Panic attacks suck. They can make you feel like you're going to die, like you're having a heart attack, as if you're losing your mind. They are also more common than you might think. According to the NHS, at least one in 10 British people experiences occasional panic attacks. So if you haven't had one yourself, you probably know someone who has. Even if they won't tell you.
Stigmas are slowly diminishing, though, and tech already offers ways to deal with episodes via apps, such as the CBT-via-iPhone MoodGym, and Flowy, a game which regulates your breathing: a key part of dealing with a panic attack.
Here's what comes next.
Out of nowhere
To get our heads around how they work, we first need to understand how panic attacks operate. They're different to a general feeling of anxiety.
"For some people, panic attacks can feel as though they come out of nowhere," Rachel Boyd, information manager at Mind, told us. "They can make people afraid that they are going mad, blacking out, or having a heart attack. Most panic attacks last for between 5 and 20 minutes and can be very distressing."
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I had my own brush with panic attacks a few years ago. I spent a Christmas Day quietly unravelling in my parents' spare bedroom, panic attacks arriving like clockwork every 40 minutes as the rest of the family opened presents downstairs. Absolutely fine one minute, completely detached from any sense of rationality the next.
Joy to the world, indeed. It seems almost comical now, but it certainly wasn't at the time. They can be borderline violent dislocations of the mind, as if your drink has been drugged by a stranger. Except that stranger is your own brain.
How to fix panic attacks
Two of the most common, immediate ways to deal with panic attack symptoms include exercise and measured breathing. "Relaxation techniques like breathing exercises can help you to manage anxiety and feel calmer," says Mind's Rachel Boyd.
That's what Prana is here to help with. It's a $150 sensor that clips onto your belt, measuring both your breathing and your posture. It calls itself the "world's most advanced breath and posture tracker".
In the app is the most chilled out take of Flappy Bird you've ever seen
These are such general 'good' lifestyle metrics that you might initially assume it has little relevance for panic attacks, and sure enough the Prana blurb talks more about its Yogic roots and COPD (a family of breathing disorders including emphysema) than any anxiety-related condition.
But Andre Persidsky, Prana's senior product manager, says tackling panic attacks is absolutely part of the thinking behind the device.
"Our CSO, Dr. Paul Abramson, used to be an emergency room doctor, and would see quite a few patients coming in thinking they were having heart attacks, when in fact they were experiencing a panic attack," he said. "One of his top, most effective interventions was getting them to do the 4-7-8 pattern."
This is a pretty well-recognised breathing technique for combating general stress and anxiety. It consists of a 4 second inhalation, 7 second breath retention and 8 second slow, steady exhalation and can "curb anxiety attacks in as little as three minutes." Prana's app guides you through it.
As with most wearables, the Prana belt sensor communicates with a smartphone app over Bluetooth. Within the app are both a scientific-looking clinical mode that lays out the data in graph form and, for us ordinary folk, the most chilled out take on Flappy Bird you've ever seen.
Breathing in and out controls a bird, moving it up and down to collect flowers, to the tune of a classic chill-out piano track. Of course, these UI elements are all subject to change as Prana is still in development. No matter what the visuals are, the key is that Prana takes the responsibility for breathing regulation. Doing so yourself might not be so easy mid-attack, when you're convinced you're dying.
As Persidsky says of the company's ER-grade CSO, "The challenge was to get Abramson's patients to comply beyond the emergency setting, and do these exercises at home. That's where Prana comes in." After originally being pencilled-in for summer 2015, Prana is now due to be released around April 2016. The reason for the delay? "A great deal of research is behind Prana, and it all took longer than expected."
Projects in the mist
One of the few wearables designed solely for panic attacks is Calming Stone, announced by Ramon Telfer in August 2014. We tried to get in contact with Telfer, but he seems to be off the grid, suggesting the project may be parked or cancelled.
