Although interoceptive exposure is the most effective strategy for overcoming panic attacks, there are other options. One strategy is to learn to be able to predict panic, catch the panic early, and nip it in the bud by applying a variety of coping strategies.
Before you really begin catching the panic early, you will need to monitor your panic attacks to find patterns of when, where, and with whom the panic attacks occur as well as learning what the earliest symptoms of your panic attacks tend to be. You learn to be able to predict the unpredictable such that you are able to catch the earliest triggers and use various forms of relaxation, mindful acceptance (i.e. if you can learn to accept the early symptoms the following reactions will not snowball into a panic), and cognitive therapy (thinking more adaptive, less negative, but believable thoughts).
So for instance, if Jill realizes that she almost always has a panic attack when she goes to stores, she may learn that she has a sensitivity to fluorescent lights and feels derealized. The derealization tended to scare her and then lead to tachycardia (rapid heart rate), dyspnea (difficulty breathing), and fear of having a heart attack. Once she has this information she can learn to deal with these symptoms differently. So she may practice relaxation before entering the grocery store, accept that the lights will make her feel derealized, and if she starts to feel anxious she thinks “millions of people feel uncomfortable under artificial lights. Feeling derealized nor panic attacks have ever caused anyone to have a heart attack.” These strategies can then help her to feel progressively less fearful in these situations until the fear of having a panic attack goes away. If you hyperventilate, certainly learn diaphragmatic breathing. However, breathing strategies are not very helpful if hyperventilation is not a problem
A combination of interoceptive exposure and coping strategies has been shown to completely eliminate panic attacks for one full year follow-up in 89-92% (2 studies) when medication free to start. In fact, research shows that taking medication significantly reduces success. However, if you prefer to take medication or there are no anxiety specialists in your area, please speak to your doctor about two similar classes of medications, SSRIs or SNRIs. Paxil, Zoloft, and Pristique are among these “anti-depressants” that affect anxiety. While they do not cure panic attacks, they do often decrease and even eliminate panic while taking the medicine. Unlike benzodiazepenes taking them will not interfere with cognitive behavioral treatment of the anxiety should you decide to engage in it later. The effect of SSRIs and SNRIs varies dramatically. Some enjoy a complete end to panic attacks, others experience a lackluster response, while other suffer side effects that worsen the panic. Finally, if your primary symptoms are tachycardia and shaking, speak with your doctor about a beta-blocker, but only if your blood pressure is normal or high as this is actually a medication designed to lower your blood pressure.