Five ways to ease a panic attack

Panic attacks can be scary and are a common reason for people to see their GP. They are sometimes treated with medication but not everyone wants to go down this route. Here are some ways to help ease the symptoms quickly using the power of your own nervous system.

What are panic attacks?

Quite simply they are when the body and mind perceives some sort of “threat” to the person. Various changes take place very quickly to deal with the threat and help, at its root to keep the person safe. There may be feelings of overwhelming panic, a sense of “impending doom”.

The heart may race and the person may sweat, feel out of control or worry that they are going mad in some way. It can feel very unsettling and people can become very worried about having another attack.

It’s really important to remember that at its root anxiety and panic are protective factors designed to keep us alive. They are usually being over-protective and so to deal with panic, we have to learn to teach our nervous system that things are safe even if they don’t feel it. Then things will start to calm. (1)

Using the breath

Breathing in a specific way when panicky is really helpful. Commonly I’ve noticed that people will either stop breathing temporarily or breath shallowly. This tends to exacerbate feelings of panic. Slowing the breathing down and allowing the out-breath to be slightly longer than the in-breath helps to turn on the relaxation part of our nervous system. It’s best to practice this when things are less intense and the brain learns to calm itself quicker and quicker with practice (2).


Tapping with a couple of fingers under the chin and around the mouth for a few minutes also helps to switch on the calming part of the nervous system (3).


It’s not uncommon for people to feel embarrassed and then want to withdraw from others when they are experiencing panic. It can be really helpful to find someone who you feel safe with to sit with until the anxious feelings subside (which they will). Being with others who understand is profoundly calming. If you are with someone who is panicking, doing less is more. Generally it’s not helpful to try and talk them out of it or offer lots of suggestions. Calm yourself and sit with the person, perhaps encourage them gently to breath and wait. Strong emotions will generally peak and then start to fade.(4)

Using the phone

This can be useful in a public place as a kind of calming and distraction technique. When people feel anxious, the senses are often heightened and there can be a sense of wanting to hide and avoid eye contact with others. It’s becoming more and more socially acceptable for people to be looking at their phones in public and so this is a way of utilising this. It works best if it is prepared in advance. Go onto Google Images and find a picture with a repeating pattern on it – I like the “Where’s Wally” pictures myself because they are amusing and remind me of being a child. Screen-shot the picture and keep preferably several different pictures on the phone. Then breathe and count the number of squares / people / whatever takes your fancy. When I was testing this, I counted the number of people wearing hats on a Where’s Wally picture. Once I’d got them all, I moved onto another category.

This works because it engages the thinking part of the brain. This part can go offline with high anxiety and engaging it in a non-threatening task (Where’s Wally) combined with breathing helps to calm the nervous system down. (5)

The Tesco trick

This method came to me whilst standing in a queue in Tesco. It was around Christmas time and the store was crowded and noisy and I started to feel anxious for some reason. I was standing next to the drinks section and I started to notice the labels of some of the drinks. I realised that I could calm myself by spelling out the letters of the name of the drink one by one in my head. In this case it was a bottle of Tango. So the trick is to breathe in and say T, out and say A, in and say N and so on. Then move on to another label until you feel calmer. This can be done with any written word that’s out there – Road signs, place names, street signs. Obviously be mindful if you are driving and pull the car over and stop if necessary.



3. Personal communication from Kevin Laye ( ).



With huge thanks to Garner Thomson for his help with the contents of this article

Psy-Tap – seriously fast change

Wouldn’t it be cool to eliminate intense emotions like anger, grief and panic in seconds? Or more importantly, perhaps to have the choice as to whether to feel these emotions or not, putting us instantly back in control.  Earlier on this week, I  attended a Psy-Tap practitioner course helping to support 50 other therapists training in this unique system.  If you haven’t yet heard of Psy-Tap, I’d suggest having a look at the website.  Despite the name, Psy-Tap has nothing to do with tapping.  It stands for “Psychosensory Techniques and Principles”.  It was developed by Kevin Laye who was a former executive with Dolby.  He has used an engineer’s mindset to create techniques which are unique and work seriously quickly.  We are talking seconds to minutes to eliminate lifelong traumas and phobias. It’s being used in schools to help calm students and reduce anxiety and there’s no doubt you will be seeing more of it out there in the near future.     

