharp scent of pine trees.
This place should be quiet, calm, and relaxing — no streets of New York or Hong Kong, no matter how much you love the cities in real life.
Research shows that regular exercise can not only keep the body healthy but boost mental well-being, too.
Experts have found that exercising at 60 to 90 percent of your maximum heart rate for 20 minutes three times per week can help reduce anxiety.
If you are not used to exercising, talk with your doctor before starting. There is some evidence that starting aerobic exercise anew can trigger additional anxiety in people with an anxiety disorder. Building up gradually can help your body adjust and avoid breathing problems. Aerobic exercise includes activities such as running on a treadmill.
If you feel stressed or you’re hyperventilating or struggling to breathe, stop and take a rest or choose a more moderate option, such as walking, swimming, or yoga.
Lavender is a traditional remedy that many people use to reduce stress and help them relax.
Research suggests it has a calming effect but doesn’t lead to dependence or cause withdrawal symptoms. Using products that contain diluted lavender oil may help reduce or manage symptoms of anxiety.
However, the Food and Drug Administration (FDA) does not regulate essential oils, and strengths and ingredients vary widely.
If you use lavender essential oil, make sure you:
  • get your oil from a reputable source, such as a pharmacy
  • follow the instructions for use
  • avoid applying concentrated oil directly to the skin
  • avoid using lavender with benzodiazepines because the combination can cause intense drowsiness
While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of essential oils. It’s important to talk with a healthcare professional before you begin using essential oils and be sure to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.
Repeating a mantra internally can be relaxing and reassuring, and it can give you something to grasp onto during a panic attack.
Whether it’s simply “This too shall pass,” or a mantra that speaks to you personally, repeat it on loop in your head until you feel the panic attack start to subside.

What is a panic attack?

Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms. If you have a panic attack, you might find you have difficulty breathing, you sweat profusely and tremble, and you may feel your heart pounding. Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they may think they're having a heart attack. Others have reported feeling like they are having a stroke.

Panic attacks can happen for various reasons, and sometimes they happen for no apparent reason.
You’re more likely to experience them if you:
A panic attack often happens when you’re exposed to a trigger, but triggers vary widely between people. In some cases, there may be no clear trigger.
However, some people find that the following can trigger an attack:
  • social events
  • public speaking
  • conflict
  • situations that remind you of past or current stress in your life
The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) defines a panic attack as “an abrupt surge of intense fear or discomfort.”
They tend to start without warning, and symptoms reach a peak within minutes.
If you have a panic attack, here are some of the symptoms you might experience:
It may not be possible to prevent a panic attack, but these strategies may help:
  • Practice deep breathing and other relaxation techniques regularly, not just during an attack.
  • Exercise regularly to help manage stress, relieve tension, and boost your mood.
  • Avoid caffeine, smoking, and alcohol, as these can make anxiety worse.
  • Eat regular meals to help maintain stable blood sugar levels.
  • Talk with a therapist or counselor to learn strategies for managing anxiety and panic attacks.
You can also talk with your doctor about medication options.