CBT along with third-wave interventions are effective for teens to manage their anxiety levels that lead to panic attacks. One evidence-based treatment specifically targeted toward panic disorder in teens is Riding the Wave therapy, and this incorporates teaching teens to learn to identify their thoughts, emotions, and actions that may trigger panic attacks, and to learn to tolerate the discomfort of those, or “ride the wave” of anxiety. This treatment, along with incorporating mindfulness, meditation, diaphragmatic breathing, and therapeutic lifestyle changes will help teen clients learn to tolerate anxious thoughts and feelings and calm their overreactive brains. I created a handout for teens to learn more about how to cope with panic in the moment, as well as things they can do daily to decrease the prevalence of panic disorder symptoms. These are helpful tools that a client can test out to find what works best for them.
- Knowledge- Know that a panic attack can be very scary, but they are not dangerous.
- Deep (Diaphragmatic) breathing- Breathe in through your nose for 4 counts, pause for 1 count, and breathe out through your mouth for 4 counts.
- Label it- It is not a heart attack, It is a panic attack. It is temporary and it will pass.
- Close your eyes- Overwhelming stimuli can be a trigger and feed the panic attack. Close your eyes and focus on breathing.
- Mindfulness- Focus your attention on the present, recognize your emotional state, and meditate regularly to reduce stress and help you relax. Mindfulness Grounding Strategy:
- Name 5 things you can SEE around you
- Name 4 things you can TOUCH around you
- Name 3 things you can HEAR around you
- Name 2 things you can SMELL around you
- Name 1 thing you can TASTE around you
- Name 5 things you can SEE around you
- Focus Object- Find something to focus your attention on until the panic attack passes
- Imagery- Visualize yourself in your happy place and focus on the details as much as possible. “feel the sand on your toes, warm sun on your shoulders, smell the pine trees, hear the rolling waves”
- Calming Yoga- Practice yoga stretches and breathing. Use Youtube, or a favorite yoga App to guide you in your practice.
- Smell Lavender- Lavender essential oil is calming and can help calm you.
- Repeat a Mantra- This can be a favorite Bible Verse, or just a simple “This too shall pass”. Repeat it in a loop in your head until you feel the panic attack subside.
Therapeutic Lifestyle Changes that can reduce panic attacks:
- Daily deep breathing- 5- 10 minutes a day
- Regular light exercise- yoga, walking, or light jogging
- Reducing sugar and caffeine in your diet
- Avoid alcohol and smoking
Riding the Wave of anxiety and Panic Attacks
So, we know that we cannot make the waves stop and we cannot rush them to move and go away any faster. They cannot be controlled or avoided. They will come and go, ebbing and flowing. The same goes for anxiety. If we resist the symptoms of anxiety by trying to control it, stop it, avoid it, or push it along quicker, the symptoms are more likely to get worse. So, what do you do about
the waves of anxiety? Well, you want to be more like a surfer. They are not intimidated by giant waves. In fact, to a surfer- the bigger, the better. Surfers are not trying to fight the waves, they are moving with the wave, flowing in the same direction. When you find yourself experiencing a wave of anxiety, try riding the
Accept your symptoms, don’t suppress them.
Remember that anxiety and panic attacks cannot kill you. You cannot die
from them. Attempting to control the anxiety will only intensify the emotion.
Try thinking to yourself, “Ok, here it is again. I can handle this. It will pass.”
Acknowledge your physical symptoms.
Anxiety not only impacts us emotionally and cognitively but also creates
changes in our bodies. Take notice of what your body feels like at the
moment. This may include heart palpitations, shortness of breath, heaviness in the chest, muscle tension, shaking, and sweaty palms. Watch and observe what is happening to your body without reacting to it with further fear or anxiety.
Redirect Unhelpful Thinking.
Often our perceptions about our physical symptoms of anxiety lead to
further symptoms of fear and panic. Examine your thoughts and beliefs
about your physiological reactions. Instead of thinking “I can’t handle this”
or “I feel like I am going to die” try thinking of something more helpful. For
example, “I know I will be okay” or “I will let my body do its thing and move
Utilize Relaxation Techniques.
Try taking some slow deep breaths. This may be called deep breathing,
belly breathing, or diaphragmatic breathing. Slow your breath and become
present in the moment. Focus on your inhale and exhale. You can also try
doing a visualization or mindfulness exercise to help ride the wave and wait
for it to pass. Remember to ride the wave of anxiety and it will eventually pass. You got this! Happy surfing!
Mindshift- meditations, journaling, symptom tracker, and it is free!
Reflect- Christian mindfulness and meditation app, also free!
Headspace- Great mindfulness and meditation app, good instructional videos, and inspirations as well. It is not free, but they do have a student discount rate.
Downdog Yoga - Great Yoga app that can be customized to your ability level. They offer a free account with your student email.
Baker, H. J., & Waite, P. (2020). The identification and psychological treatment of panic disorder
in adolescents: a survey of CAMHS clinicians. Child & Adolescent Mental Health, 25(3),
LPC, A. B. (2019, July 30). Riding the Wave of Anxiety. Therapists Raleigh Durham Chapel Hill
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R.I.D.E. the Wave of Panic | Psychology Today. (n.d.). Retrieved September 22, 2022, from
Pincus, D. B., Ehrenreich, J. T., & Spiegel, D. A. (2008). Riding the Wave Workbook: Riding the
Wave Workbook. Oxford University Press, Incorporated.