For more information, visit Kevin’s website to find a practitioner near you or my website at

How to handle exam stress

Over the ten years, I’ve been a university GP, I’ve seen many students sitting exams. It can be a tense time and below are some of the hacks that students have told me have worked for them. I see revision as a kind of training – more of a marathon than a sprint. Sitting exams and revision does seem to get easier and more familiar with practice. 


Stress can affect sleep as sleep comes when we feel safe and can let go. Around exam time, the head can feel busy with thoughts playing through the mind. A regular mindfulness practice e.g. Calm or Headspace apps can really help decompress the active mind. Keep a regular sleep routine so that your body gets used to it and avoid napping during the day. I’d suggest avoiding the use of sleeping tablets around exam time as they can affect cognitive performance and memory in subtle ways. Pause is really helpful app that some of my students have found helpful It’s best used a couple of hours before bedtime as the blue light from screens in the hour before sleep can keep us awake. 

Working smart 

It’s really tempting to spend long hours in front of books and screens chalking up the revision hours. As humans we are not really designed to be stationary for this long and I quite frequently see students in the surgery with muscular neck and back pains from sitting. I think the record for one was 8 hours without moving! Long hours in front of screens also can reduce the blink rate of the eyes increasing the chance of eye irritation. If the eyes start to become irritated, lubricating eye drops can be purchased from most pharmacies. Any red eye pain or visual disturbance should be discussed with a optician or medical professional. 

We seem to work better when we take frequent breaks to move and rest our minds temporarily. A fantastic resource is the work of Francesco Cirillo and his Pomodoro technique Basically the idea is that you pick your task and work on it without interruption for 25 minutes (set a timer). The 25 minutes is one pomodoro. Then have a five minute break before starting on the next 25 minute pomodoro. After four of these, have a longer break 20-30 minutes. These tests allow the brain to rest and assimilate the new information. 

Eating and drinking 

Working brains need nutrition and central to this is adequate hydration. The body is comprised of 50-60% water and so drinking plenty of water is important. The amount recommended per day is around eight x eight ounce glasses or two litres of water. There are some studies that suggest that mild dehydration can affect cognitive performance Eating little and often (5/6 meals per day)seems to work best as large meals can make us feel sluggish and bloated. The same goes for high fat/sugar foods such as pastries and cakes. It’s better to stick to proteins from lean meats/fruits and grains and snack on healthier snacks like dried fruits and grains Caffeine is a bit of a double edged sword and many of my students swear by it for improving concentration. I’d suggest keeping it to a minimum (max 1-2 cups / day) as it can make people feel jittery and anxious. Try to avoid drinking it after midday as this may hinder sleep. 

Schedule time for connection and play 

Humans are social creatures and are meant to be in connections with other humans Prolonged periods in isolation while revising affects us and I have come across students experiencing quite profound drops in mood because they have not caught up with their family and friends and have let their leisure activities and hobbies go by the wayside.  It is often necessary to cut back on some commitments but scheduling time for meals out and social gatherings can be really helpful. Studying in a group or with friends is also a useful antidote to isolation. Face to face connection seems to be the most helpful as opposed to interacting on social media. Spending time outdoors in nature appears to have significant health benefits

Are you struggling with stress? Please contact me for a free telephone consultation to see how I can help


Dr Lizzie Croton GP 

My four favourite health apps.

Health apps are transforming our experience of self-care and allowing us to have access to expert advice and support through the medium of technology in a way that could only be dreamed of a few years back. It’s not uncommon now for me to “prescribe” an app to some of my patients if I feel that it would help the particular issue they have come to me with. Before I recommend anything, I road test it thoroughly myself. Here are four of my favourites


iOS £4.99
Android £2.39

Buddhify is a mindfulness meditation app with a slight difference. It’s designed to work around whatever you are doing and so there are meditations for walking, phone use and dealing with difficult emotions. By slowing down and paying attention to what is happening now (as opposed to what has happened or what might happen) we start to experience things differently. Over time this mindfulness (paying attention), actually changes the structure and function of our brain which is a pretty awesome fact. We can become less reactive and more present in our lives. It’s not always easy but it’s worth it. I first started meditating 6 years ago and it’s transformed my life personally and professionally. Buddhify is different from some other meditation apps in that purchase is a one-off flat fee with no subscription service. In fact, the developers hope that one day, you won’t actually need the app as mindfulness becomes more and more of a daily habit in your life.

