The impact of grief is one that takes many different forms and is unique to each of us. Bereavement leaves us feeling sad, lost, empty, angry, scared, fearful and unsure of the ground we are walking on. A common metaphor for grief is “it hits you like a wave,” and when it does, so unexpectedly and so powerful, we tend to be very surprised at the intensity of emotions we experience. And while most of the time, we manage to either dive under these waves or ride them through to completion, some of us find ourselves having a full-blown panic attack. It may help you to know, these grief related panic attacks (GRPA) are a common reaction to loss, and something that, while still not very well understood, are in fact being studied carefully. Panic attacks, in general, can be very scary. Seemingly out of the blue, it is as if there is a psychological overwhelming, with common symptoms including chest pains, choking or smothering sensation, racing heart, sweating, hyperventilating/difficulty breathing, nausea, tingling or numbness in fingers or toes. There is a loss of control; an inability to stop these things from happening. Panic attacks occur in approximately 11% of the population; and women are twice as likely to have a panic attack than men, according to the Centers for Disease Control and Prevention. Identifying the cause and source of panic attacks is something that continues to be studied. Research continues to examine how we manage fear; particularly around the “fight, flight or freeze” reactions we have when faced with imminent danger. While we do not know why some people experience panic attacks, we do know there are risk factors which may predispose some to panic attacks. These include a personal or family history of anxiety disorders or co-occurring mental health issues such as depression, and substance abuse problems. In other words, we know that panic attacks happen, and we know that some are more likely to have panic attacks. We also know that panic attacks occur during grief; and these have been formally recognized and defined as grief related panic attacks, GRPA. In a study on GRPAs, experts Sherman A. Lee and Jamison S. Bottomley found that 55.4% of participants experienced GRPAs. Their research also suggests that those experiencing complicated grief have a high prevalence of GRPAs. And while more research needs to be done, what these findings help identify is the common reaction many grievers have to loss. Identifying and validating this reaction helps normalize grief reactions and it also gives rise to the need to further examine opportunities for support. We do not know why GRPAs occur, and we do not know how to prevent them, but we can work with them. Before moving on, the first thing you need to keep in mind is, GRPAs are a common and normal reaction to grief. Let that sink in for a minute. You are not “crazy” or “out of control.” You are in fact very normal, having a normal reaction to incredible loss. Below are a few suggestions to consider now, to prepare, should you need a few tools to manage and possibly lessen the intensity of your GRPA: 1. Don’t fight it. This may sound counterintuitive, because in the midst of the attack, we become afraid, and just want it to stop. Know the swell of emotions will pass. Sit down if you are able. Notice your breathing and work to focus on controlling a slow inhale and exhale. A good grounding technique for breathing is square, or box breathing. Breath in for the count of four, hold for four, release for four, inhale again for four. Gaining gentle control of our breathing is one of the best ways to ease anxiety, and works very well if we can do this in a panic attack.
2. Orient yourself to your space. This exercise can be done by you, or facilitated by someone with you during a panic attack, and it involves focusing on the external; another grounding technique. Counting backwards from five, you will: 5 — Identify five separate objects near you, stating the name of each and stating the use of each. For instance, “I see a chair. That is my rocking chair and I use it to relax at night.” 4 — Identify four sounds. Verbalize how you hear them, where they come from, and what this sound means. For instance, “I can hear the birds singing, and this sound tells me that nature is near.” 3 — Touch three different objects. Verbalize the feel, is it warm/cold? What is the texture and how does it feel? 2 — Identify two separate smells. Perhaps you have coffee next to you, or you can smell someone’s perfume. Verbalize whether you like these smells. 1 — Name one thing you can taste. Whether it is the gum you are chewing, or your own tears, identify and verbalize a taste. 3. Use a mantra or positive affirmation to help focus and ground yourself. “Peace is mine,” or “I release my emotions.” Something easy, yet meaningful.
4. Allow the GRPA to complete itself. Allow the emotions to flow, the energy to released and really just let the process work itself through you. 5. When the GRPA has come to an end, show some appreciation for yourself. You may want to even thank yourself for releasing these emotions. Being kind and compassionate to yourself, instead of feeling shame, like you should be in better control, will help shift your mind to a peaceful place, leaving the space of anxiety. 6. Find a way to relax. You may need to lay down for a few minutes or even take a nap. If comfortable, get yourself into nature, nothing is more grounding than a walk among the trees.
7. Monitor your body, note your heart rate and your breathing returning to normal. Hydrate well. Eat a healthy snack.
8. Debrief after you have recovered. Talk to a friend. Journal your experience. You may want to keep track of your GRPAs. Is there a triggering event, thought or experience that prompted your GRPA? Becoming aware of your experiences will help better understand yourself, and your grief.
GRPAs are a normal reaction to loss. You are not “going crazy,” nor are you the “only one” reacting to loss like this. While we continue to work to understand the reasons for and exactly how panic attacks, and GRPAs occur, please be kind to yourself as you grieve. Understand that some reactions and emotions will need to be released, whether or not you are ready for them, and this is perfectly normal. If you are struggling with your grief, experiencing frequent GRPAs, or are having difficulty with the thoughts and emotions related to your grief, know that help is always available from grief counselors who have many resources to help you navigate this journey.
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