Using Checklists to Assist in Panic Attacks
Disclaimer: Any information, advice, or graphic presented in this article is not meant to diagnose or treat any condition, or replace advice from a medical doctor. If you believe you have anxiety or suffer from panic attacks, please talk to your doctor before implementing any strategies or advice. Please call 911 in cases of emergencies.
It was 3 am on a Monday, deep into that good REM sleep, and I was stirred by a bright light and disturbing sharp breaths. I turned over and saw my husband sitting up, face white as a sheet and grasping his chest – his eyes wide and illuminated by the phone held in front of him. He was doom-scrolling WebMD. After a quizzical look, I realized he was fixated one of the many scary potential conditions: heart attack. We high-tailed it to the ER as fast as we could. After hours of waiting and testing, we got the news - a panic attack - the doctor told my husband, “Not to worry,” (super great advice for someone with anxiety!) and sent us on our way. Unfortunately, this pattern repeated. By our 5th visit to the urgent care from yet another attack, we had done our research and were more prepared, but didn’t have a good plan of action to help with the onset of symptoms in times of emergencies.
Panic attacks are defined as “a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause.” They manifest differently across people, so it’s important to look up the complete list of symptoms. In my husband’s case, the main symptoms were a sense of doom, fear of death, rapid heart rate, shortness of breath, chest pain, and abdominal cramping. Even though you may know have a panic disorder it’s difficult to move past the fear of the moment and think logically. If you’ve had a panic attack, you may recall feeling like you’ll die and are no longer in control. The fear is real. Any attempts to tell my husband he was ok did absolutely nothing to make him feel better.
The first thing most people do when they’re feeling ill is search Google, and it can be a blessing to have vital information at their fingertips for just about anything. For someone experiencing anxiety and acute attacks, places like Web MD can be a curse. Especially when symptoms of panic attacks can be consistent with such a large and chilling of other conditions. Without fail, my husband immediately logged on when these symptoms came up, just to get overwhelmed by the potential doom in front of him. Chest tightness, shortness of breath – not to worry – it can either be cancer, or pregnancy, or bronchitis, or covid, or menopause. Or you can just be having one of those routine terrifying panic attacks…again.
A doctor finally took the time to talk to us about telling the difference between my husband’s attacks and other potential illnesses. They spoke about the importance of recognizing your surroundings and offered some calming techniques that could help alleviate the impending fear. We decided not to wait around and used the information to take action and be proactive. Checklists and task analyses have been used for years in high stakes or monotonous situations to help isolate important actions and protect from mistakes. Surgeons and pilots use them to guard against potentially deadly mistakes, to sure up communication, and double-check themselves. I used information from our research and doctor and worked with my husband to build a checklist to help with self-monitoring and awareness. Their effectiveness comes from the simplicity and personalization – a visual prompt, with easy to define criteria, and clear steps to follow – also making them a good tool for grounding techniques. Grounding techniques are exercises used to help you stay in the moment during episodes of intense or overwhelming anxiety or emotions.
We lovingly called our checklist: Check Yourself Before You Wreck Yourself. It has been a helpful way for my husband to track his behaviors and symptoms during his panic attacks and to deal with the initial fear that comes with his attacks. Here are some tips that you can use to check it before you wreck it:
Write It Down
The most important (and most difficult) part of starting your checklist is to record everything that happens before, during, and after a panic attack. The more detail you can write down the more accurate and helpful your checklist will be. I broke ours down into 3 parts: triggers, symptoms, and an action plan. By writing down what happens throughout your experience, you can start to observe patterns over time.
Define Your Triggers
Triggers happen right before you start feeling the symptoms and will be different for everyone. Triggers can be external, like your environment, or internal, like your thoughts, emotions, and medical conditions. Think about what your environment looked like before your symptoms arrived and ask some important questions. Who was around you and what were they doing? Was it noisy? Did you have to attend a meeting for the millionth time that could have just been an email? Did you have to present at said meeting? Once you describe what was going on around you, describe what was happening in your body. What were you thinking about? How were you feeling? Be wary of other influences like caffeine consumption and medications that may also play a role in the occurrence of panic attacks.
Define Your Symptoms
Recording symptoms during an actual panic attack can be difficult, for obvious reasons. I used a simple symptom checklist and would check off any that my husband mentioned (yes, a checklist within a checklist: Check-ception!). There are several great resources that provide symptom checklists that make recording symptoms during an event easier. The main goal is to make your checklist as detailed and relevant as possible.
It's essential to know what symptoms you most frequently experience during your panic attacks and define them in detail. The more specific your definition, the better – as this will enable you to cancel out symptoms of other potential conditions. Many symptoms experienced during a panic attack are terribly similar to those of a heart attack, and about a thousand other things.
Analyze Patterns & Make Action Action
The last step is to describe what happened right after the symptoms started. Did you close your eyes and take deep breaths? Did you lay down? Did you walk up and down the stairs in your house? Maybe you did all those things? As you describe what you did also make note of what made your symptoms worse or better. If possible, mark the time when your panic attack started and when it stopped.
Now that your hand hurts from writing, it’s time to do it all again! To determine a pattern, you may have to look over notes from a series of instances. For example, if you see that over a few attacks, you recorded yourself in a loud and crowded environment, you can consider it a consistent trigger. Next, look to see what you did that made you feel better or worse across multiple attacks - knowing your patterns are essential to creating your action plan. Using the data we collected, we worked with the doctor as a team to determine which common triggers and symptoms my husband’s panic attacks. We included sections that listed calming techniques and an additional section re-record answers to assist with grounding and reassurance.
It’s always recommended to your doctor before finalizing your plan. Use this Check Yourself Before You Wreck Yourself Checklist as a guide to help you or someone close through the difficult and scary times panic attacks. But remember, it’s “Check Yourself,” it’s important use data, triggers, symptoms, and doctor’s recommendations involving your specific situation to build your checklist to best serve your needs.
Jeanne has been a BCBA since 2015 after graduating from the Florida Institute of Technology with an M.S. in Applied Behavior Analysis. She currently works as a Senior BCBA in Canton, GA with clients in-home, clinic, school, and communities. She believes that we should always focus on a person's potential rather than their deficiencies. Her main areas of interest include organizational behavior management, training (staff and caregiver), and adaptive living skills.