Curable – the app for chronic pain

Subscription (approx as original prices in US dollars)
Monthly £9.30
Yearly £55
Lifetime £171

Some of you may remember my chronic pain article from the previous issue of Altrincham Today. Chronic or persistent pain is a huge problem and despite medical intervention, many people remain in pain. This app focusses on the hidden emotions believed to be at the root of chronic pain. It’s described as an online pain psychology programme. The basis of the Curable approach is that factors in our brains such as our thinking patterns and behaviours play a role in how pain is experienced. Over time, the brain becomes programmed with cycles of pain. The good news is that this programming can be reversed and the pain diminishes. Sufferers gain relief through a daily exercise lasting 5-20 minutes. Check out the website for more details as to the science behind Curable

Please see your doctor first if you are experiencing any kind of chronic pain for a medical check-up and relevant tests before commencing the Curable programme. This is to rule out any physical illness or disease.

Calm – reduce anxiety, sleep better and feel happier

Subscription (approx as original prices in US dollars)
Monthly £9.30
Yearly £43
Lifetime £215.00

Calm is a smorgasbord of different features. There is a huge amount of content on the app which is broadly divided into mindfulness for anxiety and sleep and focussed practices for habit control and performance. There’s a section for improving your relationships and emotional awareness. There are sleep programmes and a fabulous “Bedtime Story” section for adults and kids read by some famous voices. I really like the masterclasses which tackle issues as diverse as screen addiction to mindfulness for pain. There’s quite a bit of free content and you can sign up for free for the first seven days to see if you get on with the approach and style. All of these apps track your progress which is a key feature of habit change and allow you to share what you are up to with your contacts on social media. We live in a world where human connection is under threat in some areas and by working on our insides, we can be more available for our fellow humans. It’s a virtuous circle.

Sleepio: an online CBT programme for sleep problems

Annual cost £286.00

Sleepio is an evidenced based online sleep improvement programme developed by Professor Colin Espie from the University of Oxford. Most people have heard of CBT or Cognitive Behavioural Therapy from its use in the NHS as a therapy to help those experiencing symptoms of anxiety and depression. Simply CBT looks at the relationship between thoughts, feelings and behaviours and aims to help people change these when they are unhelpful or causing problems. An example from sleep would be experiencing worrying thoughts about not being able to sleep. This pattern is likely to increase stress in the body and make sleep less likely to happen. An awareness of this pattern allows us to make changes and sleep better. Sleepio creates a tailored programme for the individual depending on what the particular sleep issues are. There are regular meetings with a virtual sleep expert and helpful tools to practice. Over time, the brain functions differently and sleep becomes easier. On the downside, it’s expensive but I think could be considered an investment in one’s future health given the health risks associated with poor sleep. I believe it is funded by the NHS in some areas although I was unable to find further information on this. There is also a corporate programme with some employers funding access.

Dr Lizzie Croton

Working with difficult thoughts, feelings and images

This is a really simple exercise.  The first part is not something I developed and I have not yet found the source. I have heard this described in Buddhist teachings and also have heard it described by Andy Puddicombe, the co-founder of the Headspace App (

It’s a really simple way of helping to get some distance from difficult thoughts and feelings.  The thing is that it isn’t so much the thoughts and feelings that we experience that cause problems but our reactions to them.  I was actually quite offended when I first heard this but after careful examination, it does appear to be true.

What happens to cause pain is that we experience the thoughts and/or feelings and we attach to them. If these experiences were foodstuffs, we metaphorically throw them into a pan, cook with them and perhaps even serve them at a dinner party!  The attachment creates pain.

