How to handle panic attacks during a spa experience

Posted by on September 23, 2019 in Articles

How to handle panic attacks during a spa experience

Keeping the peace.

By Vivienne O’Keeffe 

A big thanks to the many readers who responded with calls and emails to my last article about recognizing clients with menopausal symptoms. Your requests for more information on anxiety and panic attacks got me thinking about the role spas can play with respect to mental wellbeing.

My recent work on the Global Wellness Institute’s (GWI) Mental Wellness Initiative has made me acutely aware of the many contributors to good emotional wellbeing: activities within spas and other controlled environments including massage, yoga, tai chi, dance and meditation, along with benefits derived from living a generally healthy lifestyle: proper sleep, laughter, sunlight, regular physical exercise, etc. I’m proud to be working in an industry devoted in large part to improving people’s health (both mental and physical), self-confidence and self-esteem. We’ve done a lot of good for millions of people around the world.

And although we’re not miracle workers or medical professionals, we need to be knowledgeable enough about potential mental health issues to know what we can help with and what lies beyond our scope of expertise and resources – and suggest to clients afflicted with serious issues seek appropriate professional guidance.

In short, while spa experiences can do a great job in helping alleviate today’s high levels of stress and anxiety, extreme symptoms and behaviours call for professional treatment that spas are generally unable to provide.


Spas and emotional wellbeing

One of my co-workers on the GWI’s Mental Wellness Initiative is Margareth Novaes Brephol, a psychologist specializing in couple and family therapy, and co-owner of the first medical spa in Brazil, a beautiful healing facility called Lapinha. With her heritage, background and training, Margareth has a wealth of knowledge about anxiety, especially how we in the spa and wellness industry can be of help to clients and colleagues who are dealing with it.

In a recent chat with her about anxiety in our industry, she and I agreed that it’s both normal and essential to ask new spa clients for their health history, which can include information about allergies, prescriptions, blood pressure, etc. Margareth advocates going a step further.

“We need to be bold about asking questions regarding mental wellbeing,” she says. “Printed protocols and clarification around boundaries and limitations can help us establish if a client needs help outside of our facility.”

Programs like yoga and meditation may attract people who are prone to anxiety and panic attacks, she believes. Spas need to know how to respond to episodes of these afflictions.

We need to talk to our therapists about mental wellbeing, so they know how to recognize and cope with the signs of sadness, anger and despair in themselves and in clients.


Benefits of spa-administered touch

I have previously discussed the many benefits of spa-administered touch: lower heart rate and blood pressure, reduced cortisol levels, enhanced immune system, improved levels of oxytocin and endogenous opioids (linked with mood, lower pain and lower anxiety). Margareth emphasizes the wealth of other methods for soothing, such as:

  • Breathing techniques to help calm
  • Music to soothe
  • Walking on the ground barefoot to connect with the earth.

She and I also concur on the importance of spa employees needing to be mentally healthy themselves in order to be in a position to care for others. To keep therapy teams on track, Margareth suggests regular multidisciplinary team meetings to help direct the team’s mindset – possibly incorporating spirit-building activities like group exercise, circular dancing, meditation or (where appropriate) prayer.

“As spa teams, we must take care of ourselves in order to ‘hold space’ for ourselves and our clients,” she says. “Spa therapists need to be trained to discern if, for the client, that place is the wellness facility, or if she or he needs a referral to a professional psychologist, for example.”

Of particular interest to spas (and to many readers of my last article), especially spas with female clients going through perimenopause and menopause, is the issue of panic attacks. To shed some light on them, I turned to my sister Catherine O’Keeffe, perimenopause coach (Wellness Warrior,

“There are three things we need to know about panic attacks,” says Catherine: “how to identify one, what might trigger one, and what to do when you encounter one.”


Identifying a panic attack and pre-attack symptoms

Breathlessness and other symptoms can mimic those of a heart attack. Panic attacks can be so intense that those inflicted might fear they will die. Catherine says we need to be aware of the often-subtle symptoms clients may experience leading up to a panic attack, such as “clenched jaw, tightness in shoulders, and persistent shallow breathing which can lead quickly to a sense of breathlessness.”

Panic attacks might feel like they come out of nowhere, but sufferers can learn to recognize and avoid their triggers. And people should always see a medical professional after a panic attack, Catherine says.


Panic attack triggers

The base trigger emotion is fear – of crowds, flying, public speaking or even loneliness. Someone who’s afraid of crowds for example, could feel physical symptoms ranging from tightness in the chest or throat to a churning stomach, Catherine says. The reaction to chest symptoms (a perceived serious illness) can make the sufferer feel confused and out of control.

Removing oneself from a panic-attack-provoking situation is a good start. Panic attacks can also be aggravated by such conditions as low blood sugar, extreme dehydration, exhaustion or lack of sleep.


How to help a client who has a panic attack during a spa treatment

  • Keep calm.
  • Hold a space of non-judgmental care and listening, without dispensing advice.
  • Encourage the client to slowly deep breathe and place their hands on their stomach to feel the rise and fall of the breath, helping them to connect to their own body’s wisdom.
  • Ask the client about any medication she or he might regularly use for panic attacks. If they are on medication, help them take the medication.
  • Encourage the client to be gentle and compassionate with herself or himself.
  • Suggest a gentle walk post-treatment.
  • Remind the client of the importance of nutrition and good sleep hygiene.


And again, advise anyone who exhibits signs of a panic attack or anxiety to see their doctor for a checkup.


Published in Mandarin as the Global Wellness Initiative contribution “Keeping the Peace” in Spa China July/August 2020 – page 58.

Published as “Keeping the Peace” in Spa Canada September/October 2019


Vivienne O’Keeffe, AAD, PEA, CIBTAC, is President of Spa Profits Consulting Inc., and an expert in designing successful spa concepts. She is also an international consultant in developing product lines, treatment plans and training programs, a member of ISPA and a recipient of the Spa Industry Association of Canada Outstanding Industry Service Award in 2001, 2005 and 2012.

1 Comment

  1. Wow, as a counsellor in private practice, I admire the clear, concise, excellent guidelines given to help people experiencing panic attacks. Rod Baker, MA. CPRP.

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