Obese individuals often have panic attack problems and patients with panic attacks before bariatric surgery are unfortunately very worried and therefore some relaxation exercises are performed in pre-operative interviews. But this is a momentary intervention. In fact, patients should continue their panic disorder treatment after the surgery. Because the state of panic during the weight loss process can negatively affect the person’s process with behaviors such as being constantly weighed and worrying when they cannot lose weight.

In addition to these, let’s talk about how to deal with panic attacks in general, why panic attacks occur and what to do. First of all, we need to know this about panic attack: Panic attack is not a psychiatric diagnosis on its own. It usually accompanies depression or anxiety disorder and is in seizures. It appears suddenly and the person feels an intense sense of fear at that moment. Sometimes it can be the fear of death, sometimes the feeling of having a heart attack, sometimes the fear of going crazy.

And when this attack occurs, there are usually some physical symptoms. The most common of these are; shortness of breath, feeling of suffocation, heart palpitations, numbness in the body, trembling, sweating… And the person is catastrophizing these physical symptoms. So it ‘s catastrophic . When I have heart palpitations, am I having a heart attack? Do I suffocate when I’m short of breath? They exaggerate physical symptoms like when my body goes numb, when my legs go numb, I wonder if I’m going to have a stroke. So why do these physical symptoms actually occur?

  • a general level of tension
  • stressful life,
  • family problems,
  • marriage problems,
  • individual psychological distress,
  • business life,
  • education life

When the person cannot cope with them, suppresses them and does not receive any support, the body gives an alarm and gives this alarm with physical symptoms. That’s why panic attacks occur.

So what should be done to cope with a panic attack? First of all, when a panic attack client arrives, they should be asked about their first attack. When did he/she have his/her first attack, what physical symptoms did he/she experience, what thoughts were running through his/her mind? What emotions was he/she feeling? Then, it is necessary to learn about the most recent attack and to learn the most intense attack by asking the same detailed questions.

Detailing these and then writing a panic diary should begin. In this panic diary, the person should record the moments of the attack, and what physical symptoms he/she felt, what psychological symptoms he/she felt, what thought was running through his/her mind, what emotion was he/she feeling? Was he/she afraid that he/she was going to die, was he/she thinking that he/she would lose his/her mind? You should save them one by one.

Then, it should be checked whether there is a common point between these attacks. Some people realize that they only have an attack at work, some may experience this attack only when they get on the subway, some in a closed area, and some when they have a problem with their family. These are the tactics we use to find out about the problem. Triggers are found. Afterwards, the most important thing for the person to do is this: he/she must pass the medical tests. We, as Psychologists, look at psychological factors after all the medical tests and then a physical examination are done and the doctors tell him/her “you’re okay”.

These psychological factors are the family problems I mentioned earlier, spouse problems, and general stressful life. In addition, the person can sometimes be weaker in dealing with problems. They may be weaker in expressing their emotions, and therefore attacks may occur. And after we create this panic diary while we are coping, after finding the common causes, what can we do against these triggers, we apply some cognitive and behavioral methods on it. But what clients want more is to learn how to cope with that attack. Because talking about the problem at that moment may make him/her a little more bored. That’s why they want more solution-oriented techniques. So let’s talk about some more solution-oriented techniques:

Breath control

When you have an attack, you breathe quickly. We call it “hyperventilation” and you become more panicked because you can’t control your breathing. That’s why we rehearse this rapid breathing during the session and then teach how to control the breathing. So how? Some say the rule of 3 seconds or  5 seconds, or 8 seconds. Let’s say on average 5 seconds. We take a deep breath through our nose. We take this breath in 5 seconds. Then we hold this breath for 5-6 seconds again for a long time. Then, as if we are blowing soup from our mouth, we breathe in twice as many times as we breathe in, and when we repeat this 5-6 times, we take your breath under control at that moment of attack.

Imagination technique

Have an imagination in your mind. Think about the moment when you are the happiest and most peaceful, and you need to imagine that moment in such detail that at the moment of attack, that place will be your safe place and you will go to that safe place. For example, imagine you are on a beach. Let this be the moment you are happy. When you are on the beach, you need to remember where you are sitting, from what angle you look at the view, the sound of the waves, the color of the sea, and when an attack comes, we will ask you to sit in a corner and close your eyes and go to this safe place. When you go to this safe place, we will also ask you to do a breath control. This will relax you even more.

