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You’ve probably read somewhere that in the United States, anxiety disorders are the most common types of mental health conditions, affecting upwards of 40 million adults. That’s a huge number. I’ve battled a panic disorder for the majority of my life — I even wrote a book about it —and the past 12 months or so have felt revolutionary in terms of our country’s interest in discussing it. There was a time when I had to travel pretty far down the internet rabbit hole to find relevant information surrounding panic, but now mental health reports are practically landing right on the front page of my news feeds. And it’s not just me experiencing this shift.

“We are getting more comfortable talking about and mainstreaming our mental health — everyone has anxiety to some degree — why not talk about it?” says Sue Varma, MD, clinical assistant professor of psychiatry at NYU Langone School of Medicine. “I'm so happy when celebrities normalize their mental health challenges, and when TV characters are depicted in a more nuanced way.”

Unlike a broken leg where a plaster cast sends visual cues, anxiety and panic are essentially invisible. Save for labored breathing and horrendous shaking (common symptoms one might experience during a panic attack), panic is mostly an internal battle. We smile and look fully functional on the outside, meanwhile, our insides become unhinged, pushing us deep into an emotional abyss.

While my personal experience has made me feel knowledgeable in this area, it’s important to recognize that everyone's anxiety is different. Dr. Varma has treated hundreds of anxious patients over her 15 years in practice, and offers a balanced look at how everyone can be part of the mental health landscape, especially during the high-stress holiday season.

It’s not unusual for people with anxiety to experience a surge in panic during the holidays. “Family dynamics can be complicated depending on your relationship with relatives, not to mention the travel that is involved,” explains Dr. Varma. Yes, traveling itself can be a pain point: long, windy lines and big crowds can trigger sensations of claustrophobia and panic. “People may start to avoid planes, large crowds, and even traffic, fearing they may be out of control. If that happens frequently, people start to develop anticipatory anxiety, thinking that they may not be able to handle a panic attack.”

Whether you know someone with panic, or want to arm yourself with information, below is a list of things you can do the next time you find yourself wanting to help.

Start by being compassionate

Dr. Varma says you should follow your friend’s cues, but ultimately, come from a place of calm compassion. “Allow them room to breathe — literally.” That means don’t hover. “Some [people] need fresh air, want to lie down, have cold water, or air circulation.”

Suggest going in a different room/outside

As someone that’s had hundreds of panic attacks, there’s something stagnant and suffocating about remaining in an environment that’s bringing on panic. Your friend might be experiencing something similar. See if they want to go into another room, or step outside for fresh air. “[Relocating] can reduce feelings of stuffiness, lower the adrenaline response, and even induce the relaxation response, the parasympathetic nervous system that calms us down,” adds Dr. Varma.

Don’t be afraid to ask, “What do you need from me?”

It can be alarming for the person witnessing a friend behave in a way that’s “different.” It’s okay to feel this way. But don’t be shy. Step up to the plate and see what your friend needs. Maybe it’s a hug. Maybe it’s privacy. Dr. Varma suggests you give them time and space, but be available. When the panic attack is over, don’t feel pressured to “fix” them. “They will be shaken up for sometime, and it will be difficult,” she shares. When the time is right, definitely feel empowered to make thoughtful suggestions. “Help them get connected to a well-trained cognitive behavioral therapist and, when needed, medications can be helpful,” adds Dr. Varma.

Lead them through deep breathing

Part of what exacerbates the sensation that someone is hyperventilating is that they are getting too much oxygen. If your friend is taking short breaths and thinks this may be happening, help them correct this by leading them through a deep breathingseries. Have them place their hand just below the rib cage so they can feel their diaphragm, then, together, exhale fully, blowing through the mouth.

What not to do

If your friend is showing symptoms of panic during a seemingly safe activity, telling them they are overreacting only make things harder. “[Telling them to calm down] won't help. It's physiological, and it needs to play out,” says Dr. Varma. Likewise, you can’t tell them to behave differently, either. She continues: “You can't tell a person to snap out of it; the attack just needs time to subside on its own.”

As long as you approach the situation in a non-judgmental way, you’ll be surprised at how helpful you may end up being.

This post was originally published on Teen Vogue.

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