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How to fight your fears
Photo: INLSA
July 30, 2009 Edition 1

Helen Grange

As anyone who habitually worries will testify, it''s the wee hours that exploit your weakness - when every little unresolved thing takes on gargantuan proportions, and threatens to swallow you up whole by daylight!

For me, a severe bout of worrying occasionally escalates into a full-on panic attack, and there I''ll be, pacing up and down breathing fast and clutching my chest while making camomile tea, thinking, to quote the late Michael Jackson, "this is it".

It doesn''t last long, and I take comfort in the fact that, to quote Jacko again, I''m "not alone".

Christine de Nobrega was so convinced she was having a heart attack once that she ended up in hospital on a heart monitoring machine.

"Basically, a panic attack is fear feeding on fear in a downward spiral," she posits.

"I have suffered them on and off for 20 years since I was around 20, and the trigger is usually emotional trauma of some kind. "

Emotional strain accounted for Leverne Gething''s panic attacks too. At the time she had them, her then husband wanted to return to South Africa from the UK, but she didn''t.

"I''d get pins and needles down my arm and think I was about to have a heart attack. Bit tricky trying to control this when you''re on the tube trying not to look like a complete weirdo!" she says.

In the end, she did return home, and her panic attacks went away around the same time as her husband did.

"I believe they crop up when what you''re doing is at odds with what you really want to do," she says.

According to the SA Stress and Health Study, conducted between 2002 and 2004 on 4 351 adults, 16 percent of South Africans have or will experience so-called "panic attacks", and it is twice as common in women as in men, race, culture or income group notwithstanding.

The typical panic attack is described by the SA Depression and Anxiety Group (SADAG) as follows: "A sudden and strong feeling of overwhelming fear and apprehension accompanied by one or more of these symptoms: dizziness, shortness of breath, temporary vertigo, feeling of not being able to swallow, palpitation (racing heartbeat), sweating, trembling, hot flashes or sudden chills, chest pains, and being convinced that you''re going to die or go crazy. "

A common trigger is stress - particularly during life transitions like graduating, getting married, divorcing, having a first child, losing your job, retiring etc - though there is more risk of it occurring if there''s a genetic predisposition to anxiety.

Says psychologist and anxiety expert Dr Colinda Linde: "Think of it as a pot on a temperature which is too high. Eventually it must boil over. The actual trigger is usually quite random, like a ''final straw'' scenario, where something small like a late night and too many coffees, a hangover, low blood sugar, or eating something which doesn''t agree with you can push the nervous system over the edge and result in the symptoms panic sufferers experience - yet they don''t know this, so it seems the attacks come out of the blue. "

For women, the average age of onset of a panic attack is in the early 20s, while for men it''s in their 40s, although it can strike at any age, according to SADAG, and it usually lasts 4 to 6 minutes, even though it feels a lot longer.

At its most severe, panic attacks are so scary that people start avoiding situations in fear of having another one. Agoraphobia, a fear of going outdoors, is an example of panic attacks creating avoidance and debilitating normal life. Another would be resisting driving due to having had a panic attack on the highway.

"I had my first attack during a movie. I wanted to get out - fast - but being male and proud I didn''t want to admit anything was wrong," says panic sufferer James*. "I stopped going out with friends, and the thought of a movie made me cringe. I isolated myself out of fear of people finding out that I was weak. "

Another spin-off of unsolicited panic is a reliance on alcohol and drugs, as it''s been found that 30 percent of people with panic disorder abuse alcohol, and 17 percent abuse drugs. Up to 20 percent even attempt suicide.

The panic attack itself, however, is not dangerous. "Terrifying definitely, but not physically dangerous," assures SADAG founder Zane Wilson, herself a former victim of panic attacks so crippling she could not drive, shop or stay on her own.

"Panic attacks evolved to give you the impetus to fight or flee. But they are completely harmless. "

In the case of the "heart attack" misconception, a normal adult heart can sustain string palpitations for much longer than a panic attack can last, and while you might feel dizzy, it''s highly unlikely you''ll faint, as fainting is caused by loss of blood pressure, and in a panic attack, your blood pressure tends to rise a bit.

The good news is that panic attacks don''t need to disrupt your life in any way. "None of these dreadful effects of panic need to happen," says Wilson. "Panic disorder can be treated, and even people who have suffered regular attacks can lead full lives. "

For De Nobrega, it''s a case of mind over matter when she feels panic coming on. "Once you face the fear and welcome it, then start thinking of other things, the attack goes away. I have tricks to help me refocus," she says.

This coping mechanism fits in with what SADAG describes as the AWARE technique:

A stands for Accept the anxiety, just go with the experience;

W stands for Watch, observe it without judging it to be good or bad, remembering you are more than just your anxiety;

A stands for Act, as in act normally and continue what you were doing or intended to do;

R is for Repeat, go through the above steps again; and

E is for Expect the Best, in that what you fear may never happen.

Some sufferers claim homeopathic treatments or acupuncture may be of benefit, as De Nobrega found, but this has not been proved in clinical tests.

For people experiencing debilitating panic attacks, treatment most commonly includes a combination of medication (anti-depressants and tranquillisers), psychotherapy and self help (reading, support groups or relaxation techniques), and with the right combinations of these, 90 percent of people recover fully, says SADAG.

"Learning to breathe out helped me," says James.

For me, knowledge is power, so the next time it happens, I''ll try AWARE, and the tips below.

Tips to get over a panic attack

Take a "time out" and slow down. Slow your rate of breathing, slow your racing thoughts, slow your entire body, head to toe. Then slowly resume your previous activities.

Picture a relaxing scene using all your senses. Now put yourself into the scene.

If there are places available, take a stroll. If there are people available, talk to one of them.

Picture a person that you trust, someone who believes in you, supports you and cares about your wellbeing. Now imagine the person is with you, offering you encouragement.

Recall a time you handled a similar situation well, or try to bring to mind a past success and the good feeling you experienced at that time.

Focus on the present, on concrete objects around you. Make a game of noticing details or inventing questions about every object you identify.

Count backwards from 20 and with every number picture a different image of love, something that pleases you, something that calms you. These might be images you recall from the past or those you only imagine.

Occupy your mind with an absorbing task. Plan your schedule for the day or the evening; try to recall the names of all the Clint Eastwood movies you have ever seen; plan a sumptuous meal, appetiser through to dessert, and imagine yourself eating one bite of every course.

Bring to mind the image of a person you admire and imagine yourself to actually be that person. Think as they might think, act as they might act, even feel as they might feel.

Remind yourself that attacks always end. Always.

Remind yourself that panic is not dangerous.

Take again, yawn and stretch your body, head to toe.

Get mad. Vow not to let panic win out. You deserve better.

If all else fails, take as deep a breath as you can and hold it as long as you can. Use one of the other strategies to occupy your mind. Your physical symptoms should come down and stay down.

Source: Master Your Panic and Take Back your Life, by Denise Beckfield



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