Panic attacks at comps
Should athletes declare mental health issues to coaches? Yes.
When I'm grabbed in warm up, or at a comp, the most common reason is anxiety/panic attack.
We can lose it which is tough on the team as a coach and or athlete.
People like me can see athletes and look at their anxiety and help, on line or face to face. I can come see your team and help, however that’s costly. Surely a better option is teaching coaches, and older athletes to enable their team to cope with those with panic attacks etc.
So, I thought I would write a simple guide on what do if an athlete has a panic attack, here goes. Some ideas are covered here, not all! Practice them however as a panic attack is pretty catching and makes us all feel off.
So, share this with coaches and teach your athletes.
General stuff, eat well, sleep well, reduce stimulants, exercise, get therapy with someone who knows techniques and understand the physiology of anxiety and panic, see a doc for meds IF appropriate! Yoga, meditation, mindfulness and daily mantras of acceptance of anxiety vs fighting it.
Rather than worry it might happen, go with it will happen and I'm ok with that and have the tools. The mind calms differently when you experience something you expected and are prepared for vs worry will happen. So, it isn't a question of if, it's a question of when.
There are great articles around on what a panic attack is, so I won’t cover it too much. That said, actually understanding what your brain is doing during a panic attack calms most people more than they think as they understand that is an appropriate response to fear at an inappropriate time not to be fearful of.
The sympathetic nervous system kicks in and leads to an adrenaline release (epinephrine) the fight, flight, freeze response.
Physically the following can occur, increased heart rate, hyperventilating, sweating, shortness of breath, sweating, all over or on the palms. As this alters carbon dioxide levels in the lungs and then in the blood, affecting the blood PH balance, this can accelerate to tingling, numbness, nausea, butterflies, dizziness, burning and light-headedness.
The release of adrenaline during a panic attack causes vasoconstriction potentially resulting in slightly less blood flow to the brain causing dizziness and light-headedness. A panic attack also potentially causes blood sugar to be drawn away from the brain and toward the major muscles. The person experiencing the attack might feel as if they are unable to catch their breath or do not realise they are shifting breathing patterns affecting carbon dioxide levels in the blood. People share other symptoms too. Ironically it is not a lack of breath, it is because you’re not breathing out
Understand what they're going through. A panic attack exhausts the person having it and on average could last for 10/60 minutes. I can honestly say that when I am with someone that can be reduced to around 2 minutes. So, come find me if I am at your comp!
The panic feels real, people genuinely believe they will pass out and or die. The mind in that moment cannot distinguish between real or perceived threat.
◦ Palpitations or chest pain
◦ Speeding up of the heart rate (rapid heartbeat)
◦ Hyperventilation (over-breathing)
◦ Dizziness/light-headedness/feeling faint (this is usually from hyperventilating)
◦ Tingling/numbness in fingers or toes
◦ Ringing in the ears or temporary loss or hearing
◦ Abdominal cramping
◦ Hot flashes or chills
◦ Dry mouth
◦ Difficulty swallowing
◦ Depersonalisation (disconnected feeling)
(source for the list is wiki how as it saved me typing ;-))
Ask the athlete BEFORE you interact, what is best for them that they know of, what works and what their symptoms are? PLAN and pre-mortem. Be aware some people in a panic attack cannot communicate effectively. CONSENT matters here, especially around touch. Some panic attacks have no triggers or causes, and some do, ask the person you are cheering with if relevant again. If it is a first time, a doctor or ambulance should be called to confirm it is a panic attack or at least get checked over. If not a first time, their therapist may have given them techniques, so learn them and enable them, or they may have developed their own or they may have meds.
Ask the person, if they can, to share what symptoms they have whilst some are obvious. We all react differently to touch and being held, it may work for some and may make others feel a hell of a lot worse, so ask before to clarify. Each person is their own expert, really.
Ok, you’re in warm up, now what?