Relaxation exercises

Relaxation exercises should be done not only during the attack, but throughout the week. We give this as homework and in practical relaxation exercises we teach the client to relax their muscles and teach this on all organs. For example, first the right leg, then the left leg, first the right arm, then the left arm. Because when the person is nervous, panicked, anxious, his/her body contracts and teaching him/her how to relax this contraction is another technique that relaxes him/her.

Stay-in-the-moment techniques

During an attack, we focus on our body and tend to misinterpret the symptoms in our body. Therefore, in order to prevent this misinterpretation, it is necessary to remove the person from his/her body. You need to shift your focus elsewhere. To do this, one must focus on the environment . For example, find 5 objects and count the five objects you can see. Maybe you can code this by color as well. Like I’m going to find 5 red objects. Then choose 4 scents you can get.

Then select the 3 sounds you can hear. What sounds do you hear? Select 2 things you can touch. Sofa, table, car seat, it doesn’t matter. By doing this, you are getting away from your body. This is the important point. Because we focus too much on the body. And this is how we listen closely to the signs in the body, and this causes us to exaggerate. Relaxation exercises, breathing exercises, shifting focus are the most commonly used techniques and doing it with our senses works best.

In addition to these, if the person does not get over the attack despite doing these, or if there is a concern that the attack will come again, this is called expectation anxiety. In other words, the person has now recovered from his/her attacks, he/her does not experience any attacks. Maybe he/she hasn’t have attacks for a few months, but he/she is afraid that if he/she has an attack. Then, to get rid of this expectation anxiety , it is necessary to look for evidence.

What evidence is there that he/she will live again? or he/she thinks he/she will have a heart attack, what evidence is there that he/she will have a heart attack? The downward arrow technique should be applied. For example, he/she is afraid that he/she will have an attack in traffic, what happens if you have an attack in traffic? “I’ll stay there. I’ll feel so helpless.” What do you do if you feel helpless, then what? I’ll call the ambulance.

So what happens when you call the ambulance? Ambulance comes but what if it doesn’t come in traffic? Well, have you ever seen an ambulance that can’t get into traffic? Ambulances are made in traffic. By looking for evidence in this way and actually doing socratic questioning, it is shown that his/her thinking is actually a logical basis under his/her anxiety. These are solution-oriented techniques. There are also points that the person avoids due to panic attacks. There are places where the attack is afraid of its future. It could be traffic, it could be public transport, it could be an elevator.

A list of situations that he/she avoids and fears by identifying these places should be made and this list should be ordered from easy to difficult. They must then be exposed to them one by one. But this exposure should be done with in-session exposures, not in the form of “go, get on the subway alone”. In other words, the client should be taken there by imagining and imagining while in the session room , and when he/she feels that his/her attack has started, he/she should learn how to deal with that attack practically. If this is not done before the session, it is called overflow. It’s a wrong method, so you have to be exposed in such a gradual way, first in the session, then out of the session, first when there is someone with you, then when there is no one with you.

If we go back to obese individuals, panic disorder, panic attack, anxiety disorder, depression are very common in individuals with obesity problems and generally the person does not receive support until the last point. You can try solution-oriented techniques. You can try the techniques just mentioned, but at the root of the problem, for example, there are marital problems and your problems with your partner are not solved in any way.

At that time, even if you extinguish the panic attack with those techniques at that moment, it may recur in the future, and at this point, it has been observed that drug treatments for panic attacks, for example, cause the attack to recur in the future at a rate of 95 percent, no matter how effective the drug treatment is . For this reason, after discovering the problem, after discovering the triggers, support from an expert should be sought.

Panic attack is very difficult, feeling like you are going to die while experiencing that attack, not being able to control your breathing, all of these are very difficult but also very easy to deal with. You should learn these from an expert and by using a very simple coping method, you can stay away from this difficult moment and get away from this attack caused by the general tension in your life. The most important point is that you should know that the body is giving you an alarm . It means you are neglecting something about yourself. That’s why your body says “think about me now, look at me”. Therefore, listen to your body’s alarm!