When I am afraid, I put my trust in you. - Psalm 56:33 (ESV)

The Mayo Clinic defines a panic attack as "a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause."

For many of us, witnessing someone have a panic attack is somewhat akin to watching someone have a seizure. We want to help but do not know what to do. And if we do try to help, it often hurts rather than helps.

One of the criticisms sometimes leveled at those who experience panic attacks is that they are getting worked up over nothing. The implicit accusation, and perhaps the suspicion for many of us, is that the person is responsible for not making the choice not to panic. However, this is inaccurate and unhelpful. Texts like the one above help us to understand why.

Panic and Moral Agency

Notice that the verse does not say, "I will never fear because I have put my trust in you." This is not to say that there are no verses like this in Scripture. It has been said that the command not to fear is one of the most common in all the Bible, if not the most common. But this verse talks about when the psalmist fears, not if. The moral choice the psalmist is making is not related to whether he will fear or not, but what he will do when he is afraid. Perhaps he should not fear in the first place, but that is beside the point in this case.

This is not to say that there is no moral agency whatsoever in being afraid. We are comforted and told not to fear. And when we do, we should recognize the fault in it. At the same time, it does no good to cry over spilled milk. When once we are afraid, what we do next matters. Will we turn to God and his instruction or will we go our own way? The one seeks the right solution, which in this case is akin to repentance. The other only makes things worse.

Far too often, the advice people hear is to believe in themselves, to find the strength within, and to learn to stand up to their fears before the panic attack comes. The problem with this is that the advice promotes self-dependence rather  than our need to depend on God.

The fact is that this world is scary. There are many fears which besiege us, and it is frankly reasonable for someone who does not know God to be fearful. What resources do they have in such a vast and evil world with so many stronger opposing forces not looking to do them any good? And for those who are in Christ, how many of us have so matured that we are beyond the temptation to be afraid?

This declaration by David in Psalm 56 helps us to understand that there is moral agency in what we do when we are afraid. David seems convinced he will fear in the future. The superscript for this psalm refers to when David was seized by Philistines, perennial enemies of Israel and also the people who produced Goliath. David is exposed to many fearful things, and he understands about himself that he is susceptible to fear. And so are we. And yet, the question at hand is not so much about whether we fear as what we do when we fear.

And herein lies the key for those among us who suffer from panic attacks. We have in Psalm 56 a model for our fears. When we fear, what will we do? For those suffering panic attacks, it is well worth exploring not only the sources of their stresses and fears but also their typical responses. How do they handle it? To where do they turn? When they fear, they do what?

Responding to and Preparing for Panic

When a person's body produces the symptoms of a panic attack, there is not much to do other than wait for them to subside. The symptoms are, after all, not due to any apparent current cause. This means that there is nothing in the environment that is causing the fear to surge. The symptoms of fear are arising more from within the person than from anything outside. The panic is a symptom that our bodies' systems are primed to react in inappropriate ways in a given situation.

That being said, it is helpful to find a space to breathe normally and allow the body to regain calm, which normally takes a few moments. The middle of a panic attack is a poor timing choice for analyzing someone's underlying causes. This is because the problems are clearest not in the middle of the attack but in the calmer times when the person is thinking about other things. Panic attacks are symptom clusters best prevented rather than stopped in the moment.

Given the above, how should a Christian handle their panic attacks? In the cases I have seen, those who suffer panic attacks live under a near-constant state of high stress of which they themselves are less than fully aware. Some of the stories I am aware of reflect people living in difficult circumstances with high pressure and conflict in relationships in their personal lives. And when they are presented with a fairly innocuous situation such as their workplace, they may suddenly begin experiencing a panic attack and have to go find a quiet place. Sometimes they have to go to the restroom to vomit.

What has been clear to me is that panic attacks do have causes. We can say a priori that panic attacks are not uncaused causes. The tricky part is often that those around people experiencing a panic attack only see the final straw which sends their bodies over the edge without the hay bale that has been building up. The key, then, is not to focus on the final straw but the hay bale.

Preventing panic attacks is ultimately not the goal. It can't be, because panic attacks are often a symptom of ongoing and characteristic self-dependence rather than God-dependence. All believers, whether they currently experience panic attacks or not, need to work toward saying with David, "When I am afraid, I will put my trust in you." This requires a daily, deepening, delight-filled relationship with God Almighty. When God is your refuge and strength on a daily basis, it makes it difficult to panic. But this can take time, and we need to be patient with one another.

How to Live for God Through Christ with Panic Attacks