Dear Kirsten,

My daughter has started having times at school where she feels she can't breathe.

She says her heart beats really quickly, she feels like she needs to get out of the room, it feels like everyone is looking at her and she can't calm herself down.

She is making excuses to come out of lessons and sitting on her own in the school toilets trying to calm her breathing down.

She has started saying she doesn't feel well on the mornings before school and isn't sleeping well the night before.

She has started to have assessments at school which are supposed to replace the exams she was originally to sit and although she's been told these aren't as important, the scores still matter and she is spending all her time at home with her head in her books.

She spends all day through the weekend studying and shouts at us if we try and get her to balance things out. We don't pressure her and I don't know why she is so worried.

(Name supplied) 

Kirsten replies:

It sounds like your daughter is having panic attacks and is really struggling with anxiety.

Panic attacks are awful things, anyone reading this who has experienced them will empathise with your daughter. Panic attacks and anxiety are common, and knowing this can be reassuring, often when we are battling a mental or emotional health issue we can feel like the only one.

Reading your email I'm wondering if these started to increase when we returned to schools after lockdown or if they have gathered pace the closer to the tests she has got?

It's useful to try to find what's running underneath the panic - it sounds like there is a fear possibly of failure and if you can support her to look deeper at this she might find she has some central beliefs which are driving the anxiety.

For example, some young people feel they will let others down if they don't do well, some feel academia is all they have going for them.

Your daughter will have her own version of these thoughts that she needs support in finding and then gently challenging. 

The rigid routines you are describing around her study are her safety net.

She will be feeling that if she just keeps going at this revision pace she will avoid her fears.

It might be worth talking with her about why getting a balance is important, there are some great articles available online about how the brain works much better when it has work/play balance and how letting go and taking much more regular and longer breaks boosts productivity and memory.

Your daughter is scared that if she stops working at this pace her fears will be made real, helping her challenge those fear beliefs and creating more variety in her day will help her concentrate better, improve her anxiety and ultimately probably improve her test scores.

Getting support from school would be useful, they will have access to support services to help her manage her studying, her GP can help her access support for her anxiety. 

In the mean time it would be useful for both you and your daughter to understand the mechanism of a panic attack.

Sometimes we can begin to develop ways of thinking about things that overestimate the threat - for example getting on a bus might seem like a simple task for many of us, yet for some it seems to be riddled with difficulty.

Once our fear system is triggered, our nervous system gets involved and creates a reaction in our body designed to help us escape whatever danger our brains have told us we are walking into. Our heart rate increases, adrenalin is released, our pupils dilate, our stomach constricts and importantly the air sacs in our lungs dilate and we start to feel as though we can't breathe.

There has been some research done about the type of breathing we develop when we are having a panic attack - it shows that as the panic attack starts many of us forget to fully exhale, we can try to breathe air into lungs that are already full, this in turn creates more panic.

When she is panicking, increasing the length of her exhale has been shown to calm the panicking body down.

Using grounding techniques such as counting, taking sips of water, trying to involve your other senses such as smell and touch are all ways of shifting the mind away from anxiety ridden thoughts.

There are some great support websites about - try www.nopanic.org.uk, they have some great resources available.

If you feel that  things are getting worse while you wait for support, you can always go back and speak with your GP.

All best wishes

Kirsten

Kirsten Antoncich 

Psychotherapist and Neurofeedback Practitioner