Tips for coping:Take time for yourself away from the chaos. Practice yoga, listen to music, meditate, get a massage, or learn relaxation techniques. Stepping back from the problem helps clear your head.

• Limit alcohol, drugs, and caffeine. They can aggravate anxiety and trigger panic attacks. Alcohol/drugs worsens sleep and can actually cause a worsening effect on mood.

• Accept the lack of control. Agree when you don’t have control over events, details, or other. Work to see the positive in all situations. Depression and stress tends to move the focus to the negative. Accept what you cannot change. Put your stress in perspective: Is it really as bad as you think?

• Exercise often. Exercise will help burn off the extra energy and the need to pace. Manage your body or your body will manage you. Exercise is one of the best ways to manage panic attacks.

• Sleep well. Give yourself permission to nap when able and enough hours to get a full night sleep. Anxiety worsens when you are sleep deprived. When stressed, your body needs additional sleep and rest.

• Breathe deeply. Most people take short, shallow breaths which only serves to worsen anxiety. Take moments several times throughout the day to pause and breathe in slowly to the count of four, hold it for a count of four, and exhale to the same slow count of four. You will find that your body responds quickly to the additional oxygen. Inhale and exhale slowly.

• Perfection. Work towards realistic perceptions of yourself and others. Expecting perfection in all cases will leave you disappointed more times than not. Give yourself permission to not be perfect.

• Counting for distraction. Counting helps to distract your mind away from what it may be focused on or the racing thoughts. Count to 10 slowly. Repeat, and count to 20 if necessary. Work to focus on each number and match your breathing.

• Make healthy choices for eating. A well-balanced diet will help your mood and ground you during the stressful times. Eat well-balanced meals. Try not to skip meals. Avoid the cycle of over or under eating. Listen to what your body needs. Sometimes comfort foods is what you need.

• Laughter. Humor is healing and helps to distract from more serious matters. A good laugh goes a long way.

• Negative thinking. Focus on identifying Automatic Negative Thinking/Thoughts (ANTs). You may be amazed at how much of your day you spend ruminating on unproductive thoughts about yourself and your world. Think of how much could be accomplished if you were able to move past those thoughts. Make an effort to replace negative thoughts with positive ones.

• Help others. There is no better way to get a reality check than helping others. Often you will learn that you are doing much better than you thought. Volunteer or find another way to be active in your community, which creates a support network and gives you a break from everyday stress. This will assist in taking the focus off of you.

• Anxiety triggers. Knowing what triggers or starts your anxiety will help. Most anxiety has a trigger. Panic generally is related to being overwhelmed and needing to address issues in your lifestyle that have not been addressed. Is it work, family, school, or something else you can identify?

• Support. Utilize your support system of family, friends, and/or coworkers when you are struggling. Most friends and family want to be there to help, but usually don’t know what you need. Ask to go have fun, do something physical, get away, or go someplace you can talk.

• Professional help. Reach out for professional help such as a physician, therapist, teacher, coach, and/or pastor if you are unable to get relief of symptoms from the normal methods.

Dr. Julie Rickard is program manager of Columbia Valley Community Health Behavioral Medicine.