Now simply, the next time you experience a painful thought or feeling, practice acknowledging it by simply saying “thinking” or “feeling”.  You will normally find that this allows some space for the thought or feeling to be let go of.  Interestingly this also can work with unpleasant images that pop into the mind  – “picturing”. I suppose, if we work on the premise that all thoughts, feelings and pictures are messages in some form, the labelling presents us with the choice of letting go.  It also tells the sender of the message that it has been received and so both parties are happy.

This aticle is designed for educational purposes only and is not intended to replace professional, personalised advice from your doctor. Please, if you feel ill and are unsure or concerned, seek advice from a qualified health professional which could be your GP or Accident or Emergency if you have a life threatening medical problem. If you unsure, NHS 111 in the UK can be accessed by dialling 111 from any phone.  

Depression – a way out

From a colleague

My name is Rachel, I work in the medical field. I enjoy writing and sharing my experiences with others. Over the last 25 years I have experienced periods of deep sadness, anger and thoughts of not wanting to be alive anymore. Thankfully they do not last long – perhaps a few days.

As a doctor, It’s very tempting to “diagnose” myself. Is this depression? Having that sort of label can be very comforting when in pain. It appears to make the whole experience understandable. It places it in a container and it feels easier to understand something tangible. It’s also easier when talking to others, “I’m struggling with depression.” Most people have heard of “depression” before. They know the Royals talk about it and there are various campaigns out there designed to raise awareness. I applaud this work. It’s important to talk about how we feel.

I started writing articles around 20 years ago. I was probably experiencing similar feelings then, although back then it felt normal and it lasted longer. I found writing down my thoughts helped. These days, I am more interested in finding out what I can do to get myself out of this head space. This helps me to help others to do the same. I find this very rewarding.

At the moment, I am struggling myself. This article is hard to write. In actual fact, its much easier to write about the “difficult stuff” than the “positive stuff”. There is a critical voice screaming at me and It feels as though my head has become stuck and the usual fluidity of my thoughts has stalled. But I know it will change and that gives me hope.

So what helps? These things help me and perhaps they will help you too. I should say that if you are experiencing thoughts of wanting to harm yourself and you feel unsafe, please do seek help immediately and talk to someone. This may be your GP, or the Samaritans or someone who you trust. This article is very helpful

1. Sitting and thinking about how bad things are doesn’t help. It actually seems to make things feel much much worse. This is a habit for me and I can kid myself into thinking that I am doing something productive. It increases the feelings of stuck-ness and inertia. Doing something, anything other than this is going to be helpful. This might mean getting out of the house, walking briskly or a change of scenery.
2. Taking the pressure off is helpful. I have a tendency to be self-critical at times and I drive myself extremely hard to perform and succeed. This is another habit and these habits can feel normal and comfortable. A few months back, I started to see the price of this behaviour and now painful it could be. So I started to give myself permission to rest. To do nothing at times. To accept that a “good enough” piece of work was ok. To tune into myself and pay attention to what it was that was needed at this moment in time. To be kind. Interestingly I also found that when I was kinder to myself, it was easier to be kinder to others and that helps to make the world a better place. Self-compassion for our humanity is really important. Kristin Neff’s work on compassion is really worth looking at. Here’s one of her TED talks
3. Get out of bed, shower and dress. It helps.
4. About social media. I think social media has many positives. I think it can also be a miserable place at times. The key I find is to cultivate an awareness of how we are feeling and asking the question – Is our social media experience making things better or worse for us at this moment? If the answer is that it is making things worse, stop for the moment. I think a key for understanding and getting out of these head spaces is noticing the supposed cause / effect nature of things. The things that make the situation worse (and better) are usually pretty predictable. Do less of things that make things worse and more of the things that make things better. It’s about getting to know yourself better. This takes practice and is not an overnight job. Be kind to yourself.
5. Spending time with people. Spending time with people who accept where we are at the moment can be very helpful. There is also a human need to be understood and accepted. I’ve certainly noticed a real need to communicate how I am feeling to others. If I sense that they accept me as a person despite how I’m feeling, this is deeply helpful. People may not understand and I think it’s important not to take this personally because they may not have a frame of reference for the experience. They may not be able to cope with strong feelings in others. There could be something else going on – who knows? I tend to choose the people I spend time with when I am feeling like this. I have many good relationships but some people don’t really know what to say or do and that is ok. It is what it is. The only person who can change me is me but being with others sometimes helps to facilitate this.
6. Do something for someone else. This is helpful. I know many people who volunteer or help the homeless in their spare time.
7. The comparison habit. This is a common one. I think I heard the TV presenter Fearne Cotton describing it as to “compare and despair” If you think about it though, you are not really comparing “like with like” as people are so individual. I think it is more helpful to compare “oneself with oneself” over time. To see progress and to celebrate progress.
8. “This too shall pass” This is a slogan from the 12-Step program of Alcoholics Anonymous. I’ve found it best applied after the event. Once we have experience of knowing it passes, we can apply that experience the next time. I think Winston Churchill described it well when he said “If you’re going through hell, keep going.” It does and it will pass.
9. Damage limitation. For me, getting through these episodes is akin to preparing a boat to ride through a storm. It’s generally a good idea to batten down the hatches, reef the sails and make things as straightforward and simple as possible. Put off large decisions that can be put off, protect close relationships by avoiding arguments and allow people to be supportive. Sleep, eat sensibly and make time for rest.
10. Remember these experiences are not you. They are things that the brain and the mind do and the totality of what makes “you” “you” is so much more than this. It like confusing the trombone with the entire orchestra.

