This is a useful behavioural technique for managing panic symptoms where there is evidence of over-breathing, that leads to frightening sensations (commonly tingling in the hands/lower arms or around the lips and mouth). These sensations can be alarming to the sufferer, which can add to the anxiety (a vicious circle.)

PsychoEducation:

• Explain that panic is horrible, but not actually dangerous (though one of the symptoms of panic is often fearing that you are about to die.)
• Explain that panic is a natural process, and just an exaggeration of ordinary healthy mechanisms.
• When you are anxious your brain sends messages to the ADRENAL GLANDS which produce ADRENALINE.
• Adrenaline makes your heart beat faster and you breathe faster. This is all very useful if you are in a dangerous place and might be required to face, say, a tiger - but in a panic attack this natural reaction (note the stresson this being a normal, natural process) becomes unhelpful. In a panic attack it makes you think and feel as though you cannot get enough breath, when in fact the opposite is true - you are over-breathing and that is making you feel worse!
• When you breathe, you take in Oxygen and blow out Carbon Dioxide (like a car exhaust) - so far so ordinary.
• Carbon dioxide in your bloodstream keeps the blood at just the right level of acidity. When you blow out too much Carbon dioxide (when you are panting out of fear, but not actually making more Carbon dioxide by running/fighting) then your blood becomes slightly less acid than the nerves are used to - and they start to tingle...
• THIS FEELS ODD/SCARY BUT IT IS NOT DANGEROUS.

The Solution:

1. Introduce a "highly technical piece of equipment" - a brown paper bag!
2. If you scrumple and unscrumple this it becomes more pliable.
3. Explain that the young person can keep this "technical equipment" in their purse or back pocket, and nobody will ever know what it is really for.
4. If they feel panicky and are over-breathing ("hyperventilating") then they should breathe in and out of the bag for a couple of minutes.
1. By re-breathing their own Carbon Dioxide they will quite quickly replace the lost acidity, and the tingling will go down.
2. Concentrate on slowing the breathing down, count 1,2,3 after each in-breath and each out-breath.
3. Take a breath of fresh air every couple of minutes - you cannot starve yourself of oxygen in this way - it is a very safe method of repairing what medics refer to as the "acid-base balance".

Use the Progressive Muscle Relaxation to supplement this, and to try to maintain anxiety levels at a lower level.