Mental health has become an increasingly discussed topic recently. Which is great, because it's an issue that affects all of us, whether directly or indirectly. I think it's safe to say that the majority of us are either struggling with a mental health issue ourselves, or have a friend or family member who is. Maybe you're suffering yourself, as well as watching those you love do mental combat as well. No matter the situation, it gets tough. And it needs to be talked about.

For much of my life, I have battled with a panic disorder (PD). This means that I often have panic attacks. Panic attacks are sadly more common than I used to believe. One in 75 Americans have some form of panic attacks, with many suffering more than one a week. That's about three million people, and just in the U.S. I can't imagine what it might be like world-wide.

Simply put, a panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack, or even dying. It's terrifying, and it's debilitating. The chances are pretty high that you know someone who has at least occasional panic attacks. And if you don't have experience with them yourself, it's likely you feel a little helpless when your friend is having one. I know that it took my friends who don't have anxiety a while to adjust and learn what it is I need during an attack. Even I have found myself feeling unable to comfort my best friend during her infrequent panic attacks. Knowing how to be there for someone during a panic attack is no easy thing. It can be so difficult to watch them, not knowing what to do to help them get through what's going on inside their mind, inside their body.

Everyone suffers with PD differently, and not every panic attack is the same. But the general needs and wants of a person during a panic attack are similar. As a person who goes through panic attacks frequently, I have some advice for the next time someone you know experiences one. Here are some ways you can help that you may not have thought of, and some things you might find yourself wanting to do that could do more harm than good.

1. Do learn to recognize the warning signs.

Sometimes a panic attack hits like a semi truck, out of nowhere and unexpected. But often, there are clues that signal an oncoming attack. These are not always obvious to anyone but the person having the attack, as many of these hints are internal. However, the external warnings can become easy to recognize if you train yourself to watch for them. Common things to watch for may not seem concerning at first. A big thing for me is being unfocused. Often when I'm talking to a friend and I notice that I'm starting to feel like I might have a panic attack, it becomes difficult for me to process what someone is saying, and I end up looking at a point in the distance instead of whom I'm talking to. If you see that your friend seems to be staring absentmindedly into space when they were okay just a minute ago, try to get their attention. If they're slow to look at you or answer, or their answer doesn't make sense, or they talk like someone who is just waking up might, they may be nearing a panic attack. However, be sure to ask them if this is the case before you assume. Don't want to mistake a transcendent trip into their daydreams for an alarming situation.

Another warning sign is physical withdrawal. When a panic attack is setting in, the nervous system becomes overwhelmed with all sensory input such as people around them, sounds, and lights. As a result, the person usually wants to feel as protected as possible. This can show itself in a number of ways. Some people tend to make themselves smaller, while others attempt to turn invisible. Both of these are done in pursuit of feeling safe from the things that their mind is now perceiving as threats. Things to look for may include curling long sleeves around the hands. This is something that I often do when I feel like a situation is growing too much for me to process. Another thing is wrapping their arms around themselves, or crossing them as they might if they were cold or upset. They may even shiver. If they're sitting down, they might draw their knees up to their chest, often wrapping their arms around their knees. If your friend seems more nervous than usual, coupled with being spaced out, a panic attack is something that you should be watching for as well.

There are many other warning signs, and each person has their own. The best thing to do is ask your friend what theirs are, and learn to recognize them. This may help your peace of mind, and your friend will probably be happy to know that you care enough to want to know when an attack is approaching.

2. Don't try to push them.

Panic attacks are scary. And they aren't something that can be controlled. Trust me, if we had the choice, we'd never have a panic attack again. I'm sure as their friend, you know this. But it can be easy to forget how hard your friend is trying when you don't see the internal struggle they face every day. Don't forget it. So next time they have an attack, don't try to tell them to just push through it. You might be in a situation that's hard to get away from, and the best choice might seem to just ride it out. But sometimes that's just not possible. Be aware of this, and be sensitive to when your friend or family member needs to get away. It's one thing of your friend wants to try and push through. That's great, and encourage them in this. But if they tell you they need to leave, let them. And if they want you to go with them, please do it. They need you.

3. Do tell them that panic attacks are unavoidable.

You have no idea the sense of failure that comes with a panic attack if you don't have them. Every time you have an attack, every time you have to leave a class, or miss an exam, or don't get an assignment in on time, or can't return a call, or miss a party, or can't give a presentation, etc. etc., it feels as if we've failed everyone, again. We know that we can't control panic attacks. It's not our fault. But that doesn't make it any easier. We need you, our friend, to remind us of this. To remind us that panic attacks don't make us weak. They don't make us a failure. And that no one but we ourselves think this. Let your friend know that you know that they're trying, and that every day they make it through is a success. Even if they have a panic attack. Even if they miss something important. That they aren't failing, and it isn't their fault. They need to hear this more than you know.

4. Don't touch them—without permission.

During a panic attack, the nervous system is in overdrive. All of our senses are hyper-aware, and everything is just too much. Your first instinct when you see your friend suffering might be to hug them or put an arm around them. While your friend may find that comforting under usual circumstances, that hand on their shoulder might be overstimulating during an attack. Sometimes, a simple touch can feel like someone is brushing our arm with steel wool, and only makes things worse. However, there are times when I crave to be hugged during a panic attack. It depends on the attack, and it depends on the person. My friends have learned to ask if it is okay to touch me when they're with me during a panic attack, and I highly recommend doing this with your friends who have them as well. Let them know that you're aware that touching them may not be what they need right now, but that the option is open if it is something they want when the're ready. They'll appreciate this more than you can imagine.