Help and support for UK doctors, dentists and medical students concerned about their use of alcohol and drugs

I spoke to a group of consultants yesterday about the work of the Sick Doctors’ Trust, a charity that exists to support addicted doctors and dentists. Following the talk, a number of my colleagues welcomed the information given, as apparently, it’s not always clear what sources of help are out there for this group of professionals. Here’s a quick synopsis:

For doctors and dentists

If you are concerned about your drinking or drug use, talk to somebody. Addiction is a great isolator and the denial is usually very strong. Ask yourself “Is this problem costing me more than money?” If the answer is yes, then please seek help. You can obviously see your GP who can refer you into NHS or private addiction treatment services. Some other resources are listed below.

The Sick Doctors’ Trust

The Sick Doctors’ Trust  is a charity that was set up in 1996 by a group of doctors recovering from addiction. They operate an 24/7 phone line which will be answered by one of their trustees and they are happy to take anonymous enquiries.  All of their trustees have personal experience of addiction. They can put you in touch with other recovered professionals in your area and help you to find sources of face to face help and treatment.

The Practitioner Health Programme

PHP is a specialised NHS service for doctors and dentists. They will see and provide treatment for those with addiction issues. There is currently funding for London residents. Those outside London can access PHP as a self-funding patient or through local CCG funding (if approved). If you are a GP or GP trainee in England, you can also self-refer to the GP Health Service.

Narcotics and Alcoholics Anonymous

These are countrywide mutual support groups that are based on the principle of the 12 Steps. It’s a spiritual, not a religious programme and all are welcome. Meetings are plentiful in the larger cities with many daytime and evening options. There are also online meetings. Cost is by donation at the end of the meeting. To find a local meeting, put your postcode into the meetings finder box on the website and turn up.

Alternatively, you can ring the helpline listed on the website and the coordinator should be able to arrange for a local member to meet you at the meeting.

SMART Recovery

This is another style of mutual-aid recovery meeting which is countrywide. There are quite a few meetings in the larger cities and environs. There are also online meetings for those who prefer this format

Action on Addiction

A national charity providing residential and community based addiction treatment

For family members

Addiction affects the whole family and typically, family members and friends will constellate around the individual who is drinking or using and try to help them stop. This is completely understandable behaviour and usually ineffective because, try as we might, we cannot make someone else change.  The decision has to come from them and helping a friend or relative into recovery requires a “tough love” approach which appears counterintuitive. If you are a family member or friend, get some help and support for yourself first. There are a number of groups out there specifically for you.

Families Anonymous for the families and friends of those using drugs

Al-Anon for those concerned about another’s drinking

SMART Recovery also run family groups and details of these can be found on their website

The British Doctors and Dentists Group

A country-wide recovery group for doctors and dentists wishing to recover from addiction. There are currently 17 groups in the UK and Ireland – mainly in the big cities. They meet monthly and provide a useful source of support for those in recovery. Please contact the Secretary Andrew M for specific times and locations of the meetings