It's certainly interesting as a concept, though. Calming Stone is based on the same breathing ideas as Prana, but instead of a clip it's a device you hold, a reassuring presence by itself. That's not all. It lights up should an attack start in the night, features its own headphone jack that'll play meditation exercises and an internal fan blows scented air out of its front. The 'stone' even vibrates, presumably to mimic a resting heart beat.
As the list of feature goes on, the more Calming Stone starts to sound like vapourware. However, talking to design blog Dezeen back in 2014, Telfer's intentions are at least spot-on. "After years of struggling with my own anxiety problems, I developed multiple techniques to provide relief during anxiety episodes or panic attacks," he said. "I decided to design a device that combines these techniques to deliver instant panic relief anywhere, anytime."
Calming Stone seems like a dream wearable for panic attack sufferers, now all we need is a health tech startup to make it a reality.
Panic vs. VR
Just as unlikely-sounding but absolutely a reality is Deep. It's a VR game controlled by your breathing, and is probably the most interesting panic solution going, particularly from a techy perspective.
Using an Oculus Rift VR headset and a sensor that wraps around your diaphragm, Deep puts you into a highly stylised, fully immersive sci-fi world. It's first person and works because the user feels they are in this space. You look around with your head, as with most VR titles, but to move you have to breathe slowly and deeply.
Owen Harris, the game's designer, has been travelling around the world showing the software off at various games shows throughout 2015. "We have had a staggering amount of interest. We are on track to have the first therapeutic installation within the next 6 months," he told us.
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The original intention was not for Deep to take on panic attacks, though, but general anxiety. "I have anxiety and suffer bouts of depression," said Harris. "Yoga, breath-work, swimming and games have all been a great help in those times. It made sense to try and bring them together."
Deep was initially intended much more as a relaxation tool. But, despite not being released yet, it has already provided itself useful for panic disorder sufferers. "It has been a happy surprise that people with panic attacks have found it very useful. Scientists are currently studying the game and we will have a deeper insight into the effects and how they come about soon."
The real triumph here is that this is a potential therapeutic tool that makes you want to try it on first glance. It looks fun on its own terms, and the breathing conceit will just make you sink even further into the experience. A completely non-vicious circle of relaxation and engagement, it's one of the most interesting, ground-up VR projects to date.
While current demos show off the main exploration mode of Deep, Harris has also talked about a training mode which teaches you the breathing techniques needed. Virtual reality might be futuristic but we're back to those ancient deep breathing tactics we started with.
There's a definite trend for panic attack relief wearables which all seem to exploit the most common technique for dealing with the issue as it occurs: slow, measured breathing.
There's also research being done on identifying panic attacks before they set in. We talked to Jonathan Rubin of Parc, a research company based in Palo Alto, that published a white paper in September on precisely that: a panic attack-identification wearable. The crux: Rubin says that while panic attacks appear to come from nowhere, there are early warning signals beforehand. Rubin talked us though the idea. You wear a chest strap, and it monitors for increases in breathing rate, heart rate and variability in heart rate, as well as PCO2 levels, the level of carbon dioxide in your blood.
"The wearable device can collect the required physiological information. Physiological data analysis can then take place to attempt to predict an approaching panic attack," said Rubin.
This is a next-level panic attack wearable, but the way it operates is fairly familiar. "Right now the wearable device we use is a chest-worn patch that communicates via Bluetooth with a smartphone application, which performs the data analysis. Interventions and recommendations are delivered via a mobile phone application."
So your phone might tell you you're on the road to a panic attack, which is — as you might guess — a pretty good way to fire up a panic attack itself. Finesse, a light touch, in this area is really needed, but the project is more about offering something that can complement other treatments.
"I do not consider this as a replacement for direct therapy," said Rubin. "Instead this is a useful, additional tool that can be used to allow individuals to better manage their condition. It can also be used in combination with medical care providers to get an idea about what types of therapies may be working better for an individual."
Parc appears to have no current plans for a wide release of the tech it is working on, but we hope to hear a lot more from it in 2016.
It could eventually stop your doctor from having to relying on the classic, frustratingly arbitrary, "How bad do you feel on a scale of 1 to 10?" method.
And that means a lot.
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