5. Do be there for them.

I realize that you can't always physically be there for a friend who is having a panic attack. I am blessed enough to have two of my closest friends on my college campus. All I have to do when I'm having an attack is send one of them a text telling them I need them and they're there in minutes. This isn't always a possibility. Whatever your situation may be, your friend needs your support in whatever way you can give it. If you can be there physically, do it. Let your friend know that they can shoot you a text and you'll do your best to be there. If you can't be there with them, perhaps have them call you if they're comfortable with that. Whether you're there with them in reality or in spirit, be supportive. Let them know that you're there in every way that they may need. That you're not leaving. That you don't mind being there. Comfort them. Let them cry. Practice calming techniques. Talk it through with them if that's what they want to do. Be the friend that they need, because trust me, in that moment, they need you more than they ever have.

6. Don't try to give them a 'reality check.'

Panic attacks are irrational. We are often aware of this. I know it can seem like it might be helpful to tell your friend that what they're feeling isn't real, or that it's just in their head. You might even want to tell them to calm down. I warn you, don't do this. This won't help, and will only make your friend feel worse. They know that what they're feeling is only a result of their panic attack and is not any real danger to them. That doesn't make it feel any less real. To us, this is really happening. Even though we know it's not, it can be really hard to convince ourselves of that. And it doesn't help to hear someone say it to us. It can seem like you're belittling our panic attack, even if that isn't what you're trying to do at all.

7. Do remind them that it's okay.

Instead of saying what isn't happening, focus on what is. Remind your friend of the good things. Remind them that yes, while this is scary and it is happening, it will pass, and eventually, things will be okay again. This won't last forever. Make sure that in doing this, your friend doesn't feel as if you're glossing over their current feelings. If they do, simply focus on other good things. Try to get your friend's mind off of what their mind is trying to make them focus on, and give them something positive to focus on. Like puppies. Seriously. Look at pictures of cute puppies together, or watch youtube videos. Anything to let your friend know that things aren't as bad as their panic attack would have them believe, and that things will be okay again.

In addition, remind your friend that panic attacks are okay. They aren't fun, they aren't preferable, and they aren't wanted—but they're a part of life. And they happen. Let your friend know that you know this. That you know that panic attacks are hard, and they're a burden, but that you're there to help them bear it. That they don't have to do it on their own. Remind them that panic attacks don't make them any less of who they are. Remind them that they are strong.

8. Don't rush them.

I've seen it said that a typical panic attack lasts about ten minutes; for me, they last on average about thirty to forty-five. Panic attacks don't have a set time limit. And even after the panic is over, there's the recovery. This can take hours or even days. It all depends on the attack and on the person. The important thing to know is that it can't be forced. When your friend has an attack, allow them to go at their own pace. Don't try to make them talk to you, or get up, or move at all before they're ready. This could take a while. Don't make them feel like they're taking too long to get over an attack. Because the truth is, they're probably already telling themselves this. But it's not true. Recovery is different for everyone. Remind your friend of this, and remind yourself.

9. Do support progress.

However, do encourage your friend in recuperating from a panic attack. It might be hard for them, but sometimes they do need a little nudge in the right direction. Sometimes, we just don't feel like doing anything even when we know we should. If you think they're truly ready to move from the spot they've been sitting in for the past hour, help them to do so. But make sure they actually are okay to do so. Be supportive, but at the same time, you may need to be a little bit insistent.

10. Don't push them to talk.

During a panic attack, I rarely feel like talking. It's not that I don't want to, necessarily. It's that I lack the energy to physically get words from my mind out my mouth. I just can't string them together into a verbal sentence. During an attack, my mind works just fine, and while it's often racing, I lack the ability to command myself physically. Because of this, I feel trapped within myself. And when someone tries to talk to me, it isn't that I don't want to respond. It's that I can't. And I become frustrated. When your friend is having a panic attack, don't be afraid to speak to them. But if they don't respond, don't keep talking to them. It won't be beneficial for either of you, and your friend will likely become frustrated with themselves and possibly you as well as they try to reply, but cannot.

At the same time, they may just want quiet. As I mentioned before, the senses are completely overwhelmed during a panic attack, and every little thing can seem like an attack. Your voice, no matter how quiet, can sound like a scream, and your words may be echoey and sound jumbled enough that your friend may not even understand what you're saying. The effort they may exhaust trying to process what you're trying to say can waste recovery time. Unless your friend indicates otherwise, it's often best to stay mostly silent during your friend or family member's panic attack. Things will be calmer for both of you.

11. Do talk about the particular attack.

When they're ready. After you both agree that they're sufficiently recovered, it is often helpful to talk through why the panic attack occurred. Discuss whether your friend recognized a trigger, and whether they feel they handled the situation in the best way possible. Ask whether they think they should have done something differently, and if they will if it happens again. Inquire about their feelings about the whole thing. Let them talk about it without interruption unless they ask for feedback. Talking through the panic attack can help your friend separate themselves from the attack and realize the unsoundness of it. In all of this, reassure your friend that it's okay and that you're there for them. This part of recovery can be more difficult than you might think, and your friend needs your support here just as much as they did during the actual attack.

Panic attacks aren't an easy thing for anyone. Whether you suffer them yourself, or watch your friends or family go through them, it's hard. I don't know why panic attacks happen, and I wish I could make them stop. For me, and for the countless others who go through the torture of them. I can't. But I can be there for those who do.

And so can you.