This list is NOT instead of professional help. Even though I am a qualified professional, we are not in a contractual relationship so is used at your own risk and not instead of professional help (sad disclaimer) So here are some ideas that have worked for people.
STAY CALM! Anxiety and panic is literally catching, so breathe deeply and calmly and remain focused.
Is there a physical injury that has caused this? Check that first and foremost. Ask them, if they can answer, is this about now or something that has happened before, their thinking can help whilst they look for the answer.
Are they injured? If there is damage call over the first aiders who may call 999 or 91. Moving can make it worse remember. If no damage, maybe alter the environment if possible, different room or floor, move away slightly to a quieter area (often impossible in warm up).
Explain, it is a panic attack, accept it is and if they can, give them a minute, they may manage.
How you talk is important, eye contact, ask their name and get them to tell you it, then use their name (a lot and repeat repeat) to bring them in to now and use a low, yet audible reassuring tone. Ask for eye contact. Be their friendly yet firm coach right now, take charge calmly. Remain steady, no sudden movements and do not walk away.
Boundary touch can (note can) be good, rubbing of arms, slowly and calmly, a distant hug, if welcome. Or leave them the hell alone physically, ask them. However, do not squish, squeeze or restrict.
Something physical can help that is simple and repetitive as the mind refocuses, arm lifting, some small physical task, a skip, jumping jacks (normal medical precautions apply) shaking like a dog ;-) all over all, help the adrenaline get used up. Arranging something physical can help too, like close a window or pass something over to you re focuses.
Ask them to focus on you and your voice, breathe with them, in for 4, out for 7, getting them to count with you, keep talking. Diaphragmatic breathing is key here, that soft squishy point around 5/6 fingers under your nipples in the middle (hurts to poke it) needs to inflate on an intake of breath and deflate on a breath out. Practice practice. People used to use a paper bag and still do. Some prefer to breathe in for 4, hold for 7 breathe out for 8. For panic, I wouldn't hold in the middle.
DO NOT tell them it’s nothing or that they’re exaggerating or to stop, or calm down, it simply does not work and can make things worse. However, saying 'I am here, I am with you, stay with me and let’s get through this' are great words. confirming feelings is important, 'I get you’re upset and that you’re scared', also great expressions.' It’s ok to feel what you’re feeling and remember what your brain is doing right now, you’re doing brilliantly'. Tell them not to fight it but to stay with it and let it pass. Feelings and thoughts are scary but not dangerous, go with it … all great things to say. VALIDATE
Temperature matters to some, cooling down matters, cold flannel on the back of the neck or face, wrists. Think re ice, as it is a shock? Use cold water too.
Ask them to say what they see around them, descriptively, not emotionally. A clinical list of what is around, reminding them to breathe with you still.
Ask them to share their times table, to count, their alphabet, anything utterly logical to share and again reminding to breathe.
Ask them to find and describe; 5 things they can see, 4 things they can touch, 3 things they can hear, 2 things they can smell, and 1 thing they can taste if possible (specifics or order of this does not matter) It stimulates a different part of the brain. Senses are awesome and current.
A psychological safe place can be great, IF you have set this up before. Set it up by imagining the place you feel safest (for me this is the seaside) “Walk” in your head to that place at abnormal speed whilst moving your legs as if walking or running on the spot (you need the physical element) Once there, breathe and relax and stop “walking”.
Ask them where they are, what did they have for breakfast, even if they struggle and keep bringing them back if you can.
A good hand massage to add more oxytocin (IF allowed to touch)
A beat can help, a percussive beat such clapping or tapping a rhythm or a song and recalling the lyrics. Finger exercises that make someone think, great.
Being aware of their feet on the ground and even adding their own pressure to this can help, focusing upwards on each body part as grounded and secure.
Identify body symptoms with them, get them to talk and share and calm each symptom.
You don't have my permission to copy the above without crediting me as the writer
1:1 Therapy, Couples, Supervision and Workshops
BA Hons PG Dip